Objective: Acute kidney injury (AKI), observed as a clinical syndrome, presents with previously normal renal function followed by sudden decrease in the glomerular filtration rate (GFR), and increase in urea, creatinine and uremic toxins in hours or days. The causes of acute kidney injury are divided into three: prerenal, renal and postrenal. In these patients, 5-30% end-stage renal insufficiency may develop in later periods. Therefore the diagnosis, treatment and follow-up are important. Method: Between November 2012-2013, clinical data, treatment and prognosis of AKI patients who were followed-up in our Nephrology Clinic were evaluated retrospectively. The patients were considered with RIFLE (risk, injury, failure, loss, end stage renal failure) and AKIN (acute kidney injury network) classification in this study. Chronic renal failure and chronic renal failure patients with the acute episode were excluded from the study. Patient data were obtained from medical records. Results: Of the158 patients were admitted to our study with AKI, 76 (48.1%) were women, and 82 (51.9%) were men. Age average was 66 (18-90). These cases were acquired 76 prerenal (48.1%), 60 renal (38%), 22 postrenal (13.9%) AKI. In 32 of these patients (20.25%) infection was encountered. The comorbiditiy incidences of our patients were observed with19.6% hypertension and tip 2 diabetes, 17% hypertension. 47 patients (29.75%) were oliguric and 36 patients (22.78%) needed dialysis. Mortality rate was 4.43%. Major causes of death were sepsis and pneumonia. Conclusion: AKI incidence was increased in older age. Concomitant disease affects these patients' morbidity. Nowadays effective treatment options for AKI patients decrease mortality rates. Especially infections continue to be a serious cause of mortality. Improvement of renal function in a significant number of patients have been seen.

Aim: To evaluated retrospectively the outcomes of 27 patients who presented with chronic nasolacrimal duct obstruction who had undergone endonasal endoscopic dacryocystorhinostomy (DCR). Methods: 27 patients were included to study who had undergone endonasal endoscopic DCR between February 2011–June 2013. After operations, patients were followed up 6-30 months with endonasal examination. Cases were evaluated for epiphora and iatrogenic ostium size at postoperative 6th month. Results: There were 27 patients (20 female, 7 male) between the age of 12-70 years. 3 cases were bilateral, 24 were unilateral; a total of 30 endoscopic DCRs were performed. At the 6 months follow-up period after surgery; symptomatic improvement was observed in 26 operations (86.6%). However, there were no regression in symptoms at 4 operations (13.4%). Conclusions: Comparison of endoscopic and external DSR; endoscopic DCR is beneficial for leaving no surgical scar, equivalent success rates, shorter surgical time and shorter recovery period.

Objective: Cystic Echinococcosis (CE) is a tapewarm infection caused by Echinococcus granulosus larval stages. Human beings are accidental intermediate host for this parasite. In this study, it was aimed to evaluate IHA seropositivity, organ involvement, socio-demographic data such as age-sex in the patients, retrospectively. Materials and Methods: In this study, 541 cases’ serum samples who admitted with an initial diagnosis of CE to Adıyaman State Hospital between the period of 2007 to 2012, were interpreted. Samples were investigated for spesific anti-E.granulosus antibodies existence by a commercial IHA test. Results: Titer above 1/320 seropositivity was fixed in 111 (20.5%) of 541 sera taken from patients (345 female, 196 male; 64%, 36% respectively; age range: 4-81). Statistical difference was not determined with regard to sex in the cases who have IHA positivity. Cysts were observed in liver and lung 89% and 11% respectively. Seventy eight (70%) of seropositive cases were in 20-60 age group. Conclusion: In our province where many of the risk factors implicated in the formation of this disease, ideally the use of another serological method like ELISA as well as IHA will be favorable for the screening of suspected cases. Thus we believe that laboratory will assume a more active role about the diagnosis and follow-up of patients.

Objective: The objective is to share our first experiences with the recently applied micropercutaneous nephrolithotripsy method (micro PNL) in the kidney stone treatment. Material- method: Between the dates July 2008 and january 2012 11 patients were incised with 4.85 fr ‘all seeing needle’ accompanied by scopy under direct monitoring. After the incision the inside part of the needle was removed and 3 way connector apparatus was attached to the proximal end of the needle. One of the lateral channels was for the telescope and the other channel was for the usage of the central channel laser fiber in the irrigation process. Peroperative and postoperative parameters of the micro PNL patients were analyzed prospectively. Results: The average age of the patients was37.36, the average body mass index (BMI) was 26.09, the average stone size was 1.9 cm. The average scopy time was 2 minutes, the average operation time was 92.27 minutes. The average VAS score was calculated as 3.6. The average length of hospitalization was 1 day. One patient, who was experiencing renal colic, had a DUSG and multiple stones were detected in the distal ureter. The patient was treated with endoscopic ureteral stone treatment and Double-J stent. Three operations were finished with the standard percutaneous nephrolithotripsy method due to the realization of the excessive stone weigths and the prediction of post operational problems. None of the patients experienced organ damage, developed complications which require open surgical operation or treated with transfusion. Conclusion: To conclude, micro PNL is a reliable and efficient method in the treatment of not-very large kidney stones in the clinics experienced in standard percutaneous nephrolithotripsy. Lots of studies are needed on the subject due to the fact that it’s a new method.

Aim: To evaluate the complications of robot-assisted radical prostatectomy (RARP) at learning curve with standardised criteria and report the outcomes. Material and Methods: Between July 2009 and January 2012, a total of 200 RARP patients at learning curve with a minimum of 1 year follow-up were evaluated with Clavien-Dindo classification regarding peri-operative and post-operative complications. Follow-up was performed in the first month and every 3 months thereafter. Patients were seperated into two groups to be the first 100 patiens and the second 100. Results: Mean follow-up was 21 months. There were 49 complications for 38 patients in the first month. 42 of them were minor complications (Clavien1-2) and 6 complications were major (Clavien 3-4). One patient died on postoperative day 1 due to cardiopulmonary arrest (Clavien-5). There were 8 complications in 30-90-day period and 14 complications after 90 days. Conclusion: RARP with its acceptable complication rates is a minimally invasive approach for the treatment of prostate cancer. With the increasing number of patients in the learning curve is reduced complication rates.

Aim: In the presenting study, we aimed to compare spinal anesthesia (SA) with general anesthesia (GA) regarding cost effectivity in patients undergoing lumbar disc herniation (LDH) surgery. Materials and Methods: 58 patients who were operated for lumbar disc herniation between June 2013 and 2014 in Dursun Odabaş Research and Teaching Hospital of Yüzüncü Yıl University were evaluated retrospectively. Demographic data of patients, anesthesia type, invoice amounts, anesthesia amounts, drug billings, and hospitalization duration were recorded from hospital recordings. Results: Total cost and drug billings were higher in GA group, however, anesthesia amount was higher in SA group (p<0.001). Duration of hospitalization did not affect total costs excluding anesthesia amount. Hospitalization duration affected the total cost depending on the type of anesthesia, however, no statistically significant difference was observed. There was no significant difference between the age of the patients and total cost. Conclusion: The results of the presenting study showed that SA should be preferred to GA in LDH surgery when considering today’s health policy in appropriate patients due to effectivity of SA on the total cost and drug amount.

Objective: It was aimed to investigate the frequency of aspirin resistance and the related clinical and biochemical factors in patients with atherosclerotic heart disease who live in our region. Method: A total of 89 patients (57 male, 32 female) who had been diagnosed with coronary artery disease with angiography, who have been using at least 100 mg daily aspirin for at least one month were included in the study. Results: Aspirin resistance was detected in 18 patients (20.2%). Aspirin resistance was significantly higher among diabetic patients and smokers (p=0.009 and p=0.018, respectively). Although aspirin resistance was more frequent among women, it was not statistically significant (of the resistant patients, 14.0% were male and 31.3% were female, p=0.052). Laboratory parameters were not statistically significant among the patients who were resistant and sensitive to aspirin. Conclusion: Aspirin is the mainstay of antiplatelet therapy in cardiovascular diseases. Studies have indicated that response to aspirin varies. The risk for occurence or recurrence of thromboembolic events is quite high among aspirin-resistant patients. Therefore measurement of aspirin effectiveness is of quite importance for prevention of cardiovascular diseases in patients who have coronary artery disease and who use aspirin regularly. Therefore we consider that PFA-100 system may be a reliable test for investigating the effectiveness of aspirin in patients with coronary artery disease.

Aim: We aimed to assess the rates of concomitant diseases and their relationship with obesity in the patients with obstructive sleep apnea syndrome (OSAS). Methods: Nine hundred two patients who have been diagnosed as OSAS have been observed by polysomnographics and evaluated retrospectively. Body mass index (BMI), Apnea-hypopnea index (AHI), concommittan diseases have been noted. AHI values have been defined as follows: AHI<5 habituel snoring, 5?AHI<15:mild, 15?AHI?30: moderate, 30>AHI: Severe BMI values patients have been grouped under 5 categories: 18?BMI<25: Normal, 25?BMI<30: Over weight, 30?BMI<35 obese, 35?BMI<40: very high obesity, BMI?40 morbid obesity. Results: Out of 903 patients which have been examined retrospectively 97 was not OSAS, 806 was diagnoed as OSAS. Of 405 (52.7%) OSAS patients were obeses, 88 (10.9%) were morbid obese. Hypertension (HT) has been detected in 362 patients. Three hundred forty three of these patiens were OSAS, 9 was not OSAS. Out of 177 patients were diagnosed as diabetes mellitus (DM), 171 of them were also diagnosed as OSAS. Rates of both DM and HT in OSAS group was considerably high. Conclusion: Hypertension is the most common concomitant disease with OSAS. It is affected by both obesity and AHI severity. In addition, DM is directly related to obesity.

Abstract Objective: Identifiying the most encountered causative microorganisms of infections is important in terms of rapid diagnosis and therapy. In this study, we aimed to determine the types and prevalance of microorganisms isolated from different culture specimes of patients with hematological and solid organ malignancies. Material and Method: Patients with hematological and solid tumors and with positive culture test results of blood, sputum, urine, wounds, abscesses and gaita; analyses of which were performed at Yüzüncü Yıl University, School of Medicine Laboratory of Microbiology (Van, Turkey) between December 2010 and June 2014 were included in this study. Densities and distributions of bacterias were examined retrospectively. Results: A total of 957 culture specimens obtained from a total of 87 subjects comprising of 47 patients with hematological tumors and 40 patients with solid tumors in different times. A total of 68 (43.3%) and 33 (21%) of the samples in which reproduction was observed, were blood culture and sputum culture, respectively. E. coli (23.5%) and Coagulase-Negative Staphylococcus (CNS) (20.6%) were found to be the most reproducing factors of infections. While E. coli (32.5%) reproduced more in urine, CNS (38.2%) reproduced more in blood culture. Candida reproduced in all of the fungal cultures. Conclusion: In this study, we determined E. coli and CNS as the most common cause of infections in cancer patients. Having a knowledge of the microorganisms responsible for infections is crucial for the determination of empirical treatment in these patients.

Aim: Inguinal hernia repair is one of the most common procedures in daily surgical practice. A lot of methods have been described. The aim of this study is to share our data of laparoscopic totally extraperitoneal inguinal hernia repair surgery which we have done in Van Regional Training and Research Hospital, Department of General Surgery. Method: The patients who underwent laparoscopic inguinal hernia surgery in Van Regional Training and Research Hospital, Department of General Surgery between January 2013 - January 2014 were analyzed retrospectively. Results: A total of 42 patients who underwent laparoscopic totally extraperitoneal hernia repair were enrolled in this study. The mean age was 31,18 years. We made a total of 50 repairs, including; right in 27 cases, 7 cases left, bilateral in 8 patients. The average hospital stay after surgery was 3,31 days. In the early postoperative period, some minor complications were observed, such as seroma, hydrocele, testicular ischemia, epididymitis, and hematoma. There was no observed major complications or mortality. No recurrent hernia or chronic pain was observed on follow up. Conclusion: Totally extraperitoneal laparoscopic inguinal hernia repair is being performed safely in our hospital. Long term follow-up is needed to talk about the rates of success of the technique.

Introduction: Restless Leg Syndrome (RLS) is a clinical condition impairing normal life functions as a frequent cause of sleep disturbances. We intended to study the frequency of RLS in hospital staff and to seek the effect on life and sleep quality. Method: Demographic characteristics and working schemes of 218 adults were recorded. RLS was investigated by using diagnostic criteria of International RLS Study Group (IRLSSG). ‘IRLSSG Severity Scale’ was applied to RLS group. It was asked if they knew about RLS and consulted to any clinician for their complaints. Pittsburgh Sleep Quality Index and Short Form-36 were applied to all cases. Results were compared between groups with RLS and controls without RLS. Results: Prevalance rate of RLS was high as 12,5%. There was no association with demographic characteristics and working schemes. The qualities of life and sleep were lower in RLS cases. The rates of awareness and referral to clinician were low. No cases who cosulted to clinician had diagnosis or treatment. Conclusion: RLS has negative effect on qualities of life and sleep. Prevalance studies in our region and enhancement of awareness is needed.

Aim: Food allergy is an immune response directed toward food. It occurs by responses that are immunoglobulin E mediated, non–IgE mediated, or a combination of both. It is announced that the prevalence of food allergy appears to have increased in recent years in children. This study aimed to bring out the clinical characteristics of food allergic patients and the responsible food Methods: The patients admitted with complaints of food allergy and applied prick test in Van İpekyolu Obstetrics and Pediatrics Hospital between March 2014- September 2014 were included in the study. Results: The average age of 79 patients included ın the study were 34.7± 38.0 months and 63.3% of them were male. Cow milk (46.8%) and egg (27.8%) were the most seen allergens. The diagnosis of the patients were 38 atopic dermatitis, 15 food protein induced enteropathy, 7 anaphylaxis, 5 proctocolitis, 9 urticaria/angioedema, 3 food protein induced enterocolitis, 1 allergic rhinitis and 1 wheezy infant. Conclusion: Cow milk and egg were the most seen allergens among our patients. Almost half of our patients had atopic dermatitis. It is important that the patients with atopic dermatitis should be evaluated for food allergy. On the other hand food was the most common cause for anaphylaxis and it is important that families should be informed about food elimination and epinephrine usage.

Aim: We aimed to evaluate the complications of the circumcision techniques performed by local circumcisers in Yuksekova. Material and Method: Circumcision complications were examined retrospectively who admitted to the outpatient clinic of Pediatric Surgery in Yuksekova State Hospital between May 2014 - January 2015. Techniques applied by local circumcisers were investigated. Statistical analysis of the data was performed with SPSS. p <0.05 was accepted statistically significant. Results: Circumcision complications were found in 26 patients among 1387 circumcised patients who admitted to the Pediatric Surgery outpatient clinic of Yuksekova State Hospital between May 2014 - January 2015. 19 of these complications (73.1%) stemmed from the circumcision performed at home by local circumcisers, 7 (26.9%) of them stems from the circumcision done by the health care team in a hospital. The most frequent complication of local circumcisers; permanent color change of the foreskin (6 patients) and secondary phimosis (4 patients) were followed. Conclusions: Secondary phimosis and permanent color change of the foreskin are complications occurring due to local techniques in Yuksekova. Permanent color change of the foreskin is occured due to the ash of cotton cloth that used to provide coagulation after circumcision and in our knowledge it is first described in the English literature. The secondary phimosis generally occurs due to extended release of mucosal side of the prepuce. But the wound contracture after circumcision performed with a heated cutting tools to ensure circumcision and coagulation maybe facilitate the secondary phimosis. If qualified physicians performed circumcision procedure under sterile conditions, we suggest that it will reduce the complications.

Aim: This experimental study was applied to intensive care unit nurses for the purpose of evaluating the effect of problem solving training on their burnout situations. Material and Method: Universe of the study was consisted of 63 nurses who work at intensive care units of a research-education hospital. Information Form and Maslach Burnout Inventory were distributed to volunteers (32 nurses for experimental group and 31 nurses for control group). A training programme which consisted of eight sessions, durations of each were about 20-30 minutes, was applied to each nurse of experimental group individually. On the other hand, control group was not subjected to any training. In both groups the scales were filled immediately after the training and three months later. Findings: It was determined that in nurses of experimental group according to nurses of the control groups both immediately after the training ended and three months after the training ended decreased mean score of emotional exhaustion and increased mean score of personal accomplishment from sub-dimensions of Maslach Burnout Inventory, results were statistically significant. Result: Our findings indicated that problem solving training applied to nurses had effect on decrement of burnout.

Necrotising fasciitis is a soft tissue infection which has rapid progress and high mortality and morbidity rate. It is seen rarely in the head and neck region and usually occurs after dental infections. The factors affecting the success of necrotising fasciitis treatment are early diagnosis, adequate antibiotherapy and surgical debridement. In this article, we present a case of cervical necrotising fasciitis developed after dental infection.

Cardiac tamponade is a hemodynamic condition characterized by an equal increase in atrial and pericardial pressure, an excessive decrease in systolic blood pressure with inspiration (pulses paradoxes), and hypotension. The prevalence in failure of thyroid which is an endocrine disorder seen in Down syndrome patients also known as Trisomy 21, is %3 and this is higher in comparison to normal population. In this syndrome the most frequent observable thyroid disorder is autoimmune subclinical hypothyroidism. It is frequent to see pericardial effusion in the patients with hypothyroidism and it scarcely causes cardiac tamponade. In this report, cardiac tamponade which developed depending on an untreated hypotroidism in a 24 year old patient with Down syndrome has been presented.

Brain metastases are well-known complications of systemic cancers. The most common source of brain metastases is lung cancer in adults. Hemispheres, cerebellum, brainstem, pituitary (sellar region), cerebellopontine angle / internal auditory canal and leptomeningeal areas are potential localizations of metastases. The World Health Organization organized a new histological classification of malignant lung tumors in 2004. Large cell neuroendocrine carcinoma which is located in this classification is a poor prognosed, rarely seen aggressive tumor. Different immunohistochemical markers are used for the diagnosis of large cell neuroendocrine carcinoma. In this case, a 61-year-old male patient suffering from walking instability and mild headaches with a right parietal and left superior cerebellar located metastasis at the cranial MRI is presented. Craniectomy was performed to the right parietal located one and the tumor was removed. Histopathological and immunohistochemical findings were evaluated as large-cell neuroendocrine carcinoma. In this article; the rarely seen and poor diagnosis of these tumors, their metastasis, radiological features, pathogenesis and surgical approaches were discussed.

Aim: The aim of the study is to present a case of placenta previa percreta with fertility sparing surgery. Case: 29 years old, a placenta previa percreta case, was delivered by cesarean section at 35th gestational week. Bilateral hypogastric artery ligation was performed before plasental separation. After segmental resection of the anterior wall of the uterus, fertility sparing surgery was performed by leaving the uterus intact. Conclusion: Especially, fertility sparing surgery cases of placenta percreta will be selected carefully and planned by an experienced surgery team in a tertiary care center.

Benign intracranial hypertension is a syndrome characterized by raised intracranial pressure. Who presented with recurrent headaches, especially the young, women and obese patients should be considered in the diagnosis of the disease. Benign intracranial hypertension may occasionally be associated with cranial nerve palsies. Abducens nerve palsies have been reported in 10% to 20% of patients, other cranial nerve palsies have been less frequently. In this case, the right peripheral facial nerve palsy and benign intracranial hypertension in a 25 years old female patient is presented.

Pericardial localization of echinococcosis, which is an endemic disease in our country, is rarely seen. The disease may be asymptomatic or may lead to sudden death. Surgical removal of the cysts is the treatment of choice. Treatment requires surgery combined medical management with albendazole. We aim to present our case with pericardial hydatid cyst as it is rarely encountered in the literature.

Low back pain is a common health problem in community. In this article, we want to present a case which is believed to treat the low back pain with wrong and threading way such as sewing to skin by quilting needle. A 48-year-old male patient was admitted the clinic with low back pain. In the clinic examination of lumbar region, we inspected the sewing thread and ulcerated skin which had infected circumference and ecchimotic entry zone on the L5 spinous prominence. Commitment to the traditional treatments of the area are known by doctors working in the area and this situation is frequently observed in clinical practice. We believe that false beliefs will decrease gradually with education and correct information.

characterized by muscle weakness, due to the antibody of targeting postsynaptic nicotinic receptors. The incidence of MG during reproductive period is 1/10000- 1/50000. In this case, we aimed to present the management of a 28-year-old pregnant woman diagnosed with MG in the highlights of the literature. The prognosis of MG may be variable during pregnancy. This condition should be managed with multidisciplinary approach including obstetrician and neurologist. The mode of delivery should be decided according to the obstetric indications.

Favus is a superficial fungal infection usually caused by Trichophyton schoenleinii. It typically infects scalp hair but may also infect skin and nails. Although it is usually a disease of childhood, it may also be seen during and after puberty. It may cause cicatricial alopecia if left untreated. We report a 42-year-old female patient diagnosed with favus. The disease had been present for 25 years owing to misdiagnosis and unsuccessful treatments.

Leiomyoma is a benign tumour of smooth muscle derived from the arrector pili muscle. It can occur at any age from birth onwards, but appears usually in early adult life. the exact incidence of leiomyomas is unknown.The sexes are affected equally. Thirty-five-year-old male patient was admitted to our clinic with multiple bumps on the body. Dermatologic examination revealed multiple, skin coloured-red papulonodules on back. Histopathological examination of the biopsy specimen revealed leiomyoma. The patient was diagnosed with leiomyoma based on clinical and histopathological findings. Our case is reported because of its rarity.

Blank cartridge guns which are thought to be harmless and manufactured for self-defense requirements, can be easily purchased due to lack of legal regulations. Clinical findings and treatment approach of a male patient referred to our clinic on the second day after a suicide attempt by a blank firing gun is presented in this report. As a result; although they are believed to be harmless among the community, it shoud be kept in mind that damages related with this weapon can cause life-threatening injuries, especially firing at close range.

Brain injury, around the time of birth, is the greatest tragedy of life. Nearly all affected newborns were normal before birth, and the majority of those with moderate to severe encephalopathy will either die or go on to develop neurodevelopmental disabilities. In developed countries, perinatal asphyxia associated with moderate-to-severe hypoxic-ischemic encephalopathy occurs at an approximate rate of 1 to 2 per 1000 live births. However, global perspectives on this condition are entirely different. Worldwide, about a quarter of neonatal deaths are annually associated with perinatal asphyxia. Hypothermia is the first effective potential neuroprotective intervention for newborns who are critically ill following a life-threating asphyxial insult. Therapeutic hypothermia is an emerging therapy choice for hypoxic-ischemic encephalopathy in the term or late preterm infant. Cooling is used more widely and has been introduced in neonatal units. This review is a systemic review about hypothermia and emphasizes the need to understand what to expect about hypothermia.

40-70% of the ICU patients are experiencing pain. Since pain increases the risk of morbidity and mortality, an efficient pain management should be employed to the critical ICU patients. Pain management aims to minimize or annihilate the discomfort feeling stemming from the disease, to decrease the time patient spends in hospital, and to prevent the repeating complaints about pain. ICU nurses have remarkable and key roles in pain management. In order for an efficient pain management, reliability and validity proven pain and sedation assessment scales that enable patient’s response to treatment and that are easily applicable should be used. The efficiency of the treatments should be assessed and these courses should be recorded and shared with team.