Migration of Ventriculoperitoneal Shunt Catheter into the Inguinal Hernia Sac in a Patient with Hydrocephalus

Literatürde ventriküloperitoneal (VP) şant kataterinin intestinal perforasyon, inguinal herni, peritonit gibi abdominal komplikasyonlara neden olabileceği bildirilmiştir. Hidrosefali nedeniyle VP şant takılmış 2 aylık erkek hastanın klinik takibinde, şant ameliyatından otuz gün sonra sol kasığında şişlik saptandı. Yapılan abdominal ultrasonografi ve direkt grafi tetkiklerinde hastanın sol skrotumu içerisinde VP şant kateterinin distal ucunun izlenmesi üzerine hasta Çocuk Cerrahisi Bölümü tarafından değerlendirildi. Hastaya sol inguinoskrotal herni tanısı koyularak ameliyat edildi. Kateter ucu karın içerisine redükte edilerek yüksek ligasyon ile inguinal herni onarımı yapıldı. Hastanın ameliyat sonrası üç aylık takibi sonunda nüks ve/veya komplikasyon izlenmedi. Sonuç olarak VP şant takılan hastalarda inguinoskrotal komplikasyonlar akılda tutulmalıdır. VP şant ameliyatı sonrası kasık bölgesindeki şişlikler inguinal herni açısından değerlendirilmeli ve erken tanı ve tedavi için aile bilgilendirilmelidir.Ventriculoperitoneal (VP) shunt devices can cause some abdominal complications such as intestinal perforation, inguinal hernia, peritonitis. A two-month-old male who had underwent VP shunt surgery thirty days ago was admitted for swelling in his left inguinal region. Abdominal ultrasonography and X-ray examination revealed that distal part of VP shunt catheter had migrated into the left scrotum and therefore the patient was consulted to the Pediatric Surgery Department. During operation, the shunt catheter was reimplanted into the abdomen and the inguinoscrotal hernia was repaired by using the high ligation technique. No recurrence and/ or complication was occured in the patient during his three-month follow-up. In conclusion, inguinoscrotal complications should be kept in mind for patients who have VP shunts and present with a swelling in the inguinal region. This swelling should be evaluated in terms of inguinal hernia and the family should be informed for early diagnosis and treatment

The first clinical case due to AP92 like strain of Crimean-Congo Hemorrhagic Fever virus and a field survey

<p>Abstract</p> <p>Background</p> <p>Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal infection, but no clinical case due to AP92 strain was reported. We described the first clinical case due to AP92 like CCHFV.</p> <p>Methods</p> <p>A case infected by a AP92 like CCHFV was detected in Balkanian part of Turkey. Diagnosis was confirmed by RT-PCR and sequencing. A human serologic and tick survey studies were performed in the region, where the case detected.</p> <p>Results</p> <p>Thirty eight individuals out of 741 were found to be anti CCHFV IgM positive. The attack rate for overall CCHFV was calculated as 5.2%. In univariate analyses, CCHFV IgM positivity was found to be associated with the age (p < 0.001), male gender (p = 0.001), agricultural activity (p = 0.036), and history of tick bite (p = 0.014). In multivariate analysis, older age (OR: 1.03, CI:1.01–1.05, p < 0.001), male gender were found to be the risk factors (OR: 2.5, CI:1.15–5.63, p = 0.020) for CCHFV infection.</p> <p>Conclusion</p> <p>This is the first human case with AP92 like CCHFV infection. Furthermore, this is the first report of AP92 like strain in Turkey. In the region, elderly males carry the highest risk for CCHFV infection.</p

Imported Crimean-Congo hemorrhagic fever cases in Istanbul

We described a series of imported cases of Crimean-Congo Hemorrhagic Fever (CCHF) in Istanbul and investigated the genetic diversity of the virus. All the suspected cases of CCHF, who were applied to the health centers in Istanbul, were screened for CCHF virus (CCHFv) infection by using semi-nested Polymerase Chain Reaction (PCR) following RT-PCR. Simultaneous blood samples were also sent to the national reference laboratory in Ankara for serologic investigation. In 10 out of 91 patients, CCHFv was detected by PCR, and among 9 out of 10, anti-CCHFv IgM antibodies were also positive. Clinical features were characterized by fever, myalgia, and hemorrhage. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase were elevated, and bleeding markers were prolonged. All the cases were treated with ribavirin. There was no fatal case. All the strains clustered within the same group as other Europe/Turkey isolates

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Dirençli intrakranial hipertansiyonda dekompresif kraniektomi

Amaç: Bu retrospektif klinik çalışmada çeşitli sebeplerle ortaya çıkmış olan intrakranial hipertansiyon tedavisinde dekompresif kraniektominin yeri ve etkileri incelenmiştir. Gereç ve Yöntem: 18 ile 75 yaş arası 9 hasta çalışmaya alınmıştır. Dört hasta travmatik beyin yaralanması, iki hasta subaraknoid kanama ve üç hasta ise malign orta serebral arter tıkanıklığı ile takip ve tedavi edilmiştir. Bulgular: Dokuz hastaya dekompresif kraniektomi tedavisi uygulanmıştır. Bu hastaların ilk başvurularındaki intrakranial basınç (ICP) değerleri ortalaması 22.6 ± 6.7 mmHg; ortalama ameliyat öncesi ICP değeri 40.8 ± 16.3 mmHg ve cerrahi tedavi sonrası ICP ortalama değeri 9.3± 3.6 mmHg olarak ölçülmüştür. İki hastaya bilateral ve kalan yedi hastaya unilateral frontotemporoparietal kraniektomi uygulanmıştır. Kraniektomi kemik flebinin tekrar yerine konması için ortalama 25.75±10.0 gün beklenmiştir. Subaraknoid kanama ile takip edilen bir hasta cerrahi tedavi sonrası ölmüştür (mortalite oranı %11.1). Otuz altı aylık takip sonrası hastaların ortalama Glasgow iyileşme skala puanı yaklaşık 4 olarak hesaplanmıştır. Sonuç: Eğer zamanında ve dikkatli bir şekilde uygulanabilirse bu cerrahi teknik akut ya da gecikmiş dirençli intrakranial hipertansiyon tedavisinde başarılı sonuçlar verir.Aim: This retrospective study was established to analyse the effects of the decompressive craniectomy on patients with different causes of increased intracranial pressure. Material and Method: Nine patients at risk of developing malignant cerebral edema aged between 18 and 75 years were included in this study. Four patients suffered from severe traumatic brain injury, two patients from subarachnoid haemorrhage (SAH) and vasospastic ischemia, and 3 patients from malignant infarction of the middle cerebral artery. Results: Nine patients underwent decompressive craniectomy as the last therapeutic choice. At first admission mean intracranial pressure (ICP) was 22.6 &plusmn; 6.7 mmHg; mean preoperative ICP value was 40.8 &plusmn; 16.3 mmHg; and mean postoperative ICP value was 9.3&plusmn; 3.6 mmHg. In two patients bilateral; and in seven patients unilateral frontotemporoparietal craniectomy was preferred. Mean time of the re-implantation of the bone flap was 25.75&plusmn;10.0 days. One patient with SAH died postoperatively and eight patients survived (mortality rate 11.1%). Mean value of the Glasgow Outcome Scale score as evaluated at 36 months after the decompression was approximately 4. Discussion: This surgical procedure is successful for treatment of the acute or delayed intractable intracerebral hypertension with a low rate of complication if it is performed timely and carefully

Multiple Cervical Foraminal Perineural Cysts. Case Report

Perinöral kistler içi beyin omurilik sıvısıyla dolu olup epinörium ve perinöriumda kistik dilatasyonlar sonucu oluşur. En sık sakral bölgede görülen perinöral kistler nadiren servikal bölgede görülür. Çoğunlukla asemptomatiktir fakat sinir kökü veya spinal kord basısı meydana gelirse semptomatik hale dönüşebilir. Bir yıldır devam eden boyunda ağrı ve kasılma şikayetleri ile başvuran hastanın muayenesinde boyun hareketleriyle mevcut şikayetlerinin artığı fakat herhangi bir nörolojik defisitin olmadığı saptandı. Servikal manyetik rezonans görüntülemede multipl servikal foraminal perinöral kistler gözlendi. Elektromyelografisi normal gelen hastaya medikal tedavi ve istirahat önerildi. Üç ay sonrasında hastanın aktif şikayetlerinin tama yakın azaldığı gözlendi. Sonuç olarak, günümüzde nadir saptanan servikal perinöral kistlerin asemptomatik olmakla beraber spinal kord ve / veya kök basısı nedeniyle semptomatik hale dönebileceği akılda tutulmalı ve hastalar takip edilmelidir.Perineural cysts are filled with intravenous cerebrospinal fluid and cystic dilatations occur in the epineurium and perineum. Perineural cysts are most commonly seen in the sacral region and rarely in the cervical region. They are mostly asymptomatic but may become symptomatic if the nerve root or spinal cord is under pressure. The patient who had complaints of pain and contraction continued for one year. Neck movements, the current complaints increased, but noneurological deficit wa sdetected. Multiple cervical foraminal perineural cysts were observed on cervical magnetic resonance imaging. Medical treatment and rest were given electromyelography. Three months later, the patient's active complaints were observed to diminish. As a result, rarely detected cervical perineural cysts are usually asymptomatic. However, it should be kept in mind that patients with spinal cord and / or root pressure may become symptomatic and patients should be followed up

An Evaluation of the Quality of Sleep Before and After Surgical Treatment of Patients with Cervical Disc Herniation

WOS: 000443242400008PubMed: 30196657Objective : It has been reported in recent studies that 50-80% of patients with cervical disc hernia have concomitant sleep disorders. The aim of this study was to evaluate the quality of sleep before and after surgical treatment in patients with cervical disc hernia and to assess the effects on treatment. Methods : The study included 32 patients performed discectomy and fusion with an intervertebral cage through the right anterior cervical approach. Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) were applied to all patients preoperatively and at one month postoperatively. Results : The postoperative PSQI total points and all the PSQI subscale points, the ODI and VAS scores were significantly reduced compared to the preoperative values. A positive correlation was determined between the preoperative ODI points and the PSQI total points and sleep duration, sleep latency and daytime functional loss subscale points. A positive correlation was also found between preoperative ODI points and VAS points. A positive correlation was determined between the preoperative VAS points and and the PSQI total points and sleep duration, and sleep latency subscale points. A negative correlation was determined between the postoperative ODI and the daytime functional loss subscale points. Conclusion : The results of the study showed that in patients with cervical disc hernia, sleep quality and daytime functionality were negatively affected by severity of pain that limited daily activities. Bringing the pain under control with surgical treatment was observed to increase sleep quality. It can be concluded that when planning treatment for these patients, it should be taken into consideration that there could be a sleep disorder in addition to the complaints and symptoms such as pain, hypoestesia and loss of strength

Şayli Ailesi tarihi

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2018.This work is a student project of the Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.The History of Turkey course (HIST200) is a requirement for all Bilkent undergraduates. It is designed to encourage students to work in groups on projects concerning any topic of their choice that relates to the history of Turkey. It is designed as an interactive course with an emphasis on research and the objective of investigating events, chronologically short historical periods, as well as historic representations. Students from all departments prepare and present final projects for examination by a committee, with 10 projects chosen to receive awards.Includes bibliographical references (page 26).by Yasemin Başaran Doğan

Design of Hexapod Walking Robot with Double Scara Legs

Many walking prototypes have one or more degree of freedom leg mechanisms to obtain walking trajectory. Kinematic synthesis of one degree of freedom mechanisms is required to calculate correct links lengths according to desired trajectory. In this study, we designed, controlled, and tested a six-legged walking robot with double scara legs. Two actuators of double scara robot allows us to arrange any trajectory within workspace of our leg design. Three legs of them are working simultaneously to obtain smooth walking on terrain. Each servo motor attached to leg is working independently. Therefore, we can arrange several movements besides walking. Many parts of our walking robot which are necessary for assembly were designed in SolidWorks. These parts were printed by using a Ultimaker 3D printer with PLA material. Servo actuators of robot was controlled by using PWM pins of Arduino Mega microcontroller. We tested our robot using three different leg trajectories such as square, triangle and smooth trajectories. According to our test, we observed that smooth trajectory is the most energy efficient