INTRODUCTION: The Rai and Binet staging systems are used as a standard method to evaluate the prognosis of chronic lympocytic leukemia(CLL). However, CLL is a heterogeneous disease in terms of clinical features and prognosis. The Rai and Binet staging systems; may not reflect the different biological properties of CLL cells affecting survival outcomes and response to treatment. Because of this, new prognostic parameters has become important in the recent years. It is suggested that serum VEGF levels in CLL may be an important parameter in determining the progression of the disease.
METHODS: We detected the serum levels of VEGF in 46 CLL patients and 20 healthy controls with the use of ELÝSA method.
RESULTS: The CLL patients group had higher median serum levels of VEGF compared to the control group (267 pg / mL, 43,8 pg/mL, p: <0,0001, respectively). Higher median value of serum VEGF levels (>267 pg/ml) were associated with a shorter time of disease progression in Binet A and B CLL patients (p: 0,004). We also found that high serum VEGF levels showed a significant correlation with OS (p: 0,019).
DISCUSSION AND CONCLUSION: As a result, we found that the serum levels of VEGF in the CLL patients are higher than the control group and it can be a parameter associated with the disease progression and survival. For this reason and because the simplicity of analyzing with ELISA, it can be a useful clinical parameter, after its importance have been shown in larger and multi-variate studies.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is a painful intervention and usually requires anesthetic implications. Many drug combinations have been studied for procedural sedation during this procedure and the results show variability. In this study, we aimed to compare the remifentanil monotherapy with the conventional sedation methods during ERCP in terms of clinical security, recovery profiles and the satisfaction of the patients and endoscopists.
METHODS: Sixty patients aged between 18-80 years were randomly allocated into two groups to receive either remifentanil monotherapy (bolus dose of remifentanil followed by infusion) or conventional methods (propofol and/or ketamine combined with fentanyl) for procedural sedation. Clinical characteristics, Ramsey Sedation Score (RSS), recovery score (modified Aldrete score), the satisfaction of patients and endoscopists were considered as measured outcomes.
RESULTS: The cardiorespiratory parameters and adverse reactions were similar in both groups of patients. The endoscopist and patent satisfaction, RSS and recovery characteristics were significantly better with remifentanil monotherapy.
DISCUSSION AND CONCLUSION: The usage of remifentanil alone may be considered as an alternative treatment of choice during procedural sedation in ERCP due to its safety clinical performance and providing better sedation level, recovery period and satisfaction.

INTRODUCTION: Aneurysmal subarachnoid hemorrhage is a serious condition associated with high morbidity and mortality. Many factors influence outcome in patients with aneurysmal subarachnoid hemorrhage and different grading scales are used in this setting. In this study we aimed to investigate the relationship between WFNS, Fisher Grading, Hunt-Hess scale and intensive care parameters with patient mortality.
METHODS: Data from 50 patients who were admitted to our intensive care unit with aneurysmal SAH between January 2012 and October 2018 were retrospectively analyzed. Demographic data, hospitalization duration, World Federation of Neurosurgeons Scale (WFNS), Fisher Grade and Hunt-Hess scales, APACHE II score on first day of ICU admission, localization of aneurysm, as well as duration of hospitalization, and mechanical ventilation were recorded.
RESULTS: A total of 50 patients with a mean age of 53.18 ± 11.18 were included in the study. 29 (58%) were female and 21 (42%) were male. The mean duration of hospitalization was 24.7 ± 18.37 days. While 41 (82%) of the patients were discharged, 9 (18%) patients died. WFNS, Fisher Grade, Hunt-Hess scale, APACHE II score, or aneurysm localization was not different in patients with and without mortality, whereas the duration of mechanical ventilation (p: 0.006) and duration of intensive care unit stay (p: 0.008) were significantly longer in patients with mortality.
DISCUSSION AND CONCLUSION: WFNS, Fisher Grade and Hunt-Hess scales were not significantly different in aneurysmal SAH patients with and without mortality, while the duration of mechanical ventilation and intensive care stay were significantly differed. In patients with aneurysmal SAH, appropriate patient management during the intensive care period can improve patient outcomes.

INTRODUCTION: Ewing Sarcoma (EWS) is a primary malignant bone tumor of neural origin with undifferentiated characteristics. Primitive Neuroectodermal Tumors (PNET) are malignant lesions with poorly differentiated and poor prognosis. PNETs cannot be morphologically and histologically distinguishable from EWS of the bone.In this study,we aimed to compare the patterns of aggression in EWS and PNET cell lines and to investigate the changes in epithelial-mesenchymal transition (EMT) markers to determine the metastasis status of the cells.
METHODS: The doubling times of EWS and PNET cell lines obtained from Children's Oncology Group were determined. Scratch assay was performed to determine the migration capacity of cells within the scope of functional studies.EMT markers in EWS and PNET cells were determined by Real-Time PCR.
RESULTS: The doubling time in cell lines was TC71, TC106, CHLA99 in EWS, CHLA32, CHLA9 and CHLA10 in PNET.The migration capacity of the cells was similar to the doubling time. SNAIL1, SNAIL 2, ZEB1, ZEB2 and Vimentin expression levels were higher in TC71 than TC106 and CHLA99, and NCad expression was highest in CHLA99.The expression levels of ZEB1, ZEB2, SNAIL1, SNAIL 2, NCad and Fibronectin were higher in CHLA32 compared to CHLA9 and CHLA10 in PNET.ECad was found to be at most CHLA10 and CHLA9 for Vimentin.
DISCUSSION AND CONCLUSION: the most aggressive and least aggressive cells were TC71, TC106 CHLA99 in EWS, CHLA32, CHLA10, CHLA9 in PNET, respectively. In the diagnosis of EWS and PNET metastasis, early diagnosis, and the development of new treatment modalities to clarify the level of aggression of the cells are important.

INTRODUCTION: The aim of the study was to determine the level of dependence of chronic renal failure patients and to evaluate the factors that cause dependence.
METHODS: The cross-sectional study was carried out with 195 individuals who had been diagnosed with disease for at least one year, underwent hemodialysis treatment, aged 18 years or older, had no cognitive impairment and agreed to participate in the nephrology clinic of an university hospital between February and May 2019. Demographic information form, Care Dependency Scale, Fatigue Severity Scale and Visual Analog Pain Scale were used to collect study data. In the statistical analysis of the data; number, percentage, mean, Independent Samples T-Test, One Way Anova Test and Pearson’s correlation analysis were used.
RESULTS: In the study, it was determined that patients with chronic renal failure had a moderate level of care dependence, level of care dependence was higher in mobility, dressing/removing clothes, avoidance of dangers, daily activities, recreational activities, and the level of age, educational status, presence of an additional chronic disease, duration of disease and some of the symptoms significantly affected the level of care dependence. However, age, education, presence of an additional chronic disease, duration of illness and symptoms of fatigue, pain, muscle weakness, loss of appetite and itching were found to affect the level of care dependence significantly.
DISCUSSION AND CONCLUSION: Care dependence is an important issue to be evaluated in chronic renal failure patients and appropriate care, training, counseling and advocacy services should be used to support the independence of patients.

INTRODUCTION: Chronic airflow limitation in COPD develops as a result of the common effects of small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema). Our aim is to investigate whether there is a difference between COPD phenotypes of inflammatory cells in stable COPD patients.
METHODS: Stable COPD patients and control group were included. Demographic data, C-reactive protein (CRP) and hemogram parameters of the two groups were compared. Pulmonary function tests (PFT), dyspnea scales and exacerbation number of COPD patients were recorded. The relationship between inflammatory cells and control group and COPD phenotypes was analyzed.
RESULTS: Neutrophil-Lymphocyte Ratio (NLO), Neutrophil-Platelet Ratio (NPO), Platelet-Lymphocyte Ratio (PLO) and Neutrophil-Eosinophil Ratio (NEO) were significantly higher in COPD group than the control group. Total eosinophil count and NEO and ELR rates were significantly different between the phenotypes of the COPD group and asthma COPD overlap (ACO) group.
DISCUSSION AND CONCLUSION: Inflammation is present in all central and peripheral airways in stable COPD, especially the eosinophil count is significant in the ACO group.

INTRODUCTION: Ovarian masses in childhood range from functional ovarian cysts to malignant tumors. In our study, we aimed to evaluate the patients who were followed up and treated in our clinic due to the ovarian mass in terms of clinical findings, diagnostic methods, surgical treatment methods, pathological diagnoses and treatment results.
METHODS: 42 patients who were followed-up and treated for ovarian mass in Kocaeli University Medical Faculty Pediatric Surgery Clinic between 2014-2018 were included in the study. Clinical information and computer records of the patients were analyzed retrospectively. In the examination, demographic data of the patients, complaints of application, localization of the mass, laboratory hormone levels and surgical findings, histopathological diagnosis, treatment methods and treatment results were evaluated.
RESULTS: A total of 42 female patients were included in the study. The mean age of the patients was 13.3y (8y-17y). Abdominal pain and abdominal swelling were the most common complaint. Surgical intervention was performed in 11 patients by laparoscopy and 31 by laparotomy. In 25 patients unilateral oophorectomy or salpingooopherectomy was performed, in 16 patients ovaries were preserved and only cyst excision was performed. Thirteen of the cases were ovarian cyst, 15 were mature cystic teratoma, 2 were mixed malignant tumor, 1 was paraoverian cyst, 1 was serous papillary cyst adenoma, and 4 patients were ovarian torsion without mass.
DISCUSSION AND CONCLUSION: The most common clinical finding in ovarian masses is abdominal pain and mobile mass in the abdomen. Since ovarian masses are common in children, it should be taken into consideration in the differential diagnosis of girls presenting with abdominal pain. It is possible to reduce the risk of possible ovarian torsion and improve prognosis in patients with maling tumors by making early diagnosis with the widespread use of radiological diagnostic methods. Surgery to be performed in ovarian masses should be determined with advanced imaging methods before surgery and ovarian sparing surgery should be preferred as much as possible.

INTRODUCTION: Despite technical and medical advances, SVGD remains a significant problem that is associated with high morbidity and mortality rates. EAT communicates locally with coronary vessels and myocardium through paracrine or vasocrine pathways. Although the relationship between EAT and CAD is well known, there is not sufficient information about effect of EAT on SVGD. Therefore, we aimed to investigate the relationship between EAT and SVGD.
METHODS: The study population consisted of 124 consecutive patients who underwent elective CAG more than one year after CABG surgery. The patients were divided into two groups depending on the extent of SVG patency. EAT thickness measurements were determined from the low echogenic density area perpendicular to lines drawn from the parasternal long and short axes to the free wall of the right ventricle.
RESULTS: EAT thickness was significantly higher in the SVGD (+) group than in the SVGD (-) group (p < 0.001). The multivariate logistic regression models revealed that EAT thickness (p < 0.001, Odds ratio (OR) = 3.65, 95% Confidence interval (C.I.) = 2.52–8.12) was found to be independent factor for predicting SVG stenosis. An EAT thickness value of > 7.4 mm has 86.4 % sensitivity, 69.1 % specificity for the prediction of SVG stenosis.
DISCUSSION AND CONCLUSION: EAT thickness is related to the presence of SVG stenosis. EAT thickness therefore could serve as an easily measurable non-invasive adjunctive marker to classical risk factors for the prediction of SVG stenosis.

INTRODUCTION: The treatment of Acute myelogenous leukemia (AML) with differential effect of 1alpha,25-dihydroxyvitamin D(3) (1,25(OH)2D3) has been one of the popular research topics. The aim of this study is to investigate the role of 1.25 (OH) 2D3 in leukemia cell cycle regulation and apoptosis in HL-60 cells.

METHODS: We analyzed 13 genes (TNFR1, Bcl-w, Bax, Bak, Caspase–6, Caspase–8, AIF, Survivin, Cdk1 (Cdc2), Cdk2, Cdk4, Cyclin-D1 and Cyclin-E) for changes in expression associated with the cell cycle and the apoptosis of human promyelocytic leukemia HL-60 cells induced by 1,25(OH)2D3 at 18th, 36th, 48th and 72nd h, using quantitative real-time PCR.
RESULTS: We did not find significantly down or up-regulated expression profiles at mentioned time points. In our experiments, we observed decreased expression of TNFR1, Cdk-4, Cyclin-D1, Cyclin-E and Survivin genes at 72nd hours, and increased expression of Caspase-8 and Bak genes. The tendency of cell cycle related genes decrease from 18th to 72nd hours suggested that HL60 cells differentiated. Decreased expression of anti-apoptotic Bcl-w and Survivin genes and increased expression of pro-apoptotic Bak and Caspase-8 genes suggested that apoptotic process stage starts around 72nd hours.
DISCUSSION AND CONCLUSION: In conclusion, exposure of leukemic HL60 cell line to vitamin D3 derived the cells into differentiation. The clonal development completed and apoptotic stage begun.

INTRODUCTION: Iron deficiency (ID) and iron deficiency anemia (IDA) are common comorbidity in heart failure (HF). Although ID is well-known subject in HF patients, there are not enough epidemiological studies examining the prevalence of ID and IDA in HF patients in our country. The aim of this study is to evaluate the prevelance of ID and IDA in Turkey and to detect a marker for progression of ID to IDA in HF patients.
METHODS: ID was described as serum ferritin<100µg/L (absolute ID) or ferritin level 100-299 µg/L with TSAT<20% (functional ID).Anemia was described as a hemoglobin level<13g/dl in males and <12g/dl in females. Clinical determinants of IDA in patients with HF were established using univariate and multivariable logistic regression models.
RESULTS: We examined 288HF patients.239 (83.3%) were HF patients with ID and 49 (16.7%) were HF patients without ID. ID prevalence was 83.3% and IDA prevalence was 44% (127/288) among all HF patients in our study. Multivariate regression analysis; pulmonary artery systolic pressure (PASP), right heart failure (RHF) symptoms, eGFR and sedimentation appeared as independently correlate with the HF patients who had IDA (P=0.027; P=0.033; P=0.086; P=0.001 respectively).
DISCUSSION AND CONCLUSION: Remarkably, PASP and RHF symptoms were independent predictor for IDA. These parameters may be an early marker for progression of iron deficiency to iron deficiency anemia in HF patients.

INTRODUCTION: The aim of this study is to investigate the attitudes of emergency physicians towards snakebites.
METHODS: This study includes a questionnaire aiming to examine emergency physicians’ knowledge, skills and experience regarding snakebites as well as demographic characteristics. It also aims to identify the causes of shortcomings in the management of emergency department (ED).
RESULTS: A total of 611 physicians participated in the study. 71.4% of physicians (n = 436) experienced snakebite cases before. Emergency medicine specialists (EMS) had the highest rate 42.0% (n = 183) (p <0.001). 48.9% (n = 299) of the physicians stated that snake antivenoms should be used intravenously (IV), whereas 32.4% (n = 198) declared that snake antivenoms should be used as half wound edge / half intramuscular (HWE / HI). The rate of IV use in snake antivenoms was found to be 58.3% (n = 123) in EMSs, 54.0% (n = 115) in emergency medicine residents (EMR), and 32.6% (n = 61) in general practitioners (GP), while the rate of HWE / HI use in snake antivenoms was 39.6% (n = 74) in GPs, 31.3% (n = 66) in EMSs, and 27.2% (n = 58) in EMRs (p <0.001).
DISCUSSION AND CONCLUSION: We report high rates of misuse of antivenoms, the primary treatment of venomous snake bites, which is thought-provoking. This issue should be examined in detail through both undergraduate and postgraduate trainings.

INTRODUCTION: Diabetic cardiomyopathy is a consequence of free fatty acid oxidation, dysfunction in mitochondria, oxidative stress and diffuse myocardial fibrosis. We aimed to investigate the anti-inflammatory and anti-fibrotic effect of ursodeoxycholic acid in streptozocin-induced diabetic rat model.
METHODS: Male Sprague Dawley albino mature rats were divided into 3 groups: Group 1 (n=10) control group; group 2 (n=10) diabetic rats group; group 3 (n=10): diabetic rats treated with ursodeoxycholic acid group. Diabetes mellitus model was established after injection of intraperitoneal streptozocin. Histopathological and biochemical examinations were done after 4 weeks from heart tissues. Immunoexpression levels of fibronectin and TGF-β were obtained. Malondialdehyde levels were used to determine lipid peroxidation and pentraxin-3 levels were used to determine inflammation. Myocardial damage was also determined with troponin-T and pro-BNP levels.
RESULTS: Cardiac muscle cell thickness (hypertrophy), TGF-β levels, fibronectin immunoexpression malondialdehyde, pentraxin-3, troponin-T and pro-BNP levels were increased significantly in groups 2 and 3 when compared to control group. Administration of ursodeoxycholic acid significantly reduced inflammation and fibrosis in group 3 compared to group 2.
DISCUSSION AND CONCLUSION: In this experimental study, we demonstrated the anti-inflammatory and anti-fibrotic effects of UDCA on diabetic rats and it can be a good drug candidate for DM patients

INTRODUCTION: The aim of this study is to evaluate retrospectively the clinical property, pathology results and operative approach in patients who were operated in our clinic and whom pathology results were reported as dermoid cyst.
METHODS: The data of 105 patients who were diagnosed with dermoid cyst and operated between January 1, 2009 - July 1, 2019 was analysed.
RESULTS: The mean age of the patients was determined as 35,21±12,88. The most common symptom was abdominal pain (40%). 45.71% of the patients were asymptomatic. 16.19% of the patients were in postmenopausal period and in six patients (5.71%) pregnancy was detected. In ultrasonografic evaluation the mean diameter of the dermoid cyst was 6,18±3,22 cm and dermoid cyst was bilateral in seven patients (6,66%). Laparotomy was perfomed in 85 (80,95%) patients. For the remaining 20 (19,05%) patients, laporoscopy was perfomed. Adnexal torsion was diagnosed in five (4,76%) patients. The median value of Ca125 was 14,85 U/ml (min-max: 1,20-100,60 U/ml), and the median value of Ca 19-9 was 10,90 U/ml (min-max: 0,8-1993 U/ml). Malignancy was not detected in any patient with high levels of tumor markers.
DISCUSSION AND CONCLUSION: Dermoid cysts are one of the most common ovarian tumors of the reproductive age. The diagnosis was generally made by ultrasonographic evaluation. There are no spesific tumor markers for dermoid cyst diagnosis. Because dermoid cysts mostly seen in reproductive age women, ovarian preserving surgery must be preferred. Oopherectomy should be considered in elderly patients with no fertility concern.

INTRODUCTION: Current data comparing advantages, disadvantages and early post interventional complications of percutaneous endoscopic gastrostomy (PEG) and open gastrostomy (OG) is limited. The present study aimed to compare the early post interventional results of patients undergoing PEG or OG tube insertion.
METHODS: Retrospective data regarding the demographic features, interventions, and complications of 70 children undergoing gastrostomy tube insertion were obtained from institutions digital database. Patients were divided into two research groups according to the technique used in gastrostomy tube placement: group 1 consisted of 40 patients undergoing OG tube placement under general anesthesia and group 2 consisted of 30 patients undergoing PEG tube placement with sedation.
RESULTS: Overall major complication rate was significantly higher in OG patients than PEG patients (28 % vs. 7 %, p=0.032). Bronchospasm (25% vs. 7%, p=0.035) and intraoperative arrhythmias (17% vs. 3 %, p=0.049) were also more prevalent in patients receiving OG tube placement compared to those receiving PEG tube placement. Length of hospital stay was longer in OG group than that of the PEG group (3.8 ± 1.4 days vs. 1.2 ± 0.5 days, p < 0.001).
DISCUSSION AND CONCLUSION: In children undergoing gastrostomy tube placement, PEG tube insertion compared to OG tube insertion, is associated with decreased frequency of intraoperative complications, postoperative major complications and shorter hospital stay. Our results show that PEG technique with sedation provides better safety profile than OG in children undergoing gastrostomy tube insertion.

INTRODUCTION: Carotid and femoral artery intima media thickness (cIMT and fIMT) and body mass index (BMI) have been studied individually in patients with obstructive sleep apnea syndrome (OSAS). But no studies have examined the effect of the neck and waist circumference (NC and WC) on arterial IMT in their region. The aim of our study; to reveal this relationship and the possible causes.
METHODS: A total of 245 study subjects were included in the study. Patients with a history of smoking, apnea, stroke, angina pectoris, chronic kidney disease, diabetes and those over 65 years of age were excluded from the study. Sonographic IMT measurements were performed with B-mode Ultrasound (Philips EPIQ 7). CIMT measurements were taken from the posteromedial wall of the right common carotid artery. FIMT measurements were also measured from the posterior wall of the right main femoral artery. NC and WC were measured and BMI was calculated in both groups.
RESULTS: The mean cIMT, BMI, NC and WC were significantly higher in the OSAS group, but there was no difference in the fIMT values. In the OSAS group, there was a positive linear correlation between NC and cIMT measurements, whereas there was no correlation between WC and fIMT.
DISCUSSION AND CONCLUSION: Early evaluation of OSAS patients is beneficial because it is an independent risk factor for cardiovascular and cerebrovascular diseases. Timely measurements of cIMT, NC and BMI may provide time for taking necessary measures for these diseases. In addition, even the NC measurement can provide information about cIMT.

Since the ancient times of the physician-patient relationship, withholding information from the patient or keeping the patient in the dark about his health status, diagnosis or treatment in anticipation of benefiting or not harming the patient, exists. However, this practice may cause violations of the patient’s right to be informed, right to privacy and right of self-determination, protected by both the law and the international patient rights documents. Today, even though such approaches are being abandoned, withholding information from the patient regarding his health status is still common in some cultures.

In Turkey, provisions that allow withholding the truth from the patient, in order to avoid harming the patient can be found in the health legislation. In the Medical Deontology Regulation and the Patient Rights Regulation; it is stated that, in cases, where it may harm the patient, the information about his health status can be hidden from the patient.

In this article, these provisions were examined in terms of the patient’s right of self-determination, right to give consent to the medical intervention, right to respect for private life and some suggestions are included regarding the reorganization of these provisions in accordance with medical law and ethics.

Myosin Heavy Chain 9 (MYH9) missense mutations have been characterized by large platelets, leukocyte Döhle bodies, in variable extent sensorineural deafness, cataracts, and glomerulopathy.
A 25-year old female with triad of thrombocytopenia, sensorineural hearing loss and end stage renal disease (ESRD) presented with uremic symptoms with a history of chronic thrombocytopenia with since childhood. She was misdiagnosed with ITP, Bernard -Soulier and Alport syndrome chronologically. First she was treated oral methylprednisolone, then pulses of intravenous immunoglobulin (IVIG) and azathioprine 300 mg/day were tried with no response. The diagnosis was re-evaluated; bone marrow biopsy revealed increased number of megakaryocytes with decreased platelet budding, increased reticulin build-up. The audiogram revealed a profound high-frequency sensorineural hearing deficit bilaterally. Renal biopsy revealed features consistent with chronic glomerulosclerosis. MYH9 gen NM_002473.5 p.R702C (c.2104CT) heterozygous mutation was found. She has been diagnosed with MHY9 Related Disease (MHY9RD) and treated with eltrombopag 75 mg/day. After a successful increase to 17 000mm3 in platelet count, the peritoneal catheter was implanted successfully without complications.
MHY9RD is a rare syndrome that can end with ESRD and severe hearing loss. This rare diagnosis should be kept in mind and treatment modalities like renal biopsy should be done with Eltrombopag.

INTRODUCTION: The treatment of patients diagnosed with acute pancreatitis depends on the severity of the disease. The severity of acute pancreatitis is very important for predicting clinical complications and for identifying potential risk of death.

OBJECTÝVE:
We aimed to investigate the efficacy of APACHE II, Ranson and Balthazar scoring systems on morbidity estimation and their superiority to each other in order to determine the severity of pancreatitis in patients with acute biliary pancreatitis.

METHODS: We prospective investigated 131 consecutive patients with acute biliary pancreatitis between 2009 and 2011. APACHE II, Ranson and Balthazar severity scores were determined.
RESULTS: We observed totally 77 of the patients ( % 58.8 ) with complications, ýn turn, 51 of the patients ( %38.9 )were local and 68 ( % 51.9 ) had systemic complications. We determined patients with severe pancreatitis according of the APACHE II, Ranson and Balthazar scores respectively, 61 (%46.6), 77 (%58.8), göre 58 (%44.3).
DISCUSSION AND CONCLUSION: APACHE II, Ranson and Balthazar scoring systems were found to be effective in predicting morbidity of patients with acute biliary pancreatitis but Balthazar scoring system was found to be more effective in predicting morbidity and local complications, and APACHE II scoring system was more effective in predicting systemic complications than other scoring systems.

Gastrointestinal system (GIS) endoscopy is used for diagnosis and treatment by allowing minimally invasive intervention. Upper and lower GIS bleeding, polyp excision, GIS perforations that can be treated by endoscopic intervention. In this case, a 69-year-old female patient underwent polyp colonoscopic excision of the distal sigmoid colon during colonoscopy one year ago. The pathology result is high grade dysplasia and borderline is clean. The patient presented with symptomatic cholelithiasis and underwent simultaneous colonoscopy with laparoscopic cholecystectomy. Colonoscopy was performed after general anesthesia. The scar tissue at the polypectomy site was ruptured with air flow during colonoscopy. Approximately 2 * 1.5 cm in diameter perforation occurred and small intestine and peritoneum were seen through this hole (Figure 1). Air pressure was reduced and this area was closed to mucosa-mucosa using three endoscopic clips (Figure 2). The process was terminated by aspirating air. Then laparoscopic cholecystectomy was performed. In laparoscopic exploration, in abdomen GIS content and free fluid were not observed. The patient had spontaneous discharge on the 3rd postoperative day and oral food was started on the 4th day. The patient tolerated oral intake and was discharged from hospital on the 6th day without any problem. Preop white blood cell was 7.5 thousond/ul, C-reactive protein (CRP) was 3.5 mg / l and was within normal limits. Postop infection follow-up was performed with CRP. The use of endoscopic clip is currently used in the treatment of iatrogenic perforations.

INTRODUCTION: The primary aim of this retrospective study was to describe the performance of I-gel on postoperative sore throat due to endobronchial ultrasonography guided trans-bronchial needle aspiration (EBUS-TBNA).
METHODS: Forty patients meeting the criteria of American Society of Anaesthesiologists (ASA) status I-II adults were included who are aged 18–70 and scheduled for EBUS-TBNA. In Group E, endotracheal tube and in group I, I-gel were administrated. All patients’ demographic data (gender, age, and body mass index), type of anesthesia used for induction and maintenance, recovery time, the duration of procedure and anesthesia were recorded. The anesthesia records were interviewed for the presence of coughing, desaturation, and bleeding during the operation. The postoperative complications (hoarseness, sore throat, earaches, dysphagia) were interviewed and recorded at 0 (T3), 2th(T4), 4th(T5) and 24th(T6) hr after the operation from patients care form.
RESULTS: Ten patients in the group E, 2 patients in the I-gel group at the T4 period and eight patients in the group E, 2 patients in I-gel were suffered from a sore throat at the T5 period. Three patients in group E and one patient in group I were suffered from hoarseness at the T4 period.
DISCUSSION AND CONCLUSION: In this study, our results showed that the incidence of sore throat and hoarseness could be reduced by using the i-gel. We also found that hemodynamic response due to i-gel application was lower than with endotracheal intubation.

INTRODUCTION: This study aims to determine working conditions, phsical activity status and musculoskeletal system (MSS) complaints in White-collared office workers.
METHODS: This descriptive research was carried out in March 2018 and April 2018 in White-collared officers who are working at an Office in Kocaeli province. Research data was collected via questionnaire and also two standard scales filled by participants. Scandinavian Musculoskeletal Scale and International Physical Activity Questionnaire (IPAQ SF) were used. Mann Whitney and χ2 tests were used for statistical comparisons. Ethical approval and relevant institution approval were taken before data collection.
RESULTS: The age mean was 37.0 (SD: 10.0). Around %51.0 of participants were females and %48.1 of all participants were overweight/obese. More than half of the participants had medium/high level of physical activity. In the past year; %79.0 of participants suffered with MSS and %74.0 had at least one day absence from work due to MSS complaint. Having a MSS complaint was more frequent in females in the past year (p<0.05).
DISCUSSION AND CONCLUSION: Improvement of ergonomics in work environment and introducing simple MSS exercises for workers during work hours can help reducing MSS complaint and work-related absences.

INTRODUCTION: The number and complexity of the interventions are increasing at endoscopy units thus sedation requirements also increases. However complications may occur under sedation. The aim of the present study is to evaluate the correlation among complications, given anesthetic agents, patient related causes during interventions undersedation.
METHODS: A Total of 717 patients undergoing endoscopic interventions under sedation were inclueded the study. Demographic data, ASA Status, mallampati scores, administered anaesthetic agents, co-morbidities, peroperative vital parameters, and developed complications were retrospectively recorded
RESULTS: 10 (1.5%) patients developed hypoxia and 38 (5%) patients developed arrythmias. There was no statistically significant difference accross the groups in complication rates. When the complications of the patients were analyzed by the ASA groups, the incidence of hypoxia in the ASA 3 group was statistically significantly higher. The incidence of other side effects by the ASA groups was similar.
In the model to be created, it was seen that the variables "BMI (p=0.009) and Sedation (p=0.038)" could cause hypoxia complication to arise. In addition "Age (p = 0.000)" could cause heart rhythm problems to arise.

DISCUSSION AND CONCLUSION: Adequate monitoring conditions and an expert anesthesia team are required for safe sedation in gastrointestinal endoscopy unit. Moreover, BMI of patients and the type of sedation are independent risk factors for the development of hypoxia and the age of patient is an independent risk factor for the emergence of arrythmias.

INTRODUCTION: In this study, we aimed to evaluate the early laparoscopic cholecystectomy (LC) results of cholecystocholedocholithiasis (CCL) and acute biliary pancreatitis in patients treated with choledocholithiasis by endoscopic retrograde cholangiopancreatography (ERCP).
METHODS: Between January 2015 and July 2019, the records of 80 patients who underwent LC within the first 48 hours without discharge were evaluated retrospectively from 152 patients who were diagnosed with acute biliary pancreatitis by clinical, laboratory and imaging methods and treated with choledocholithiasis with ERCP. Age, gender, laboratory, upper abdominal ultrasonography (USG), magnetic resonance cholangiopancreatography (MRCP) and ERCP results were evaluated. Duration of surgery, morbidity, mortality and postoperative hospital stay were recorded.
RESULTS: 80 of 152 patients hospitalized for ABP and diagnosed with CCL underwent LC within 48 hours after ERCP. Of 80 patients, 32 (40%) were male and 48 (60%) were female. The mean age of the patients was 53.8. When USG findings were evaluated, 58 patients had millimetric multiple stone in gall bladder and cystic duct. In 16 patients, several stones and sludge in cystic duct. In 6 patients had slugde and crystalloid in gall bladder and cystic duct. The mean score of ranson criteria was 2.1. All patients were confirmed with CCL by MRCP. 73 patients had large common bile duct and intra hepatic bile ducts. Choledochal stones cleared with ERCP. Mean length of hospitalization after LC was 2,5 days.
DISCUSSION AND CONCLUSION: We believe that it is an effective treatment option to prevent recurrent episodes of cholecystitis and pancreatitis and nuchal choledocholithiasis in patients with early LC after ERCP.

INTRODUCTION: This study was planned to investigate the protective role of p-coumaric acid against intestinal ischemia/reperfusion (I/R) injury.
METHODS: For this purpose, an experimental intestinal I/R model was established in our study. In the p-coumaric acid and I/R groups, superior mesenteric artery was clamped for 1 h. Then, the clamp was removed and reperfusion was allowed for 2 h. At the end of 2h, rats were sacrificed and intestinal tissue samples were collected rapidly.
RESULTS: It was determined that MPO activity, MDA levels, TOS and OSI values increased due to severe oxidative damage depending on I/R. In addition, TAC value and SOD activity decreased in the I/R group. Also, TAC value and SOD activity increased while TOS, OSI values, MPO activity and MDA level were reducing in the I/R + p-coumaric acid (50 and 100 mg/kg bw.) groups. Moreover, in the p-coumaric acid 100 mg/kg group, TAC value and SOD activity more increased and OSI, TOS values more decreased compared with p-coumaric acid 50 mg/kg group.
DISCUSSION AND CONCLUSION: It can say that the different doses of the p-coumaric acid demonstrated protective effects against intestinal I/R (1hour: 2hour) injury in experimental animals.