Objective: The results of Emergent Coronary By-Pass Surgery (CBPS) on Acute Coronary Syndrome (ACS) patients were compared with patients who had elective CBPS in our clinic. Method: Between October 2011 and January 2013, 380 CBPS were performed. 32 patients had emergent CBPS in 6 hours who had acute coronary syndrome. 24 of the 32 patients were male (median age: 58±2), 8 of 32 patients were female (median age: 60±3). The patients who had emergent CBPS (n: 32); 20 (63%) patients were performed BeatingHeart (BH) CBPS, 10 (31%) patients were performed CBPS with heart and lung machine (HLM), 2 (6%) patients were performed BH CBPS accompanied with HLM. In all patients Left Inter Mammary Artery (LIMA) was used for the Left Anterior Descending (LAD) artery. The patients who had elective CBPS (n: 348); 263 (75%) patients were performed Beating Heart (BH) CBPS, 67 (20%) patients were performed CBPS with heart and lung machine (HLM), 18 (5%) patients were performed BH CBPS accompanied with HLM. In all patients Left Inter Mammary Artery (LIMA) was used for the Left Anterior Descending (LAD) artery. Results: Considering post opertaive results in emergent CBPS patients (n: 32); early mortality (≤10 days): 2 (6%), late mortality (10-30 days): 2 (6%), high dose inotrop need: 9 (28 %), Intra Aortic Baloon Pumping (IABP) usage: 6 (19%), median intensive care unit (ICU) stay (days): 3.2±1.5. Elective CPBS patients (n: 348); early mortality (≤ 10 days): 11 (3%), late mortality (10-30 days): 7 (2%), high dose inotrop need: 11 (3%), Intra Aortic Baloon Pumping (IABP) usage: 4 (1%), median intensive care unit (ICU) stay (days): 2.6±0.7. There were no statistically significant difference between groups in postoperative hemorrhage. Conclusion: Considering high morbidity and mortality rates, emergent CBPS should be performed without delay. By close surveillence and support therapy in post operative period, close prognosis to elective CBPS could be achieved by IABP.

Objective: Gestational diabetes (GDM) is diabetes that occurs during pregnancy. Pregnancy is characterized by insulin resistance. This increase in insulin resistance in non-diabetic pregnant women is thought to be compansated by various adaptation mechanisms. It is thought that this adaptation is not enough response so gestational diabetes can develop. Desnutrin is a lipolytic protein that has role in the regulation of lipolysis in adipose tissue. It is known that there is a clear correlation between adipocyte triacylglycerol (TAG) lipolysis disruption and disorders such as type 2 diabetes mellitus (DM), obesity, insulin resistance and serum free fatty acids. Methods: In this study; serum desnutrin levels of healthy pregnant women and patients with GDM were compared and the role of desnutrin in the pathogenesis of GDM was investigated. Results: In our study; desnutrin levels of GDM group were lower than those in control group. Conclusion: Although this decrease is not statistically significant (p > 0.05), desnutrin may play role in the etiology of GDM.

Aim: The evaluation of patients over 65 years old applying to Plastic Surgery Clinic because of trauma. Method: Geriatric age group trauma patients who applied to Plastic Surgery Clinic between the 2010-2014 years were included in the study. The ages, genders, diagnosis, trauma reasons, localizations, surgical applications, additional internal problems, anesthesia types and additional treatments given were classified. Results: When trauma reasons were examined in 9 patients (39.13%) falling, in 6 of them (26.09%) traffic accident, in 2 of them (8.7%) injuries of sharp objects, in 2 (8.7%) injuries of animal, in 2 (8.7%) injury of tractor belt, in 1 of them (4.34%) pounding and in 1 of them (4.34%) injury of rope were obtained. When applied surgeries were examined in 6 (26.09%) patients open reduction and internal fixation was done for maxillofacial fracture, in 6 of them (26.09%) saturation for cuts, in 5 of them (21.74%) follow up for maxillofacial trauma, in 4 of them (17.40%) tendon repair, in 1 (4.34%) patient intermaxillar fixation for mandibula fracture and in 1 patient (4.34%) flap repair for tissue defect. Conclusion: Surgical treatment of many old facts can be done securely with well preoperative preparation and efficient and functional results can be taken.

Aim: The aim of this study was to investigate the effect of oral contraceptive usage and follow-up management on the anxiety levels of asymptomatic premenopausal patients with benign ovarian cyst. Methods: Ninety asymptomatic premenopausal women were admitted to this prospective study. All of the women (21-39 years) underwent gynecological examination and transvaginal ultrasound examination. The patients with benign ovarian cyst were followed up in 3 months and divided into 2 groups. Although Group 1 was begun with oral contraceptive containing with ethinyl estradiol plus drospirenone, Group 2 was followed up without any medical treatment. Group 3 was the healthy control group without any ovarian cyst. Anxiety levels were measured by State Trait Inventory (STAI) when the patient firstly learned having cyst and after 3 months. Results: The demographic characteristics of the groups were similar. Cyst diameter and CA-125 levels were comparable between the group 1 and 2. Anxiety scores were statistically significant higher in follow-up group with ovarian cyst. Anxiety scores were lower in the oral contraceptive administered group than follow-up group. However, all of the groups that learned having benign ovarian cyst had increased anxiety scores comparing with healthy control. Conclusion: Having benign ovarian cyst without any malignancy suspicion was associated with increasing anxiety in women. Although oral contraceptive usage was not superior than following-up management for the benign ovarian cyst treatment, oral contraceptive administration might decrease patient’s anxiety.

Facial paralysis is the total loss of voluntary muscle movement of one side of the face. It can be divided into two types including peripheral and central facial paralysis. Approximately %80 of patients with peripheral facial paralysis recovers completely in 3 months. However in 2-9% of patients, recurrences can be seen on ipsilateral or contralateral side. Although most of the cases are idiopathic, recurrent peripheral facial paralysis may develop due to an underlying severe disease. Therefore to enlighten the etiology, careful investigation and differential diagnosis is essential. Herein, we present 4 patients with recurrent peripheral facial paralysis with possible etiological causes and literature review. In conclusion, we wanted to emphasize the significance of approach to improve the prognosis of disease.

Aim: Recently, the early diagnosis of gastric cancer has an evident significance for curative surgical therapies and for providing longer survival period. In this study, a cut-off value to contribute the differentiation of benign and malign gastric processes was aimed to be obtained by the comparative assessment of the endoscopically gained pathologic findings and antropyloric thickness measured from abdominal computed tomography examinations. The effect of subclinical H. Pylori infection to gastric antrum thickness was also investigated. Materials and Methods: 73 patients who had antral biopsies via endoscopical examinations, and who also had an abdominal computed tomography examination with an optimal quality for the antral thickness measurement were included. The antral thicknesses measured from CT examinations were compared with the pathological findings and ROC analysis was performed to calculate the cut-off value regarding the antral thickness for differentiating benign and malignant aspects. Additionally, patients with benign conditions were assessed in terms of H. Pylori infection, the relationship between the antrum thickness and H. Pylori was investigated. Results: The distribution of pathologic findings in 73 patients (49 male, 24 female; mean age 50.9 years; range 18-80) was; 17 cases were malignant (16 patients with adenocarcinoma, 1 patient was with metastasis from esophageal cancer) and 56 cases were benign (active chronic gastritis, chronic gastritis). The cut off value to differentiate benign from malignant conditions regarding the antropyloric wall thickness was calculated as 11.9 mm with a sensitivity of 100% and specificity of 98%. No significant difference was found in terms of antral thickness between the patients with and without H. Pylori infection (p=0.249), and also between the different subtypes of H. Pylori positive patients (p=0.638). Conclusion: Antropyloric wall thickness measurements from optimally achieved abdominal CT examinations can provide remarkable information that can be beneficial to differentiate the benign and malignant processes originating from gastric antrum. However, further studies with extended series are encouraged to support the determined cut-off value.

Aim: To present our experiences with percutaneous nephrolithotomy performed in pediatric age groups within prior 3 years. Method: Percutaneous nephrolithotomy was performed in 25 renal units of 25 patients (14 boys, 11 girls) with mean age of 12.76 (5-16) years. Stones were localized at right side in 16 patients (64%) whereas at left side in 9 patients (36%). Of the stones, 12 were localized at renal pelvis, while 6 at lower pole, one at middle pole, and 6 at both renal pelvis and lower pole. In all patients, 18 F balloon dilation was performed to access kidney. Again, in all patients, 15 F rigid nephroscope was used for percutaneous nephrolithotomy. Results: Mean size of stones was 321.68±142.377 mm2. Mean percutaneous nephrolithotomy time was 58.48±11.8 min. Mean duration of scopy use was 3.48±1.75 min. Balloon dilation was performed for access to kidney. Stone-free status was achieved in 21 patients (84%) on the postoperative day 1. Residual stones were detected in 4 patients (16%) after percutaneous nephrolithotomy. In one patient, it was found that broken tip of ureteral stent during extraction of stone by using forceps was migrated to lung. Two patients (8%) required blood replacement at postoperative period. Mean length of hospital stay was 2.76±1.6 days. Conclusion: PNL is a safe treatment modality with successful outcomes in the treatment of pediatric stone disease.

Background: Dermatoscope is used to increase the precision ratio of clinical pre-diagnosis in terms of dermatological lesions. This study aims to compare statistical significance of dermatoscopic versus pathological diagnoses in terms of melanocytic and non-melanocytic lesions in which surgical excision is recommended. Methods: Dermatological examinations were performed by the same doctor with 15mm (10x focus), 8 white LED hand dermatoscope (3GEN DermLite DL 100). A total of 184 patients were enrolled; 116 of them were (63.04%) women, 68 of them were (36.96%) male. A total of 300 excision materials were compared in this study. Findings: The youngest patient was 7 years old and the oldest patient was 80 years old (average age was 36,47 years). 220 of the lesions were melanocytic, and 80 of the lesions were non-melanocytic. 190 of the melanocytic (86.36%) lesions had the same pathological diagnoses. 30 of the melanocytic (%13.64) lesions had different pathological diagnoses. 30 of the non-melanocytic (%37.5) lesions have the same pathological diagnoses. 50 of the non-melanocytic (62.5%) lesions had different pathological diagnoses. Results: Melanocytic lesions had statistically significant (p=0.001) higher ratio of same (precise) diagnosis than non-melanocytic lesions. Dermatoscopy provided significantly higher rates of success in cases of melanocytic lesions. We believe that increasing of precision ratio of clinical pre-diagnosis is very helpful for pathologists in finding right diagnoses. In addition, follow up of patients, planning of surgical interventions would be greatly improved by right diagnoses.

Brucellosis is common all over the world. Frequency of the disease is inversely proportional to the level of development of countries. In our country brucellosis is endemic in many areas. Brucellosis is a systemic disease. Skeletal system involvement is most common. Patients with skin lesions and clinical symptoms are rarely seen. In this case report, a 50 years old female patient who had brucellosis with cough, fever, papular rash on both ankles and legs was presented.

Aim: The purpose of this study was to investigate the incidence of left renal vein anomalies in routine abdominal computed tomography scans. Methods: One thousand and four patients (590 men, 414 women) were evaluated retrospectively with routine abdominal computed tomography scans. Results: Sixty three patients of 1004 were identified with renal vein variants (6.3%). Forty three (4.3%) patients exhibited retroaortic left renal vein and twenty (2%) patients had circumaortic renal veins. Conclusion: The incidence of renal vein variations observed in this study is discussed and compared with that reported in the literature. It is necessary to emphasize that the presence of these renal vein variations in particular must be acknowledged since they have significant clinical importance.

Pneumatization which occurs in bone structures of conchas called concha bullosa. It is the most common anatomic variation of lateral nasal wall and it is considered that it develops due to migration of ethmoid air cells. Mucocele develops due to accumulation of mucosa in concha bullosa because of the blockage of ostium and pyocele develops with the accruing of infection. In this case, in the anterior rhinoscopic examination of 17 years old male patient who had nasal obstruction, headache and postnasal draining complaints for nearly 4 months, it was seen that there was a bulk filling right nasal passage almost completely and the septum was deviated to the left. When lateral and inferior parts of concha bullosa pyocele were resected endoscopically under local anaesthesia; plenty of viscous purulent materials were aspirated. No complication occurred in intraoperative and postoperative era. In postoperative follow-ups, it was observed that the patient had no complaints and nasal passage was open. This case is presented in order to draw attention to concha bullosa pyocele in patients who apply with nasal obstruction and headache complaints.

Meckel diverticulum is one of the most common congenital abnormalities of gastrointestinal system. In this case report, a meckel diverticulum diagnosed and managed under laparoscopy assistance is reported. The patient was a twelve-year-old boy with left lower quadrant abdominal pain lasted for a week. Diagnostic laparoscopy was done by a 10 mm umblical and two 5 mm left upper and lower quadrants ports. Meckel diverticulum was seen and brougt out from umblicus. Diverticulum excised like wedge-shaped and cure was provided. As a result, laparoscopy is important for diagnosis and management of Meckel diveticulum. Surgeons who are not experienced enough on laparoscopy may turn to open surgery or bring out diverticulum from umblical port and excise the diverticulum extracorporally. Experienced surgeons can do the whole surgery laparoscopically. The value of ultrasonography and computed tomography for the diagnosis of Meckel diverticulum is low. Laparoscopy could be used for diagnosis in centers where scintigraphy is not avaiable. At the same time additional abnormalities could be diagnosed with laparoscopy.

Breast cancer is the most common cancer of women. Multiple myeloma is characterized by monoclonal proliferation of plasma cells. There are malignancies secondary to chemotherapy and it has long been recognized. We describe a woman presented with breast cancer and after chemotherapy and radiotherapy she had achieved remission. Because of complaints about skeletal discomfort we reevaluated the patient and diagnosed multiple myeloma and decided to treat with chemotherapy and bone marrow transplantation. In this case we determined multiple myeloma after the administration of chemotherapy for breast cancer and there was not another etiologic factor except antineoplastic agent administration.

Aim: To present imaging findings of a case with bilateral anophthalmia and septo-optic dysplasia. Material and Method: A two-month-old patient was admitted to our hospital with complaint of absence of eyeballs. A cranial MRI revealed absence of bilateral eyeball with atrophy of optic nerves and ocular muscles. Agenesis of septum pellucidum and corpus callosum dysgenesis were accompanying. Result: Bilateral anophthalmia and septo-optic concomitant anomalies are quite are. It may be accompanied by a variety of craniofacial anomalies. MRI is ideal examination in the detection of associated anomalies and optic tract pathologies.

Our objective is to share experience on administration of dexamethasone in massive enteric bleeding. Patient was admitted to our clinic with severe fever, vomiting and widespread myalgias. Tazocin 12gr/day i.v was empirically started. After a day, fresh blood was seen in his stools. Dexamethasone was started stopping blood transfusion as bleeding continued actively besides 4 units of erythrocyte suspension. On the second day of dexamethasone bleeding stopped. The general condition of the patient improved and was discharged with recommendations. The usage of dexamethasone should be considered as an alternative way in the control of massive lower gastrointestinal bleeding prior to surgical intervention.

It is essential to identify the anatomic variations of neurovascular structures in terms of preventing complications which may develop during neurosurgery and interventional neuroradiological procedures. It is necessary to be aware of the middle cerebral artery (MCA) outlet anomaly to understand collateral blood flow in events of cerebral ischemia related to duplicated or accessory MCA in cerebral aneurysm surgery. Intracranial vascular anomalies involving the MCA are relatively rare. Duplicated MCA has been reported at rates of 0.2%-2.9% in literature. In this paper, the imaging findings of a 71-year old male with duplicated middle cerebral artery are presented in whom the complaints of mildly ataxic step and cloudy consciousness were present.