How deep should the double vertical incision used in tubularization for hypospadias be?

AMAÇ: Tübülarizasyon, özellikle hipospadias olmak üzere lümen gerektiren organların cerrahisinde kullanılan tekniklerden biridir. Bu çalışmada çift vertikal insizyon ile oluşturulan tüplerde insizyon derinliğinin yara iyileşmesi ve lümen genişliğine olan etkileri araştırılmıştır. GEREÇveYÖNTEMLER: Yedi adet New Zealand tavşanda her bir tavşan üzerinde 3 adet derin 3 adet yüzeyel çift vertikal insizyon içeren toplam 42 adet tüp oluşturduk. Postoperatif 3., 5. ve 21. günlerde her bir tavşandan bir yüzeyel, bir derin insizyonla yapılan tüp olmak üzere ikiser adet tüp çıkarıldı. Tüpler hematoxylin-eosin ve Masson's trichrome ile boyandı ve inflamasyon, fibrozis ve lümen çapları açısından incelendi. Gruplar arası parametrelerin karşılaştırılması için Mann-Whitney tek yönlü varyans analizi ve Kruskal-Wallis testi kullanıldı. Istatistiksel anlamlılık için P<0.05 değeri kabul edildi. BULGULAR: Yüzeyel ve derin insizyon gruplarının kendi içerisindeki karşılastırmasında postoperatif 21. gün lümen çaplarının postoperatif 3. ve 5. günlerden istatistiksel olarak anlamlı olarak fazla olduğu saptandı (p<0.05). Yüzeyel ve derin insizyonların karşılastırılmasında ise istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Enflamasyon skorları açısından ise tüm gruplar arasında yapılan karsılastırmada istatistiksel olarak anlamlı fark saptanmadı.(p>0.05) SONUÇ: Çalısmamızda derin insizyon ile yüzeyel insizyon arasında histopatolojik incelemede ve lümen çaplarının değerlendirilmesinde anlamlı fark olmaması, aynı lümen genisliğine yüzeyel çift vertikal insizyon ile ulaşılabilmesi çift vertikal yüzeyel insizyon ile tübülarizasyonun uygulanabilir bir teknik olduğunu göstermektedir.OBJECTIVE: Tubularization is one of the techniques used in surgery of luminal organs and especially for hypospadias. In this study, the effects of incision depth on wound healing and luminal dimensions were investigated. MATERIALand METHODS: Seven New Zealand rabbits were used. On the skin of each rabbit, 6 tubes were constructed (3 were with deep incision and 3 were superficial) with a total of 42 for the experiment. On postoperative days 3, 5 and 21, one tube with deep incision and one with superficial incision were removed from the each rabbit. The tubes were stained with hematoxylin-eosine and Masson's trichrome dyes. They were examined for inflammation, fibrosis and luminal diameters. Mann-Whitney U variance analysis and Kruskal- Wallis tests were used for statistical analysis. P<0.05 was accepted for statistical significance. RESULTS: When the superficial incision and deep incision groups were compared within groups, the luminal diameter on day 21st was satistically significantly larger than the 3rd and 5th days in both superficial and deep incision groups (p0.05). No significant difference was observed among groups when compared for inflammation scores (p>0.05). CONCLUSION: Since there is no significant difference for histopathological examination and luminal diameter between groups with deep and superficial vertical incisions, and to be able to achieve similar luminal diameters with double superficial vertical incisions, tubularization with double superficial vertical incisions is suggested to be applicable to hypospadias surgery

Does sepragel (hylan b) have any preventive effect on two-stage orchidopexy in the first stage?

Amaç: Iki asamalı inmemis testis operasyonlarında birinci operasyonda skrotuma indirilemeyen testisin indirilebildigi yerde çevre dokulara yapıstıgı bilinmektedir. Bu çalısmada bir adhezyon bariyeri olan Sepragel'in, ratlarla olusturulan iki asamalı inmemis testis modelinde fibrotik yapısıklıklar ve spermatogenezis üzerine etkisinin arastırılması amaçlandı. Gereç ve Yöntem: Çalısmada rastgele seçilen 6 adet eriskin erkek rat kullanıldı. Her bir ratın sag testisi kasık insizyonundan dısarıya alınıp tekrar inguinal kanal içerisine yerlestirildi ve etrafına 0.5 cc Sepragel uygulandı. Ratların sol testisleri de kasık insizyonu ile dısarıya alınarak tekrar inguinal kanal içerisine yerlestirildikten sonra herhangi bir isleme tabi tutulmadı ve kontrol grubu olarak degerlendirildi. Postoperatif 21. gün testisler çıkartılarak histopatolojik olarak testis etraf dokularında fibrozis, enflamasyon skorlarına ve testis dokusunda da Johnsen skorlarına bakıldı. Istatiksel analizler için Mann-WhitneyUtesti ve ki- kare testleri kullanıldı. Bulgular: Fibrozis, enflamasyon ve Jonhsen skorlarının karsılastırıldıgı Sepragel uygulanan testisler ve çevre dokular ile kontrol grubu testisleri ve çevre dokuları arasında istatistiksel olarak anlamlı fark saptanmadı. Bulgular: Çalısmamızda Sepragel kullanımının ratlarla olusturulan iki asamalı inmemis testis modelinde, ilk operasyondan sonra çevre dokulara olan fibrotik yapısıklıklar ve spermatogenezis üzerine etkisinin olmadıgı saptandı.Objective: In two stage orchidopexy, it is a known fact that the testis which could not be fixed in the scrotum during the first operation adheres to circumferential tissue. The aim of this study was to evaluate the effect of Sepragel, an adhesion barrier agent, on fibrosis and spermatogenesis in two-stage undescending testis in a rat model. Methods: Six adult male rats were operated. Left and right testes of rats were taken out simultaneously via inguinal incision and placed back in the inguinal canal. Afterwards, 0.5 cc Sepragel was applicated in the surrounding tissue of the right testes (Spragel group). Left testes served as controls. All testes were extracted in the postoperative 21st day and they were examined histopathologically and their scores of fibrosis and inflammation and Johnsen scores were assessed. Mann-Whitney U and ki-square tests used for statistical analysis. Results: There was no significant difference between Sepragel and control groups in terms of fibrosis, inflammation and Johnsen scores. Conclusion: The use of Sepragel did not have any effect on the degree of fibrotic adhesions and spermatogenesis in a rat model of two-stage orchidopexy

Rediscovery of penicillin of psychiatry: haloperidol decanoate

BACKGROUND: Haloperidol has been used as an effective antipsychotic for many years and continues to be one of the first options in difficult patients who require parenteral therapy in the acute phase. However, the depot form is less preferred in the treatment of patients with non-adherence among these patients whose clinical stabilization has been achieved by using parenteral haloperidol in the acute phase. Therefore, updating the information about the side effects of the depot form of haloperidol, which is still an effective treatment option, will be useful in reconsidering the position of this medicine among new and different options. METHODS: A total of 54 schizophrenic patients with severe symptoms and poor adherence to treatment who were hospitalized and treated with depot haloperidol following an acute stabilization period were included in this study. First, the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-CV) was used to confirm the diagnosis, the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) to assess the clinical severity and Global Assessment of Functioning (GAF) to assess the functionality. The Simpson-Angus Scale (SAS) was used to assess extrapyramidal side effects. With the exception of Visit 0, plasma haloperidol levels were measured at all visits. Also, measurements of waist circumference and weight, plasma fasting blood glucose, triglyceride, HDL, iron, haemoglobin (Hgb), prolactin (PRL) and HbA1c were also used for evaluation of the metabolic effects. RESULTS: Significant improvements were observed in the BPRS, SANS, SAPS scores in the long-term follow-up with the depot haloperidol treatment. While the dosage decreased over time, the plasma levels remained changed, and symptom improvement was maintained. No signs such as neuroleptic malignant syndrome or acute dystonia were observed and SAS scores were within acceptable limits during the treatment (mu = 1.40 +/- 2.55). There is no statistically significant difference between measurements of the weight even there was a significant difference between three of the waist circumference values (p = 0.987). The first measurement of the waist circumference is statistically significantly higher than both the mid-measurement and the final measurement, interestingly (p = 0.002). When fasting blood glucose, triglyceride, HDL, iron, Hgb, PRL and HbA1c were measured at different times throughout the study, only prolactin levels increased significantly over time with the use of haloperidol (p < 0.001). At the end of a year, 50% of the patients participating in the study still continued to use the haloperidol decanoate. This means also that half of the patients had stopped to use haloperidol decanoate. However, only 18.5% of them (n = 5) discontinued use of this drug because of extrapyramidal side effects. CONCLUSION: Depot haloperidol remains an effective treatment option that improves treatment compliance in challenging schizophrenia patients with severe symptoms. The long-term metabolic and extrapyramidal side effect profile of the patients were generally within the safe limits with the use of haloperidol depot. According to the obtained data, the depot haloperidol continues to be a reliable treatment option in terms of adverse effects in the maintenance treatment of schizophrenia patients with severe symptoms and poor adherence to treatment

Evaluation of quality of life, anxiety and depression of the partners of patients with obstructive sleep apnea syndrome

Tıpta Uzmanlık TeziObstrüktif uyku apne sendromu yaşam kalitesini olumsuz yönde etkileyen ve ruhsal durum bozukluğuna yol açan yaygın bir hastalıktır. Bu hastalarla yaşamının büyük bir bölümünü beraber geçiren eşlerinin de yaşantıları birçok yönüyle etkilenmektedir. Bu çalışmanın ana amacı hastaların eşlerinin yaşam kalitesi, anksiyete ve depresyon durumlarını değerlendirmek ve bunlara etki eden faktörleri belirlemektir. Çalışmamızda Trakya Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Polikliniği'ne başvurarak Polisomnografi yapılan ve obstrüktif uyku apne sendromu tanısı konularak "positive airway pressure" raporu çıkartılan hastaların poliklinik kayıtları incelendi. Bu hastalardan, eşlerinde kronik bir hastalığı olmayan ve çalışmaya katılmayı kabul eden 100 hasta ve eşi çalışmaya alındı. Hastaların demografik özellikleri, hastalığı ile ilgili klinik ve polisomnografi bulguları, "positive airway pressure" cihazı kullanıp kullanmadıkları, cihaz kullananların kullanım özellikleri kaydedildi. Hasta eşlerinin demografik özellikleri kaydedildikten sonra hasta eşlerinin yaşam kalitesi Kısa Form-36 ile, depresyon düzeyi beck depresyon ölçeği ve hastane depresyon ölçeği ile, anksiyete düzeyi ise beck anksiyete ölçeği ve hastane anksiyete ölçeği ile değerlendirildi. Hasta eşlerinin beck depresyon ölçeği ile %33'ünde, hastane depresyon ölçeği ile %26'sında depresyon, beck anksiyete ölçeği ile %45'inde hastane anksiyete ölçeği ile %14'ünde ise anksiyete tespit edildi. Obstrüktif uyku apne sendromu tanısı konularak "positive airway pressure" cihaz raporu çıkartılan hastaların %32'sinin cihaz kullandığı, %68'inin kullanmadığı saptandı."Positive airway pressure" tedavisi alan hastaların eşlerinin yaşam kalitesi alt parametrelerinden; fiziksel fonksiyon, fiziksel rol kısıtlılıkları, genel sağlık ve emosyonel problemlere bağlı rol kısıtlılıkları skorları, tedavi alamayan hastaların eşlerininkine göre anlamlı olarak daha yüksek bulundu (p0.05). Sonuç olarak, yaşam kalitesinin bazı alt parametrelerinin ve depresyon durumunun "positive airway pressure" tedavisi alan hastaların eşlerinde daha iyi olduğunu ancak anksiyete ile ilgili anlamlı bir değişiklik olmadığını saptadık. Rapor çıkarılmasına rağmen hastaların önemli bir kısmının cihazı almamış olmaları da düşündürücüdür. Anahtar kelimeler: Obstrüktif uyku apne sendromu, hasta eşleri, yaşam kalitesi, anksiyete ve depresyon ölçeği, cihaz kullanımı.AbstractObstructive sleep apnea syndrome is a common disease that affects the quality of life and causes physiological disorder. The lives of these patients partners who spend most of their time with them are also affected in many ways. Main aim of this study is to evaluate the quality of life, anxiety and depression of the partners of the patients with Obstructive sleep apnea syndrome and determine the factors that affect them. In our study, the poliyclinic records of the patients who administered to Trakya University Medical Faculty Chest Disease poliyclinic and performed Polysomnography and have positive airway pressure report with Obstructive sleep apnea syndrome diagnosis were analysed. One hundred patients and their partners who have no chronic disease and accepted the including study were involved. The following issues of the patiens were recorded; demographic features, clinical and polisomnography findings, whether they use positive airway pressure device, and how they use it. Having recorded the demographic features of the partners, their quality of life was evaluated with Short Form 36, depression level was evaluated with beck depression scale and hospital depression scale and anxiety level was evaluated with beck anxiety scale and hospital anxiety scale. With beck depression scale 33% of the partners, with hospital depression scale %26 of the partners were diagnosed with depression. With beck anxiety scale 45% of the partners, with hospital anxiety scale 14% of the partners were diagnosed with anxiety. Having been diagnosed with Obstructive sleep apnea syndrome and given the report for a positive airway pressure device, 32% of the patients have used the device and 68% of them did not use it. As the subparameters of quality of life for the partners of the patient who were using the positive airway pressure device, scores of physical function, physical role limits, general health and emotional role limits were significantly higher than the partners of the patients who did not use the positive airway pressure device (p0.05). Consequently it has been found out that depression and some of the subparameters of the quality of life were better for the partners of the patients who use the positive airway pressure device. However, there is no significant change within anxiety. It should not be ignored that although they were given the report for a device, significant majority of the patients did not use the device. Key words: Obstructive sleep apnea syndrome, patient partners, quality of life, anxiety depression scale, device using.

Planlanan havalimanlarının yolcu talep miktarlarının tahmin edilmesi : Zafer ve Or-gi havalimanları örneği

The economic evaluation of a new airport investment requires the use of estimated future air passenger demand.Today it is well known that air passenger demand is basicly dependent on various socioeconomic factors of the country and the region where the planned airport would serve. This study is focused on estimating the future air passenger demand for planned airports in Turkey where the historical air passsenger data is not available.For these purposses, neural networks and multi-linear regression were used to develop forecasting models. As independent variables,twelve socioeconomic parameters are found to be significant and used in models. The available data for the selected indicators are statistically analysed and it is observed that most of the data is highly volatile, heteroscedastic and show no definite patterns. In order to develop more reliable models, various methods like data transformation, outlier elimination and categorization are applied to the data.Only seven of total twelve indicators are used as the most significant in the regression model whereas in neural network approach the best model is achieved when all the twelve indicators are included. Both models can be used to predict air passenger demand for any future year for Or-Gi and Zafer Airports and future air passenger demand for similar airports. Regression and neural models are tested by using various statistical test methods and it is found that neural network model is superior to regression model for the data used in this study.M.S. - Master of Scienc