\r\n PURPOSE
\r\n             The aim of this study is to analyze if there were any factors that would indicate the diagnosis of dilating vesicoureteric reflux (VUR) (≥ grade 3) in the second voiding cystourethrogam (VCUG) of children with a normal first VCUG.

\r\n MATERIAL AND METHODS
\r\n             Patients who underwent VCUG between 2012 and 2017 were retrospectively reviewed. Within the cohort, patients who required more than one VCUG were abstracted and those with an abnormal first VCUG (VUR, posterior urethral valve, etc.) were excluded. Factors such as; age, gender, lower urinary tract dysfunction (LUTD), renal scarring, recurrent urinary tract infection, abnormal ultrasonography findings (bladder abnormalities/variable degrees of hydronephrosis), and technical problems (absence of voiding phase) were noted. Mann-Whitney U test was used for continuous variables whereas Chi Square test was used for categorical values.

\r\n RESULTS
\r\n             A total of 25 patients were found to have undergone more than 1 VCUG (19 girls, 6 boys; mean age 6 ± 3 years). Median time period between the two VCUGs were 12 months (range 1 – 72 months). VUR was detected in 11 patients, while dilating VUR was discovered in 7 patients. Among those, 6 patients were diagnosed with bilateral VUR. Recurrent UTI was found to be the only factor that would indicate dilating VUR in the second VCUG (p=0,049). Interestingly, no VUR was detected in cases that were performed after a first VCUG with inadequate technique. 

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\r\n CONCLUSION

\r\n             Recurrent UTI was shown to be the sole factor that would indicate the diagnosis of dilating VUR in the second VCUG. In our study, 28% patients with a normal first VCUG were shown to have dilating VUR in the second study. Therefore, in recurrent febrile UTI, second VCUG should be considered in patients with a normal previous imaging.
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\r\n ABSTRACT

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\r\n Aim : In this study, it was aimed to determine burnout, occupational satisfaction, depression symptom levels and sociodemographic characteristics affecting health personnel working in the operating room.

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\r\n Patients and Methods:The sample of the study consisted of a total of 230 people, including an anesthesiologist, a surgical nurse and an anesthesia technician working in the Erzurum Regional Training and Research Hospital and Atatürk University Medical Faculty Hospital. In the study, the Sociodemographic Data Form, Maslach Burnout Inventory , Minnesota Satisfaction Scale  and Beck Depression Inventory were requested from participants

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\r\n Results:Emotional Exhaustion , Desensitization  and Beck Depression Inventory  scores were significantly higher and Personal Achievement scores were lower in operating room personnel working more than 60 hours a week (p <0.05). Desensitization scores were found to be significantly higher (p <0.05). Doctors' Emotional Exhaustion   and Desensitization scores were high. (p <0.05). There was a significant negative correlation between the Beck Depression Inventory  and the Minnesota Satisfaction Scale  and Personal Achievement scale scores of the employees; There was a significant positive correlation between the mean scores of the Emotional Exhaustion   and Desensitization subscales (p <0.05)

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\r\n Conclusion:The operating room, which is a unit under intensive work pressure that requires effective, accurate and rapid intervention, will be useful in evaluating the mental health and working conditions of employees, reducing the work pressure and burden of employees and increasing the quality of service by increasing mental health and functioning.

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Objective: Conjunctiva is a region where various neoplastic or non-neoplastic lesions may develop.  In this study, we aimed to perform a histopathological analysis of conjunctival lesions and to determine their prevalence.

Material & Methods: Conjunctival biopsies of 401 patients who presented to the pathology laboratory between 2009 and 2019 were retrospectively examined. The cases were histopathologically divided into two groups as non-neoplastic and neoplastic lesions. Neoplastic lesions were further divided into subgroups as benign, premalignant, and malignant lesions. The prevalence of lesions and distribution of age and gender among the groups were analyzed.

Results: In our series of 401 patients, the mean age was 49.89±21.75 years. Of all patients, 209 (52.1%) were male and 192 (47.9%) were female. Non-neoplastic lesions were found in 296 (73.8%) and neoplastic lesions in 105 (26.2%) patients. The mean age was found as 50.79±19.34 years in patients with non-neoplastic lesions, and 47.34±27.39 years in patients with neoplastic lesions. Of neoplastic lesions, 64 (60.2%) were benign, 17 (16.2%) premalignant, and 24 (22.6%) malignant. The most commonly found non-neoplastic lesion was pterygium (n:220; 54.78%) while the most common benign lesions were nevus and other pigmented lesions (n:38; 9.5%), and the most common malignant lesion was squamous cell carcinoma (n:14; 3.5%). The prevalence of neoplastic lesions significantly increased over 45 years old (p<0.05).

Conclusion: In the current study, conjunctival lesions diagnosed in our laboratory over 10 years were reviewed and histopathologically analyzed. Recognition of conjunctival lesions and being aware of the rates of non-neoplastic and neoplastic lesions are crucial for treatment planning and protection of visual functions.

Aim: Many scales have developed to assess daily living activities, clinical functions of patients with brachial plexus palsy. "Brachial Plexus Outcome Measure " was developed by Emily Ho in 2012, activity and self-rating substance scale consisting of components total 14 items. Aim of this study, make an inter-observer reliability of scale, to make clinical trial in patients.

Materials and Methods:Demographic and clinic datas recorded,"Brachial Plexus Outcome Measure " was applied by two different observers. Inter-observer reliability in items examined by using kappa statistic.

Results:Eighteen female (37.5%) totally 48 patients included. Mean inter-observer agreement in the items was almost perfect (kappa 0.93) in raters. Fitted statistics showed much variation in observers had moderate (kappa 0.57) agreement in items.

Conclusion: Between observes, “Brachial Plexus Outcome Measure” is reliable measurement for assessing functions in children with brachial plexus palsy in Turkey. Clinical usage is appropriate.

Aim: Index of cardiac electrophysiological balance (iCEB), calculated as QT interval / QRS duration, has been described as a novel indicator for predicting malignant ventricular arrhythmias. Herein, we aimed to explore the relation of coronary collateral circulation (CCC) degree with iCEB and Tp-e / QT ratio.

Patients and Methods: Forty-four patients diagnosed with chronic total occlusion (CTO) and 55 healthy subjects in comparable age and sex distribution were included. We classified the CTO patients as good (n= 24) and poor (n= 20) collateral groups. Standard 12-lead standard electrocardiogram (ECG) of all patients was recorded and Tp-Te interval, QT interval, QRS duration, Tp-Te/QT ratio and QT/QRS ratio were measured.

Results: Mean Tp-e interval and Tp-e/QT ratio were similar between groups. Also, the groups were comparable regarding iCEB or iCEBc values. In subgroup analysis, there was no relationship between the degree of CCC and ECG parameters including Tp-e/QT ratio, Tp-e and QT/QRS ratio.

Conclusion: There was no significant relationship between the iCEB and Tp-e/QT ratio, and the degree of CCC development in patients having CTO.

Objective: Pap smear test is a commonly used and effective screening method in detection of cervical cancer and its precursor lesions. There is a very limited number of studies on use of Pap smears in diagnosis of the endometrial carcinomas. We have aimed to investigate the incidence rate of atypical endometrial cells in Pap smears of the patients diagnosed with endometrial carcinoma and the correlation between these cells and clinicopathological parameters.

Material and methods: In this study, patients who were diagnosed with endometrial carcinoma and who had smear sampling between January 2015 and September 2017 were examined retrospectively. Histological type, nuclear grade and Pap smear results of endometrial carcinoma cases were evaluated.

Results: Pap smear sampling was concurrently performed in 59 of the 97 patients diagnosed with endometrial carcinoma. The ages of the patients who underwent smear sampling ranged between 42 and 82 years (mean 57.43±9.08 years). The menopausal status evaluation of the women revealed that 12 (20.3%) and 47 (79.7%) patients were premenopausal and postmenopausal, respectively. Endometrioid type carcinoma was encountered in 51 (86.4%) patients as the most commonly found histological type. Serous, clear cell and mucinous carcinomas were determined in 6 (10%), 1 (1.8%) and 1 (1.8%) patients, respectively. The results of Pap smear tests were atypical in 24 (40.7%) patients whereas normal results were obtained in 35 (59.3%) patients. Nuclear grade assessment of the carcinomas showed that grade 1, grade 2 and grade 3 carcinomas were discovered in 24 (40.7%), 25 (42.3%) and 10 (17%) patients, respectively. The rate of the atypical endometrial cells encountered by Pap smears has increased as grade of the tumors increased.

Conclusion: We have concluded that the detection rate of atypical cells by Pap smear in endometrial carcinomas is considerably high. The incidence of atypical cells is higher in nonendometrioid and high-grade carcinomas.

\r\n Prognostic importance of thrombocyte indices in children with carbon monoxide poisoning

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\r\n Abstract

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\r\n Objective: Carbon monoxide (CO) poisoning is still being a major cause of morbidity and mortality all over the world. Although the role of platelet functions in CO poisoning is not clear, increased platelet activation and aggregation had been reported previously. Increased thrombotic tendency due to endothelial damage, increased platelet stickiness, and alterations in the fibrinolytic pathway occurs in CO poisoning. The aim of our study was to determine whether platelet indices provide clinical benefit or not in children with CO poisoning.

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\r\n Materials and Methods: We retrospectively reviwed the records of children with the diagnosis of CO poisoning who admitted to the pediatric emergency departments of Konya Beyhekim State Hospital and Necmettin Erbakan University Meram Medical Faculty. A total of 92 children with CO poisoning and 62 age- and gender-matched healthy controls were included in the study.

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\r\n Results: While mean platelet volume (MPV) and platelet distribution width (PDW) levels were significantly higher (9,34±0,55 vs 9,78±0,97fL, p=0.001 ; 11,46±2,64 vs 10,57±1,41, retrospectively, p=0.007), platelet count and plateletcrit (PCT) (324,05±82,07 vs 357,27±89,70 x10⁹ p=0.015 ; 0,31±0,06 vs 0,33±0,07, retrospectively, p=0.039) were significantly lower in patients with CO poisoning. MPV levels were also significantly higher in patients with a carboxy hemoglobin (COHb) level higher than 20, when compared with COHb levels between 10-20 (9,40±0,84 vs 10,08±1,22 fL, p=0.003).

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\r\n Conclusion: Our results showed that platelet indices MPV and PDW are markedly elevated in patients with CO poisoning while platelet count and PCT were decreased. MPV and PDW levels, which reflect the changes in platelet activation and function, may predict the development of especially thromboembolic complications in the course of CO poisoning.  MPV and PDW levels may be useful in prognostic estimation of CO poisoning.

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\r\n Keywords: carbon monoxide; children; platelet indices; poisoning

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 Today an increasing prevalence of obesity, which is one of major health problems is associated with many chronic diseases such as diabetes, cardiovascular disease, stroke, cancer, asthma obstructive sleep apnea syndrome. Therefore, treatment of obesity contribute to  prevention of many chronic diseases risk. Recent years, it has started to consider on effects on the gastrointestinal system in treatment of obesity as well as adequate and balanced diet, increasing  physical activity and lifestyle changes. Especially it was seen that gut microbiota has been associated with obesity. Many studies showed that gut microbiota may be vary with eating habits and obesity. It is discussed changed microbiota might be associated with obesity and many obesity-related diseases. It is thought that long term-controlled studies in this area   will create a new approach to the treatment of obesity and come into prominence in the fight against obesity. In this review,it was aimed to evaluate the relationship between body weight and the gut microbiota.
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Background: Tyrosine rich crystals (TC) are curious structures, rarely encountered at histopathology, more so at cytology. These crystals have been documented exceptionally in various non-neoplastic and neoplastic lesions of salivary gland, lacrimal gland and rarely in larynx. The finding of these crystals in nasolabial cyst has not been reported till date.

Case: A 35-year-old female with a clinical and radiologic diagnosis of nasolabial cyst underwent fine needle aspiration cytology (FNAC). Tyrosine crystals in singles and in groups assuming ‘petaloid’ and ‘daisy head’ forms were noted along with few lymphocytes and histiocytes. Amylase crystals were also noted.

Conclusion:  Regardless of the precise cause, cytologic recognition of TC is important to avoid confusion. Identification of these crystals at FNAC is a matter of avid observation and encourages cytopathologist for meticulous examination of all fluids. The case also highlights that the occurrence of TC is not restricted to SG and the circumstances in which it occurs is diversified.

Bone wax is a commonly used hemostatic agent derived from beeswax. It is used widely in neurosurgery, orthopaedic surgery, maxillofacial and orthognathic surgery.  Although few case reports have emerged regarding complication due to the bone wax, the use of it continues in various surgical sites.  We report an unusual case of a non-healing ulcer over the iliac crest appearing one year after bone harvest was done for alveolar bone grafting

Bezoars are concretions in the gastrointestinal tract that increase in size by continuous accumulation of non-absorbable food or fibers. Most bezoars in children are trichobezoars from swallowed hair from the dolls or brushers. Trichobezoars typically cause abdominal pain and nausia, but can also present as an asymptomatic abdominal mass, progressing to intestinal obstruction and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngers. We report a case of an unusual giant trichobezoar in 8-year-old girl. It was not extracted endoscopically, because it was huge and passed into the duodenum. Attempts at dissolving the bezoar with enzymes (papain) or meat tenderizers have not been efficacious. The abdomen was explored through a supraumblical median incision, an approximately 15X3 cm trichobezoar in diameter was identified in 50 cm distance from ileocecal segment, and was removed. In addition, ischemic and rupture 10 cm jejunal segment was repaired. These two rupture segments were repaired using Heineke Mikulicz procedure.

 Fourty one years old female and 64 years old man were admitted to our clinic  because of abdominal pain. In investigating the liver was reported with a giant hemangioma. It was symptomatic and look like malignancy for each cases so they were operated. In operation it was not a liver mass , one of them observed right giant adrenal adenoma and the second one is renal cell carsinoma.  Resection was performed for each cases. Adrenal mass could be noted that mixed hemangiomas.

 Achillestendonrupture is a commonmusculoskeletalinjury. Itusuallyoccursunilaterally in activemiddle-agedindividuals. Spontaneousruptureswithoutany risk factorspredisposingthepatient is uncommonandfor it tooccurbilaterally is veryuncommon. Wereport a case of bilateralspontaneousAchillestendonrupture in a 32- year-oldmanwithnocertainpreviousandcurrentrisk factors. Therupturesoccurredafterliftingbarbell in whichtheweightcaused a severe stressandelongation of thebilaterallygastrocnemiuscomplex.After a clinicalexaminationconfirmedthediagnosis, ultrasonographyof theAchillestendonsrevealedbilateralruptures. Thepatientunderwentbilateralprimarysurgicalrepair. Rehabilitationwasbegun 6weekslater. Weallowedtheweightbearingpartially at 8 weeksaftersurgery, fully at 12 weeksaftersurgery.Thepatient'sreturntopremorbidworkandsocial life wasuneventful.BilateralAchillestendonrupturesareveryrare but increasedawarenesswouldhelpavoid a rupture of thecontralateralsidebeingmissed.

\r\n Silent thyroiditis and Graves’ disease are autoimmune disorders which are common cause of thyrotoxicosis and should be given different treatments. Anamnesis and physical examination are not sufficient in the differential diagnosis of these two diseases, and advanced examinations such as thyroid scintigraphy, iodine reuptake study and thyroid stimulating receptor antibody could be needed. In this case, we present a patient diagnosed with a silent thyroiditis as a result of a thyrotoxicosis of a patient who was following up due to Graves' disease in remission and we aimed to emphasize the importance of differential diagnosis of these two diseases.