INTRODUCTION: .Testicular torsion (TT) is a urological emergency that may result in the testicular loss if medical intervention is not immediately available. The anesthetic management of cases of TT operated in our clinic within 5 years and the results of their seasonal distribution have been discussed with the current literature
METHODS: Fifty-seven patients, who were operated for TT by pediatric surgery and urology clinics at our hospital between January 2013 and December 2018, were included in the study. Patients were divided into two groups (group1: detorsion, group2: and orchiectomy) according to the surgical operation we underwent. Patient demographic data, the elapsed time from onset of symptoms to operation, ASA scores, anesthetic method, duration of hospital stay and seasonal distribution of cases were examined.
RESULTS: The mean age of the 50 patients operated due to testicular torsion was 19.86 ± 13.23 years. We used general anesthesia in 32 (64%) patients and spinal anesthesia in 18 (36%) patients. Detorsion was performed in 38 patients (76%) and orchiectomy in 12 patients (24%). The time elapsed from the onset of symptoms to the operation was 16.1 hours in patients undergoing detorsion and 30.1 hours in patients undergoing orchiectomy (p <0.05).The incidence was higher in the cold weather conditions, but the difference was not statistically significant
DISCUSSION AND CONCLUSION: Detorsion is sufficient in these cases where the time elapsed from the onset of symptoms to operation is short. As hospitalization duration is short, it is a patient population that is suitable for outpatient surgery..

INTRODUCTION: Deep venous thrombosis(DVT) is the coagulum formation due to stasis,endothelial damage and hypercoagulability,which is also called as Virchow triad.It may cause severe sequel and death if it is not treated in a timely manner.In this article,we aimed to share the factors that affect the success rate of DVT patients treated with mechanical thrombectomy and our experience on this subject.
METHODS: In the last year,mechanical and aspiration thrombectomy was performed in 13 patients with lower extremity venous thrombosis in the acute and subacute period in the interventional radiology clinic.
RESULTS: Sonographically 3 patients were acute and 10 patients were subacute DVT.In the case of acute DVT,mechanical aspiration led to significant lumenal opening.In subacute DVT patients,partial opening with mechanical thrombectomy was achieved while half as much lumenal opening was provided as a result of simultaneous aspiration thrombectomy.In a month later,no significant luminal openings were observed in the subacute period when complete opening was observed in the acute phase.
DISCUSSION AND CONCLUSION: We do not have enough information about what causes the long-term results of thrombectomy because it is a procedure that has recently been put into practice.However,because it reduces the thrombus burden and improves the efficacy of medical treatment,it is thought that the vein reduces the possibility of recurrent thrombosis and gives positive results in the long term.If the procedure is done in the early period with vena cava filtration,it is a safe and effective treatment method.Mechanical thrombectomy alone should not be sufficient and should be supported by aspiration,especially in long-standing cases from fifteen days.

INTRODUCTION: We aimed to evaluate intercondylar notch morphology of femur in patients with knee osteoarthritis (OA) and to investigate the relation of anterior cruciate ligament (ACL) injury. Magnetic resonance imaging (MRI) was used to assess the femoral notch type, notch width index (NWI) and α angle in patients with OA or ACL injury and compare these differences.
METHODS: The study was included 106 patients with OA and 79 healthy patients. Fifty-two of the patients with OA had ACL injuries (OA + ACL), 54 of them had no ACL injuries (OA-ACL). The intercondylar notch shape was classified as type A, type U or type W. NWI was the ratio of the width of the intercondylar notch to the width of the distal femoral condyles at the level of popliteal groove. The angle between the longitudinal femoral axis and the Blumensaat line was identified as the ‘α angle’.
RESULTS: More type A notch and lower NWI values were seen in the OA + ACL group. No statistically difference was detected between the groups for α angle. When the regression analysis of the factors affecting the presence of ACL rupture was performed, it was shown that the strongest link was associated with the notch type and it was concluded that having type A notches increased the probability of rupture by 5.17 fold.
DISCUSSION AND CONCLUSION: In osteoarthritic knees, there is a strong relationship between ACL injury and notch type and NWI; Type A notch type is the most powerful risc factor for ACL injury.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and is believed to be caused by genetic and environmental factors. Various studies have reported that body iron levels and ADHD are correlated. In our study, we aimed to investigate the correlation of serum ferritin and transferrin saturation index (TSI) with ADHD subtypes and Conners’ Teacher Rating Scale (CTRS) scores.
METHODS: This retrospective study included 131 boys and 16 girls between 7 and 16 years of age who were diagnosed with ADHD in accordance with DSM-IV TR diagnostic criteria. The data on serum iron, total iron-binding capacity, ferritin, and CTRS scores were obtained from the patients’ hospital files. Statistical analyses were then done on these data.
RESULTS: The mean serum ferritin level was 27.1 ± 15.6 ng/mL and the mean TSI level was 18.1 ± 9.1%. The mean serum ferritin level of those diagnosed with combined type ADHD (25.78 ± 12.90 ng/mL), in accordance with DSM-IV TR criteria, was lower than those diagnosed with predominantly inattentive type (32.75 ± 23.54 ng/mL) (p = 0.034). However, there was no difference in serum TSI values (p = 0.835).
DISCUSSION AND CONCLUSION: In the present study, serum ferritin levels were lower in patients with ADHD than in patients with attention deficit predominant type, and the relationship between iron parameters and ADHD was demonstrated. The necessity of evaluating iron parameters in ADHD cases has been understood once again.

INTRODUCTION: In relation to torsion, mass appearance may occur due to hemorrhage into the cyst, and blood supply of the over tissue may not be well evaluated radiologically. For this reason, the diagnosis of torsion and non-torsion MCT continues to be a serious dilemma.
METHODS: The laboratory and imaging methods of ovarian teratomas with or without torsion were compared with the statistical method. The results were evaluated statistically by using SPSS version 24. Normality checks were performed with the Shapiro-Wilk test. The groups were compared with the independent samples t-test. Statistical significance was p <0.05.
RESULTS: 40% of the cases with CRP level elevation, torsion were significantly higher (> 5 mg / L). The most common surgical approach was fertilization protective cystectomy applied in 14 cases (77 %).
DISCUSSION AND CONCLUSION: The first choice in benign ovarian masses is fertility protective surgery. CRP, WBC and CA19-9 can be a marker, especially in torsion cases. The planning of the study with prospective and large number of patients will be appropriate.

INTRODUCTION: This study was conducted to determine the level of knowledge of midwifery and nursing students about the responsibilities of nurses and midwives in judicial cases.
METHODS: The study, which was planned as a descriptive study, was carried out with 502 students studying in 3rd and 4th class who volunteered to participate in the midwifery and nursing departments of Manisa Celal Bayar University Health Sciences Faculty between 1 October and 30 November 2017. In the collection of the data, "Questionnaire Form on the Introductory Characteristics of Midwifery and Nursing Students" and "Questionnaire Form for the Examination of Knowledge Levels of the Midwifery and Nursing Students about the Forensic Cases and Responsibilities" were used.
RESULTS: The average age of the students were 21,27 ± 1,57 and 82,3% females. 82.1% of the students were not trained about judicial cases and responsibilities, 76.7% were judicial cases and responsibilities, 70.5% were forensic cases report, 79.1% of judicial cases and responsibilities were not fulfilled. It was also determined that 83.7% of them needed separate training for judicial cases and responsibilities and 65.9% of them could not evaluate the cases coming during the internship in terms of forensic cases.
DISCUSSION AND CONCLUSION: Midwifery and nursing students were found to have a low level of knowledge about their responsibilities in the forensic cases. It may be suggested that pre-service training programs should be strengthened to increase the level of knowledge about the forensic cases and responsibilities of candidates for midwifery and nursing profession.

INTRODUCTION: Atrial fibrillation (AF) is the most important cause of stroke. Here, the characteristics and follow-up results of your AF ablation with cryobalon technique were presented.

METHODS: Between February 2016 and November 2017, patients with cryoablation therapy with paroxysmal and persistent AF were included. Data from patient files were analyzed retrospectively. Patients reached by phone

RESULTS: 45 patients were evaluated in the study. 23 of the patients were female and 22 were male. The mean age was 52 ± 14.5 years. The early success rate of cryotherapy was 100%. as a computation.

DISCUSSION AND CONCLUSION: In this study, single cryoablation therapy was effective in paroxysmal and persistent atrial fibrillation, but recurrence of persistent atrial fibrillation was significantly higher

INTRODUCTION: In recent years, many studies have been conducted on the perfusion index (PI) in the evaluation of block success. Aim of this study is to assess the success and efficiency of supraclavicular block by perfusion index.
METHODS: After the approval of the ethics committee for the study; 30 volunteer orthopedics and traumatology patients with American Society of Anesthesiologists (ASA) I-II, 18-70 years who are gonna have hand, wrist, forearm, elbow and arm surgery, were included in the study. In this prospective study; after ultrasound guided supraclavicular block has been applied by enjecting local anesthetic that consists of prilocaine 12.5 ml+bupivacaine 12.5 ml to all patients,sensory block was checkhed with pin-prick test every 3 minute, motor block was checked by using modified Bromage scale every 2 minute,hemodynamic parameters and PI values were recorded on 0th,5th,10th,15th,20th,25th,30th minutes.
RESULTS: When the measured perfusion index values were compared, the differences were significant. When the PI measurements were compared in pairs, the differences between basal and 5th min,10 min,15 min,20 min,25 min and 30 min were significant. Positivity time for pin-prick test was 8.83±2.70 min,motor blok onset time was 6.7±2.89 min,total motor block onset time was 10.83±3.07 min.In the 5 th minute PI values, an average increase of 148% was observed compared to basal PI values.
DISCUSSION AND CONCLUSION: The supraclavicular block provided faster sensory-motor block than other upper extremity blocks.It was concluded that perfusion index was faster,more objective and simpler than traditional methods on assessment of block success, because of vasodilatation that is occured before sensory and motor block.

INTRODUCTION: To evaluate the long-term results of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling in patients with myopic foveoschisis (MF)
METHODS: In this retrospective study, the medical records of the patients who underwent PPV combined with ILM peeling due to myopic foveoschisis were examined. The best corrected visual acuity (BCVA) and the change in BCVA were evaluated. Preoperatively fovea detachment (FD), presence of postoperative ellipsoid zone defect (EZD), and preoperative and postoperative central macular thickness (SMC) were evaluated using optical coherence tomography (OCT).
RESULTS: Twenty-five eyes of 20 patients were included in the study. The mean preoperative BCVA was 1.41 ± 0.32 logMAR (1.0-1.8 logMAR) and postoperative BCVA was 0.87 ± 0.41 logMAR (0.3-1.8 logMAR). Postoperative visual acuity improved in 20 eyes (80%). Postoperatively, 4 eyes (16%) had no change in visual acuity and 1 eye (4%) had a decrease in visual acuity.
The mean CMT was 683.8 µm ± 155.4 and 262.6 µm ± 46.5 preoperatively and postoperatively, respectively. There was a significant decrease in CMT in the first year after surgery when it was compared with the preoperative CMT (p <0.001). In 20 (80%) eyes, foveoschisis was completely resolved anatomically in the first year after surgery. In 5 eyes (20%), there was a decrease in CMT in the OCT, and a partial improvement in the foveoschisis.

DISCUSSION AND CONCLUSION: It is concluded that vitrectomy combined with ILM peeling in the treatment of myopic foveoschisis is an effective and reliable surgical method for increasing visual acuity and providing anatomical improvement.

INTRODUCTION: The aim of this study was to assess vitamin D levels in obstructive sleep apnea syndrome (OSAS) and whether there is a relationship between the severity of the disease and vitamin D.
METHODS: In this retrospective study, demographic data, serum 25-Hydroxycholecalciferol [25 (OH) D3], parathyroid hormone (PTH), calcium (Ca), phosphate (P), magnesium (Mg) levels and disease severity [mild, moderate and severe OSAS (AHI = 5-15, 16-30,> 30 / hour)] of patients diagnosed with OSAS by using polysomnography [apnea-hypopnea index (AHI> 5 / hour] and normal patients (AHI <5 / hour)] were evaluated based on hospital records.
RESULTS: Of the 293 subjects whose records were examined, 229 had OSAS (mean age 55.7 ± 11.3 years; age range 26-86 years), whereas 64 subjects were normal (mean age 55.4 ± 13.7 years; age range 24-78 years). 25 (OH) D3 level was significantly lower while BMI and PTH levels were higher in OSAS patients compared to the control group (p <0.05). 25 (OH) D3 levels were significantly lower in patients with severe OSAS (p <0.05). In addition, there was a weak negative relationship between AHI and 25 (OH) D3 (p: 0.001, r: -0.328), while a weak positive relationship was observed between PTH (p: 0.001, r: 0.186) and BMI (p: 0.001, r: 0.208).
DISCUSSION AND CONCLUSION: We think that vitamin D is deficient in OSAS patients, and vitamin D treatment may be beneficial in reducing the severity of the disease.

INTRODUCTION: The aim of the study was to evaluate retrospectively the burn injuries referred from our city region to our burn care unit.
METHODS: 667 patients were admitted and hospitalised between Apri 2013- December 2018 to Burn Care Unit. All data including age, gender, burning etiology, total burning area of patient, stay of hospital time and period, microbiologic culture results of burning, surgical operations and mortality were recorded and analysed statistically.
RESULTS: Mean age of patients was 15.2 years (0-86 years). The burn trauma was found the most frequently in 0-12 pediatric age group (421 cases, 63.1 %) and this group was followed by 19-59 age group (184 cases, 27.5 %) as second most frequently. 398 patients (59.7%) were male and 269 (40.3%) were female. The most and second frequent etiologic factors in this study were scolding (438 patients, 65.6%) and flame burning (109 patients, 16.3%) respectively. While scolding was the most frequent reason (83.8%) in pediatric age group, flame burning was found most frequently (34.7%) in adult age group.
DISCUSSION AND CONCLUSION: With these results we think that more educations and preventive measures of burning especially for children needs to be taken in our region. It was found that most of burning traumas can be prevent with home accident educations, simple preventive home measures and occupational safety measures. Consequently, physical and psychological morbidities, mortalities and burden financial loss can be minimized.

INTRODUCTION: Chronic venous insufficiency (CVI) is a common disease in the community. Endovascular procedures have been widely used in the treatment of this disease in recent years. In this study, we aimed to reveal the results of radiofrequency ablation (RFA) treatment and compare the local / spinal anesthesia in the treatment of great saphenous vein insufficiency.
METHODS: One hundred and fifty-three(153) patients who underwent RFA treatment due to great saphenous vein insufficiency between January 2016- 2018 were included in the study retrospectively. Operations were performed under spinal anesthesia or local anesthesia. Group 1 was used for local anesthesia while Group 2 was used spinal anesthesia.
RESULTS: Local anesthesia was used in 105(68.6%) patients(Group 1) and spinal anesthesia was used in 48 (31.4%) patients(Group 2). The mean age of the patients was 36.1 ± 9.2 years in Group 1 and 36.5 ± 7.7 in Group 2 (p = 0.794). Female gender ratios were 60% in Group 1 and 54.2% in Group 2 (p = 0.497). Postoperatively, 9 patients had ecchymoses, 9 patients had hematoma, 4 patients had thrombophlebitis, 3 patients had cellulitis, 11 patients had paresthesia and 1 patient developed deep vein thrombosis. There was no statistically significant difference between the groups in terms of complications. The total stay of hospitalization was 11.9 ± 8.5 hours.
DISCUSSION AND CONCLUSION: The RFA method can be used safely to treat great saphenous vein insufficiency. Use of local anesthesia in this treatment may shorten hospitalizations.

INTRODUCTION: To investigate whether the ionized calcium levels calculated by Zeisler Method can be an alternative to each other by comparing the ionized calcium values measured with blood gas device.
METHODS: In this study, serum total calcium and venous blood gas ionized calcium values of 388 same patients were evaluated retrospectively in the past 1 year (April 2018 - April 2019).
RESULTS: The mean blood gas ionized calcium (KGiCa) was found to be 1.164 ± 0.20 mmol / l, while the ionized calcium level (ZMiCa) calculated from the serum total calcium by Zeisler Method was 0.99 ± 0.16 mmol / l. The difference between the two methods (KGiCa - ZMiCa) was 0.17 ± 0.22 mmol / l. Blood gas ionized calcium levels were% Bias = 8.91%, Total CV% 7.60, and% TAH = 21.44%.
DISCUSSION AND CONCLUSION: We think that it is more appropriate to use direct measurement method for ionized calcium. However, if ionized calcium is calculated by Zeisler Method, we think that it is appropriate to evaluate the mean difference between the two methods we found in this study by considering the regression equation and the total permissible error intervals calculated for ionized calcium.

INTRODUCTION: Rectal cancers (RC) constitute one third of colorectal cancers. Chemoradiotherapy (CRT) is the standard treatment of locally advanced stage RC.
European Organization for Research and Treatment of Cancer Quality of Life Questionnairer (EORTC-QLQ C30) is a quality of life scale and that is highly valid and reliable all over the world.
State-Trait Anxiety Inventory (STAI) is an anxiety scoring questionnaire is examined in two forms; STAI1 (statefulness) and STAI2 (continuity). The Beck Depression Inventory measures depression symptoms. The aim of this study was to compare the quality of life, anxiety and depression of patients before and after radiotherapy (RT0) and after radiotherapy (RT1).

METHODS: EORTC-QLQ C30, STAI1, STAI2 and Beck depression questionnaires were applied to 32 patients who applied to our clinic with the diagnosis of RC between November 2016-August 2019.
RESULTS: Social function score, dyspnea which are compared at RT0 and RT1 times; was not statistically significant p> 0.05, borderline pain score was found to be significant p = 0.067 and the other quality of life scores were statistically significant p<0.05. STAI2 and Beck test were statistically significant p <0.05 which are compared at RT0 and RT1 times, STAI1 test was not statistically significant p> 0.05.
DISCUSSION AND CONCLUSION: Based on these results, quality of life, anxiety and depression of the patients with RC should be closely controlled during RT.

INTRODUCTION: To evaluate the results of retrograde intrarenal surgery (RIRC) performed in our clinic in cases with renal stones.
METHODS: The results of 90 patients that underwent RIRC between June 2016 and January 2019 were evaluated retrospectively. The demographic data and the preoperative and postoperative clinical characteristics of the patients were examined.
RESULTS: The mean age of 90 patients that underwent RIRC (41 men/49 women) was 43.35 (21-84) years, and the mean stone size was 16.22 (10-28) mm. The operation was performed under general anesthesia in 38 patients (42.22%) and spinal anesthesia in 52 (57.78%). The mean operation duration was 61.76 (30-115) min, and the mean stone fragmentation time was 48.33 (15-95) min. In 23 patients (25.55%), a double-J stent was inserted into the ureter since the kidney could not be reached due to stenosis. In 75 patients (83.33%), a double-J stent was placed at the end of the operation. The mean hospital stay was 1.08 (1-3) days. The stone-free rate was 71.12%. Of the cases with residual stones, 21 (23.32%) underwent an additional intervention and five (5.55%) were followed up without further intervention. Complications were observed in 13 patients (14.44%) and evaluated according to the modified Clavien classification.
DISCUSSION AND CONCLUSION: In the presence of adequate equipment and experience, RIRC is an effective and safe procedure with high success, low complication and minimal morbidity rates in the treatment of renal stones.

INTRODUCTION: To determine which anesthesia method is preferred and why by the operating room staffs who are faced with anesthesia applications every day, when they need a surgery about themselves or their relatives.
METHODS: A semi-structured questionnaire consisting of questions was sent to the 1000 operating room staffs who are working in different hospitals on different regions of Turkey by technological methods of communication (Google forms over the Internet, messenger, like WhatsApp). Age, gender, occupation and duration of occupation of participiants, whether or not anesthesia was applied to them, and if applied the method, which anesthesia method they would prefer or not and why, and which anesthesia method they suggest to their relations were asked in questionnaire.
RESULTS: Of the participants aged between 20 and 60, 51.2% (n = 327) were men and 48.8% (n = 312) were women. 69 % (n = 440) of the participants indicated that anesthesia was applied to them for any reason, while 31% (n = 199) indicated that they were not anesthetized. While general anesthesia, regional anesthesia, peripheral nerve block methods were the most suitable methods for the participants,choice was regional anesthesia (spinal, epidural, combined spinal epidural anesthesia) with 47%. The answer to the question of which anesthesia method do you recommend to your relatives and patients has been predominantly regional anesthesia.
DISCUSSION AND CONCLUSION: We found that regional anesthesia more preferred in the operating room staff in Turkey. We believe that it will be possible to find out the direction of anesthesia preferences through larger studies and this situation may be important in terms of labor and cost planning.

INTRODUCTION: Thyroid cancers are the most common endocrine tissue malignancies. In recent years, it has been increasingly seen in childhood throughout the world. The aim of this study was to investigate the effect of thyroid nodule volume, diameter and multicentricity on malignancy in patients undergoing surgical procedures in our clinic.
METHODS: A total of 20 pediatric patients aged 1-17 years who underwent total thyroidectomy and / or lobectomy for thyroid nodule between 2014-2019 were evaluated. The effect of age, sex, nodule diameter, volume and multicentricity in the patients were examined on malignity retrospectively.
RESULTS: The study patients were 15 female and 5 male. The mean age of the patients was 14 years, nodule diameter was 3 cm in malignancies and 2 cm in benign tumors, while nodal volume was 7.8 cm3 in both malignant and benign patients. According to the pathology results after surgery, multicentricity was present in nine patients. Seven of the these nine patients were malignant and two were benign.
DISCUSSION AND CONCLUSION: High nodule diameter, volume and multicentricity did not increase risk of malignancy. Therefore, we concluded that the diameter, volume and multicentricity of the nodule cannot be used to predict malignancy or to decide surgical resection.

In this case report, the patient was diagnosed with type 1 aortic dissection that was diagnosed with chest pain three days before and was diagnosed as having delayed diagnosis, and the patient was successfully treated with tubular graft implantation.

We presented five cases who were sent referred to our department for a judicial report. We discussed the effect of post-traumatic psychiatric diseases on the results of the report and we aimed to emphasize the importance of psychiatric examination in the forensic-medical evaluation. Traumatic lesions resolved basic medical intervations such as ecchymosis and laceration had been described in the medical documents of the three assault injury cases and two traffic accident cases. All cases referred to our department for preparation of a judicial report. The results of the psychiatric consultation, four cases diagnosed with “Post Traumatic Stress Disorder” and one case diagnosed with “Acute Stress Disorder”. We think that along with the evaluation of physical findings of cases, to have a psychical evaluation and if necessary to take the opinions from psychiatry clinics are important for a complete exhibition of posttraumatic pathologies of the individual.

Constipation is an important symptom of functional disorders of the gastrointestinal system that affects individuals from all ages and causes a threat to health. The frequency of constipation increases with age and 40% of individuals who are 65 and older experience constipation. When the frequency of constipation in a hospital environment is examined, 71.7% of the cases are seen in surgery clinics, in 95% of patients with heart disease and in 100% of cancer patients.
Non-pharmacological integrated methods have been widely used in health care in recent years. Acupressure, which is a treatment that is used to reduce the pain, to relax and relieve and reduce the symptoms by application of certain point pressures and scrubbing manipulations on the body’s acupuncture meridians and meridians. Constipation is one of the areas of acupuncture which is frequently used in many different diseases and symptoms. Studies reported that the acupressure has positive effects on the constipation. Nurses should be knowledgeable about non-pharmacological methods in order to manage the problem of constipation which is among the common symptoms in the hospital. This article investigated the acupressure method known to be effective in preventing and eliminating constipation

The relationship between diabetes and sexual dysfunction was first discribed as a complication distinctive to diabetes in the 10th century by Avicenna with the name “collapse of sexual function”, but this issue was not investigated until the 1950s due to sexual taboos. Diabetes affects %3-6 of all population. Concern or incentive for sexual interaction may be affected by suboptimum glycaemic control, reduced energy, changed body image, and person-specific problems resulting from hardship with dietary compliance or glucose monitoring. The incidence of diabetes-associated erectile dysfunction increases with age, and some studies have reported rates as high as 75% in. Studies on female sexual function appear to have been neglected until the first publication of Kolodny in 1971. When the published articles were scanned, it was seen that there were 477 publications on the role of diabetes on sexual function in men—but only 19 in women. This disproportion in data is partially because of difficulties in measuring the sexual response in women. While erectile dysfunction is easily measured in men and reflects directly subjective arousal of men, it is more difficult to measure genital congestion due to erroneous correlation with subjective arousal in women Throughout this article, we will analyze the pathophysiology of sexual dysfunction and its up-to-date treatment options in men and women.

Suturless and transaortc valve implatation performed low mortality and morbidity in high surgical risk patients for aortic stenosis.