Laparoscopic treatment of morgagni hernia: Two case reports

Morgagni hernias account for only 2–3% of all diaphragmatic hernias, and most of them (91%) are rightsided. Most Morgagni hernias are diagnosed in childhood, but rarely diagnosis may be late because they can be asymptomatic or present nonspecific-nonrespiratory symptoms. Thus, Morgagni hernia diagnosis is incidental in the majority of adulthood cases. The defect arises from a fusion failure of the diaphragm with the central arches. Surgery is the main treatment modality of the Morgagni hernia due to defect enlargement and strangulation- incarceration risks. In this paper, we present two Morgagni hernia cases treated with laparoscopic surgery. Minimal invasive techniques can be used in Morgagni hernia with all advantages

Five-Years Tigecycline Experience an Analysis of Real-Life Data

Aim: Tigecycline has been approved by the Food and Drug Administration for the treatment of complicated intra-abdominal infections, skin and soft tissue infections and community-acquired pneumonia. In our study, we examined the efficacy of tigecycline in clinical practice and reported real life data from our hospital over a period of five years. Methods: The study was conducted between 2008 and 2013 on patients who received tigecycline for longer than 48 hours in Ankara Training and Research Hospital. Clinical success was defined as clinical recovery and microbiological cure in patients who used tigecycline. Any reason for discontinuation of tigecycline treatment was considered a clinical failure. Results: In our hospital, 320 patients were administered tigecycline between 2008 and 2013. Tigecycline was mainly used for pneumonia and skin and soft tissue infections. Tigecycline was used as monotherapy in 174 patients (54.1%). The most frequently isolated agent in tigecycline-treated patients was Acinetobacter baumannii (43.4%) followed by Enterococcus (6.9%). A change in treatment was not considered necessary in 243 (75.9%) patients who received tigecycline, while it was changed in 77 patients (24.1%). Conclusion: In conclusion, the use of tigecycline can be an effective treatment choice, either as monotherapy or as a combination antibiotic therapy

Monocyte-to-HDL-cholesterol ratio is associated with Ascending Aorta Dilatation in Patients with Bicuspid Aortic Valve

Background: The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a common complication in the patients with bicuspid aortic valve. In this study, we aimed to investigate the relationship between MHR and the presence of aortic dilatation in the patients with bicuspid aortic valve. Methods: The study population included totally 347 patients with bicuspid aortic valve.169 patients with aortic dilatation (ascending aorta diameter 65 4.0 cm) and 178 patients with no aortic dilatation. Echocardiographic and laboratory measurement was done and compared between groups. Results: The mean age of the participants was 44.7 \ub1 15.4 years and average ascending aorta diameter was 3.2 \ub1 0.3 cm in dilatation negative group and 4.4 \ub1 0.4 cm in positive group. MHR was significantly increased in in patients with aortic dilatation. MHR and uric acid level was independently associated with the presence of aortic dilatation in the patients with bicuspid aortic valve. Conclusion: We found a significant relationship between MHR and aortic dilatation in the patients with bicuspid aortic valve

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

A Research On Transportation Demand Management Strategies And An Evaluation For Ankara

Tez (Yüksek Lisans) -- İstanbul Teknik Üniversitesi, Fen Bilimleri Enstitüsü, 2015Thesis (M.Sc.) -- İstanbul Technical University, Instıtute of Science and Technology, 2015Ekonomide önemli bir yeri olan talep yönetimi kavramı, getirdiği yaklaşım ve sağladığı sonuçlarıyla hayatın bir çok alanında kullanılmaya başlanmıştır. Pazarlamada hizmetler için özellikle önem taşıyan talep yönetimi fonksiyonunda denge, talebi yönetmekle işletme kapasitesini ayarlamak arasındaki uyumdur. Benzer şekilde, ulaştırma hizmetlerinde de talep yönetiminin planlanması ve uygulanması olumlu sonuçlar doğurmuştur. Gerçekçi bir bakışla, ulaştırmada ve tüm diğer sektörlerde, bireyin, kendi isteklerinin karşılanmasını birinci öncelik olarak gördüğü düşünüldüğünde, tüm bireylerin, dolayısıyla toplumun isteklerini imkanların el verdiğince karşılamaya çalışan bir planlama sistemi, muhtemelen çok uzun soluklu başarı elde edemeyecektir. Ulaştırmada talep yönetimi, bu noktada kendi sahasındaki bu problemi çözmek için gayet mantıklı öneriler sunar. Bu çalışmada, ulaşım talebini karşılamak için ulaşım arzının arttırılmasının, problemi çözme adına doğurgan sonuçlar vermeyeceği anlatılmaya çalışılmış; bunun yerine talebi olumlu sonuçlar elde edilecek şekilde yönetmenin önemi vurgulanmıştır. Tezin birinci bölümünde konuyla ilgili bilgiler aktarılmış ve tezin amacına değinilmiştir. İkinci bölümde ulaştırmada talep yönetiminin ne olduğu tanımlanmış, çözüm sunmaya çalıştığı problemler sıralanmış ve yurtdışında uygulanmış ve olumlu sonuç elde edilmiş UTY uygulamalarına değinilmiştir. Bu bölümde ayrıca, UTY’nin gelişim süreci anlatılmış ve başlıklar halinde UTY’nin faydaları özetlenmiştir. Finansal olup olmamaları, uygulama biçimleri ve daha bir çok kritere göre sınıflandırılabilecek olan UTY stratejileri, üçüncü bölümde, tezin de içeriğine uygun olarak amaçlarına göre bir sınıflandırmaya tabi tutulmuştur. 4 ana başlıkta toplanan stratejilerin tanımları, uygulamaları ve sonuçları kısa kısa anlatılmıştır. Bu bölümde, bilinen tüm UTY stratejilerinden söz etmenin yersiz olacağı düşünülmüş ve çalışmaya konu olan Ankara kenti için daha uygulanabilir olduğu değerlendirilen 21 strateji ele alınmıştır. Bu bölüm, UTY stratejilerinin maliyetlerine göre etkinliğini de konu edinmiştir. Bölümün sonunda, tarihsel süreç göz önünde bulundurularak ülkemizdeki UTY stratejileri ve uygulamalarından kısaca bahsedilmiştir. Tezin dördüncü bölümünde, UTY stratejilerinin Ankara için kabul edilebilirlik seviyesinin tespiti adına kentte yapılan bir anket çalışmasına yer verilmiştir. Demografik yapı göz önünde bulundurularak yapılan çalışmada, katılımcılara birebir mülakat şeklinde, anket formu ve internet üzerinden 18 adet soru yöneltilmiştir. Ankara’yı tanıtıcı genel bilgilerle başlayan bu bölümde, anket sonuçlarına göre hangi stratejinin neden uygulanabilir veya uygulanamaz olduğu yorumlanmıştır. xvi Tezin son bölümünde yapılan anket çalışması da göz önünde bulundurularak UTY stratejilerinin uygulanmasıyla ilgili elde edilen sonuçlar sunulmuştur. Bu sonuçlara göre, kentte ulaştırma adına yapılması planlanan çalışmalara ışık tutabileceği düşünülen öneriler sıralanmıştır. Sadece Ankara için değil, tüm kent içi ulaştırma planlarında UTY stratejilerinin bulunması gerektiği, ayrıca bu stratejilerin tek tek uygulanmasındansa, birbirini tamamlayacak ve beraber çalışacak şekilde bir çok stratejinin aynı anda uygulanması, tezden çıkarılabilecek en önemli sonuçlardandır. Bu çalışmadan elde edilen sonuçları sadece Ankara’ya bağlı bırakmak, çok yerinde bir değerlendirme olmayabilir. Günümüzde, İstanbul gibi trafik sorununun kentin en önemli problemleri arasında yer aldığı kentlerimizin yanı sıra; gelişmekte olan ve gelecekte ulaşım problemleri yaşaması muhtemel olan tüm kentlerin, çalışmada bahsedilen teşvik edici stratejileri, arazi kullanımı yönetimini geliştiren stratejileri ve farklı politikalar öne süren UTY stratejilerini içeren kapsamlı planlamalar yapmaları ve başarılı uygulamalar gerçekleştirmeleri, mevcut ulaşım problemlerinin çözümü adına kritik bir adımı oluşturmaktadır.With the approaches it brings and the results it provides, demand management concept, which has an important place in the economy, has been used in many areas of life. The balance in the demand management function, particularly important in marketing services, is the harmony between to adjust the operational capacity and to manage the demand. Similarly, for the transportation services, the demand management planning and implementation has yielded positive results. From a realist perspective, for transportation and all other sectors, as the individual's own desire is considered to meet the first priority, a planning system which tries to satisfy as possible as it can for all individuals’, and therefore society's aspirations will probably unable to meet a long-term success. At this point, transportation demand management makes perfect sense to solve this problem, offers suggestions in its respective fields. In this study, it has been explained that increasing the supply of transport to meet the transport demand, will not solve the problem on behalf fertile results; instead, the importance of managing the demand with achieving positive results has been emphasized. In the first part of the thesis, relevant information about the subject and the object of the thesis has been given. In the second part, the transportation demand management (TDM) was described, the problems it deals with have been listed and some abroad applications of TDM which obtained positive results have also been given. This section also describes the process of the development of TDM and the benefits of TDM are summarized in an outline. With possible criterion of classification such as application formats, financial identification an so on, TDM strategies, in the third section, was subjected to a classification according to their purposes, propitiously to the content of the thesis. The strategies have been classified in 4 main headings. The definitions, implementations and results have been described briefly. In this section, it was considered inappropriate to describe all the known TDM strategies. Instead, 21 strategies were discussed which are considered more feasible for the subject of study, which is the city of Ankara. This section also subjects the effectiveness of TDM strategies regarding their cost benefits. At the end of the chapter, taking into consideration the historical process in our country TDM strategies and applications are summarized. In the fourth chapter of the thesis, to determine the level of acceptability of the TDM strategies for Ankara, a survey polled in the city has been given. In the survey, which demographic structure was a criterion on selecting the attendee, 18 questions had been asked to the attendees over the internet, questionnaire and with personal xviii interview. In this chapter, starting with general information about identifying Ankara, the cause of which strategies have been interpreted to be applicable or not, according to the survey results. In the last part of the thesis, taking the survey into consideration, the results about implementation of the TDM strategies have been elucidated. According to these results, the recommendations considered to shed light to the planned work on behalf of transportation in the city have been listed. It is one of the most important results that can inferred from the thesis that, not just for Ankara, but for all cities, TDM strategies must have a role on urban transportation plans; besides a multi-strategy implementation must be performed to complement each other and work together simultaneously rather than individual application of these strategies. Significant incentives are needed but do not have enough effect for TDM. Encouragements should also have public acceptance. There are number of strategies that may have an instantaneous influence on traffic jamming (unusual driving days, prevention of private vehicles in urban areas, congestion pricing), but so far they have met with solid community resistance. Such strategies enforce controls and decrease the assortment of choices. Public recognition is more likely when encouragements compromise commuters a wide assortment of choices and elasticity. A wide-ranging valuation of the possible TDM must also study the unintended properties of TDM policies, both at home and in the work place. The effect of work schedule changes on nonwork activities. Such impacts are unevenly distributed; workers with the most constrained schedules and resources are likely to be most affected. Policies that increase the costs of driving alone, for example, are most likely to affect lower income workers. These workers will switch to carpooling or transit, trading off their time for money. Such policies are easily justified, because drive-alone commuters currently do not pay the full cost of their trip. But shifts to other modes and their attendant effects on household activity schedules will fall more heavily on lower income workers. Thus, policies that provide commuters with more choices are much preferred. The availability of choices can potentially offset at least some of the costs of responding to TDM incentives. The revisions show that travelling performance may vary when suitable conditions occur, and that TDM strategies can endorse these changes. Interactive modification needs meaningful and viable incentives that significantly alter the relative cost and convenience of driving alone. Different approaches in commuting behavior result in a complicated array of indirect effects both on workers and on the workplace. The potential of TDM criterion, even large-scale projects, to reduce traffic congestion is even more uncertain. These case studies suggest that future policies regarding TDM should proceed with caution, after full consideration of both the benefits and costs. Even though most individual TDM strategies only affect a small portion of total travel, and so their benefits appear modest with respect any particular problem, their impacts are swelling. When all profits and expenses are considered, TDM programs are regularly the most cost effective approach to increase transportation. Straight estimation practices tend to misjudge the overall assistances of technical keys since they disregard indirect costs (such as the problems resulting from induced vehicle travel), and they tend to underrate the full assistances of TDM strategies (such as helping to increase flexibility for non-drivers, or maintenance for intentional terrestrial use purposes). More wide-ranging estimation and arrangement performs are needed for TDM to obtain the acknowledgement and sustenance that is acceptable. Significant incentives are needed but not adequate for effective transportation demand management. Incentives have to ensure community’s approval. There are lots of policies that may have an direct influence on traffic jamming, however so far they have struggled with solid community resistance. Such policies inflict controls and decrease the scope of varieties. Community’s approval is more possible when incentives compromise commuters an extensive scope of varieties and elasticity. The concern of TDM strategies is marked not only by the totals of travel that folks essentially did, but also by individual charges, wishes, and sympathies with related to travel. Mostly, practical and individual flexibilities are surely connected with the contemplation of these approaches. Though, the effects of comparative preferred flexibility and travel weakness are slightly more complicated. Contrary to practical flexibility, individual preferred flexibility is more likely to adversely mark the contemplation of these approaches as a whole, however there are some possible progressive properties on contemplation. The effects of travel choices seem to be varied while it dependably marks the contemplation of cheaper approaches. However, the influence of practical flexibility, individual flexibility, comparative preferred flexibility are generally entangled in persons’ alteration procedures, which subsidizes to the considerable variety of the reactions. In addition, since it is practical flexibility that is frequently the base of community strategy, these relations additionalyl indicate that persons could not react to community strategies planned to regulate their performances in the manner that rule producers anticipated. Considering the results of the thesis just for Ankara city would not be a fair approach. Today, in addition to the cities like Istanbul, where the traffic problems is among the major problems of the city, all the developing cities that are likely to experience these transportation problems, must prepare comprehensive plans including incentive, land usage and policy reforms TDM strategies mentioned in the study; and perform successful implementations on behalf of taking a vital step to provide a solution to current transportation problems.Yüksek LisansM.Sc

ALTERNATİF PARA POLİTİKASI STRATEJİSİ OLARAK NOMİNAL GSYİH HEDEFLEMESİ: KARŞILAŞTIRMALI BİR ANALİZ

2008 kriz sonrası ortaya çıkan ekonomik konjonktür, enflasyon hedeflemesi rejiminin başarısının sorgulanmasına ve alternatif para politikalarının tartışılmasına neden olmuştur. Bu tartışmalar içinde yer alan Jeffery A. Frankel’in de içinde olduğu birçok iktisatçının önerisi, Nominal GSYİH hedeflemesidir. Finansal istikrarsızlık, yüksek işsizlik, durgunluk vb. sorunların çözümünde enflasyon hedeflemesi politikası etkisiz kalmış ve enflasyonun yanında başka ekonomik hedeflerinde kontrol edilebildiği para politikası rejimlerine ihtiyaç artmıştır. Bu nedenden dolayı bu çalışmada, enflasyon hedeflemesi rejimine kadar para politikasının tarihsel gelişimi incelenecektir. Son olarak, enflasyon hedeflemesi rejiminin avantajları ve dezavantajları tartışılacak, Nominal GSYİH hedeflemesiyle karşılaştırmalı analizi yapılacaktır

Comparison of Tension Band Wiring Method Applied with K-wire or Cannulated Screw in Mayo 2A Olecranon Fracture Fixation: A Biomechanical Study

Aim: The study aimed to compare the biomechanical stability and strength of the tension band wiring method used to treat mayo 2A olecranon fractures with Kirschner (K)-wire or cannulated screw configurations. Material and Methods: A total of 24 anatomical ulna models (Sawbones Model 1004, Pacific Research Laboratories, Vashon Island, WA) used in the study were divided into two equal groups of 12, tension band fixation with K-wire (Group 1) and tension band fixation with cannulated screw (Group 2), and groups were compared. The mechanical comparison was performed with a universal measuring machine (Shimadzu Autograph 50 kN; Shimadzu Corp). Results: Fixation methods comparison (K-wire/cannulated screw) were the main factors that determined the stability and the strength of the internal fixation. The median flexion strength of Group 1 was 107.92 (range, 94.22-121.72) N, and that of Group 2 was 109.67 (range, 105.07-113.86) N. The median varus strength of Group 1 was 100.02 (range, 83.24-102.18) N, and that of Group 2 was 76.32 (range, 68.44-78.43) N. Varus strength and stiffness were significantly higher in the K-wire group than in the cannulated screw group (both p values were <0.001). No significant differences were detected between the groups regarding flexion strength and stiffness (both p values were 0.999). Conclusion: Although no significant differences were detected between the two fixations in flexion bending cyclic loading, a significantly more stable fixation was achieved in tension banding applied with K-wire in varus bending cyclic loading. No reduction loss was detected during cyclic loading tests in either technique

Turkish literature

This book offers an in-depth overview of Turkish history and politics essential for understanding contemporary Turkey. Based on interviews with leading intellectuals and academics from Turkey, the book's theme follows the dramatic transformations that have occurred from the 1980 military coup to the coup attempt of 2016 and its aftermath

Foreign body: A sewing needle migrating from the gastrointestinal tract to pancreas

Of all ingested foreign bodies, 2.4% comprise of sewing needles. Through perforation of gastrointestinal tract, which occurs in 1% of cases, they can migrate into the liver and pancreas. Foreign bodies in pancreas should be considered in the differential diagnosis of chronic abdominal pain. Computed tomography scans provide valuable information for the localization of the lesion, which guide the surgeon during the operation. Secondary to foreign bodies that migrate to the pancreas, complications with high mortality such as pancreatitis, pseudoaneurysm, and pancreas abscess can be seen. Thus, for this patient group, diagnostic laparoscopy is recommended, considering its advantages of decreased postoperative pain, decreased wound infection, and faster recovery time. Here we present a case of a 23-year-old female patient, from whom an ingested needle that migrated from the back wall of the stomach to the pancreas was extracted by laparoscopic surgery