Management of spontaneous major rectus sheath hematoma in a COVID-19 patient: A case report and literature review

A rectus sheath hematoma, which is mostly encountered due to abdominal traumas or anticoagulant use, can be challenging, and a delayed diagnosis may lead to hypovolemic shock and even death. In this study, we aimed to present the management of a case of rectus sheath hematoma that developed in a patient who was hospitalized and under coronavirus disease 2019 (COVID-19) treatment. A 70-year-old female patient was admitted to the intensive care unit (ICU) due to respiratory failure and developed a sudden onset of tachycardia and hypotension. The patient was then diagnosed with a rectus sheath hematoma and after ensuring hemodynamic stability she was treated with angiographic embolization. Following the treatment, the patient remained hemodynamically stable and a control computed tomography (CT) revealed regression in the hematoma. Rectus sheath hematomas especially accompanied by additional comorbidities or aggressive surgical interventions may result in high mortality rates in the early period. It should also be kept in mind that during the COVID-19 pandemic, which has affected the world in the last two years, rectus sheath hematomas may be the underlying cause of sudden hypotension and abdominal distension, and it should not be forgotten that angiographic embolization performed by experienced interventional radiologists is the mainstay of treatment in cases where hemodynamic stability can't be achieved

Effect of cartilage thickness mismatch in osteochondral grafting from knee to talus on articular contact pressures: A finite element analysis

Objectives: The aim of this study was to investigate the effect of cartilage thickness mismatch on tibiotalar articular contact pressure in osteochondral grafting from femoral condyles to medial talar dome using a finite element analysis (FEA). Materials and methods: Flush-implanted osteochondral grafting was performed on the talar centromedial aspect of the dome using osteochondral plugs with two different cartilage thicknesses. One of the plugs had an equal cartilage thickness with the recipient talar cartilage and the second plug had a thicker cartilage representing a plug harvested from the knee. The ankle joint was loaded during a single-leg stance phase of gait. Tibiotalar contact pressure, frictional stress, equivalent stress (von Mises values), and deformation were analyzed. Results: In both osteochondral grafting simulations, tibiotalar contact pressure, frictional stress, equivalent stress (von Mises values) on both tibial and talar cartilage surfaces were restored to near-normal values. Conclusion: Cartilage thickness mismatch does not significantly change the tibiotalar contact biomechanics, when the graft is inserted flush with the talar cartilage surface

The Experience of Ibrutinib in Chronic Graft-Versus-Host Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Single Center Experience

Introduction:Chronic graft-versus host disease (GVHD) is a serious complication that develops in 35-50% of patients in the late period after allogeneic hematopoetic stem cell transplantation. About half of the patients are resistant to corticosteroids, which is the first-line treatment of chronic GVHD, and therefore new treatment options that can be effective in chronic GVHD are needed. In the present study, we aimed to share our experience with the use of ibrutinib therapy in patients with steroid-resistant chronic GVHD who have previously received multiple lines of systemic therapy.Methods:The characteristics and clinical outcomes of steroid-resistant chronic patients with GVHD receiving ibrutinib were retrospectively reviewed.Results:A total of 10 steroid resi-stant chronic patients with GVHD who received ibrutinib was included. While 50% of the patients had more than one organ involvement, 50% had a single organ involvement. The most commonly affected organs were the skin and liver. The patients received a median of three lines of systemic therapy before ibrutinib. After a median of 210 days of ibrutinib usage, the complete response rate of patients was 40% and the partial response rate was 40%. Corticosteroids were completely discontinued in 30% of patients after ibrutinib were initiated. Before ibrutinib, patients were given a median of 0.3 mg/kg methylprednisolone. The median methylprednisolone dose after ibrutinib was 0.03 mg/kg.Conclusion:Ibrutinib therapy causes a quite high overall response in steroid resistant chronic patients with GVHD and appears to be a good option in these patients

Evaluation of Financial Performance By Grey Relational Analysis Method: A Research on BIST Cement Companies

Bu çalışma 2005 – 2016 yılları arasında Borsa İstanbul’da faaliyet gösteren 16 çimento şirketinin finansal performanslarını incelemektedir. Performans değerlendirmesinde çok kriterli karar verme modellerinden birisi olan Gri İlişkisel Analiz (GİA) yöntemi kullanılmıştır. İşletmelerin geleneksel finansal oranları kullanılarak GİA değerleri elde edilmiş ve her bir yıl için sıralamalar yapılmıştır. Buna ek olarak, Satın Al ve Elde Tut getiri yöntemi aracılığıyla işletmelerin hisse senedi getirileri hesaplanmış ve GİA değerleriyle karşılaştırılmıştır. Çalışma sonuçlarına göre, çimento şirketleri dönemler itibariyle genel olarak kârlı, etkin ve yüksek hisse senedi getirisine sahiptir. Bununla birlikte, çimento şirketlerinin GİA değerleri ile hisse senedi getirileri arasındaki ilişki son derece zayıftır. Gri İlişkisel Analiz yöntemi ve hisse senedi getirileri ile elde edilen sıralamalar birbirinden ciddi anlamda farklılaşmaktadır.This study examines the financial performances of 16 cement companies that operate in Borsa Istanbul between the years of 2005 and 2016. Grey Relational Analysis (GRA) which is one of the multi-criteria decision-making models is used in the performance evaluation. GRA values have been obtained and sorted for each year through using the traditional financial ratios of the firms. In addition, stock returns of the firms have been calculated through the Buy and Hold Return method and compared with the GRA values. According to the results, cement companies are generally profitable, efficient and they have high stock returns over the periods. Nevertheless, the relationship between GIA values and stock returns for the cement companies is extremely weak. The rankings obtained from the Grey Relational Analysis method and the stock returns differ significantly from each othe

The Association Between Corporate Governance and Firm Performance: Malmquist Total Factor Productivity Index Application

Bu çalışmada kurumsal yönetim endeksi kapsamında yer alan, finansal olmayan ve verilerine ulaşılabilen 18 şirketin 2012 – 2016 yılları arasındaki finansal performansı Veri Zarflama Analizi ve Malmquist Toplam Faktör Verimlilik Endeksi ile incelenmiştir. Öncelikle şirketlerin Veri Zarflama Analizi ile elde edilen yıllık etkinlik skorları ile Kurumsal Yönetim Endeksi notları karşılaştırılmıştır. Sonrasında, Malmquist Toplam Faktör Verimlilik Endeksi sonucu elde edilen verimlilik değişim oranları hesaplanmış ve bu endekste yer alan şirketlerin genel performansı ortaya konulmuştur. Çalışmada 3 girdi (Cari Oran, Finansal Kaldıraç Oranı ve Net Satışlar / Toplam Varlıklar) ve 4 çıktı (Aktif Karlılığı, Satışların Karlılığı, Temettü Oranı, Hisse başına Getiri) belirlenmiştir. Veri Zarflama Analizi sonuçlarına göre, 18 firma içerisinde yıllar itibariyle sırasıyla 9, 9, 12, 9 ve 9 adet firmanın etkin olduğu görülmektedir. Buna ek olarak, 5 şirket tüm yıllar için etkindir. Verimlilik değişimi oranları firmalar ve yıllar açısından ciddi farklılıklar sergilemektedir. Kurumsal yönetim notu ile analizler sonucu elde edilen sıralamalar arasında kısmen benzer sonuçlar elde edilmiştir.The financial performance of the 18 companies, which are non?financial and in the corporate governance index and have accessible data are examined with Data Envelopment Analysis and Malmquist Total Factor Productivity Index between the years of 2012 and 2016 in this study. Firstly, annual efficiency scores of firms obtained by Data Envelopment Analysis are compared with Corporate Governance Index scores. Afterwards, the total factor productivity change ratios obtained by Malmquist analysis are calculated and the overall performance of the companies is presented. In the study, 3 inputs (Current Ratio, Financial Leverage Ratio and Net Sales / Total Assets) and 4 outputs (Return on Assets, Sales Profitability, Dividend Yield, Earnings per Share) are determined. According to the Data Envelopment Analysis results, 9, 9, 12, 9 and 9 firms are efficient in 18 companies for the sample period respectively. In addition, 5 firms are efficient for all the years. Productivity change ratios show significant differences in terms of firms and years. There are partially similar results between the rankings obtained from the results of the analyzes and corporate governance scores

Femoral herni ameliyatlarında 19 yıllık deneyimimiz ve bassini-kischner onarımı

Amaç: Femoral herni onarımı yapılan son 19 yıldaki hastaların incelenmesi, Bassini-Kischner yöntemi uygulanan olguların literatür ışığında irdelenmesi. Gereç ve Yöntem: Nisan 1988-Mart 2007 yılları arsında ameliyat edilen femoral hernili olgular çalışmaya alındı. Başvuru şekli; acil-elektif, ortalama yaş, kadın erkek oranı, herninin sağ ve/veya solda oluşu, seçilen cerrahi onarım yöntemi dökümante edildi. Bassini-Kischner onarımı yapılan olguların uzak dönem sonuçları incelendi. Bulgular: Ameliyat edilen olgu sayısı 141 idi. Doksan yedi olgu (%69) elektif koşularda 44(%31) olgu ise acil olarak ameliyat edildi. Onarım olarak 96 olguda McVay, 31 olguda Bassini- Kischner yöntemi kullanılırken 14 olguda mesh ile onarım yapıldı. Bassini-Kischner onarımı yapılan hastaların dosya kayıtlarında ve kontrole gelenlerin muayenesinde nüks görülmedi. Sonuç: Femoral hernia daha çok acil koşullarda ameliyat gerektirir. Bassini- Kischner onarımı uygulaması kolay bir tekniktir, elektif femoral herni onarımlarında tercih edilebilir.Background and Purpose: Patients undergoing surgery for the repair of femoral hernia during the last 19 years were examined and reviewed in the light of previous studies evaluating the results of BassiniKischner repair. Methods: Patients undergoing surgery for femoral hernia between April 1988 and March 2007 were identified. The mode of admission, emergency vs. elective surgery, mean age, female to male ratio, hernia side and the preferred surgical technique were documented and long-term results of Bassini- Kischner repair were reviewed. Main Findings: A total of 141 cases were operated. Ninety-seven patients (69%) underwent elective surgery while 44 (31%) had emergency surgery. The methods used for repair were McVay method in 96 patients, BassiniKischner method in 31 patients, and mesh repair in 14. No cases of recurrence were determined either from patient records or during follow- up visits of patients who underwent Bassini- Kischner repair. Conclusions: Femoral hernias require emergency surgery more frequently and Bassini- Kischner repair is a simple technique and it may be preferred for the elective surgical treatment of femoral hernia