Vascular resection and reconstruction in pancreatic tumors

Objective: We aimed to to present our patients who underwent pancreaticoduodectomy with vascular resection and reconstruction for borderline pancreatic tumor. Materials and methods: The retrospective study included six patients undergoing pancreaticoduodenectomy with portal vein resection due to locally advanced disease over a 2- year period. Demographic characteristics, symptoms, imaging findings, exploration findings of surgery, types of resections, perioperative complications, postoperative hospital stay were recorded. Results: The patients were cosisted of 2 females and 4 males. Tumor location was in the head of the pancreas in 4 (66.7%) patients and in the body in 2 (33.3%) patients. Vasculary reconstruction was achieved by end-to-end anastomosis in 2 (33.3%) and primary closure in 4 (66.7%) cases. The hospital stay of the patients was 11 to 35 days. Intraoperative and postoperative blood product transfusion was not required in 3 of the cases. One patient was reoperated on the second postoperative day due to bleeding in the gastroduodenal anostomosis line and the bleeding was controlled. None of the patients developed pancreatic fistula. Conclusions: In cases of pancreatic cancer with vascular invasion, vascular resection- reconstruction is inevitable to provide a negative surgical margin. Vascular resection and reconstruction can be performed safely similar to standard pancreatic surgery

Prevalence of Helicobacter pylori in Children and Their Family Members in a District in Turkey

The aim of this study was to determine the prevalence of Helicobacter pylori among children and their family members and to evaluate some epidemiologic characteristics. The study included 275 children, aged 1-15 year(s), suffering from different gastrointestinal complaints. Blood serology and stool antigen testing were used for the diagnosis of infection due to H. pylori. Sixty-five (23.6%) of the 275 children were positive for H. pylori, and this positivity had a significantly increasing correlation with age (p<0.001). H. pylori-associated infection was observed among 45 (69.2%) and 17 (8%) mothers in the H. pylori-infected and non-infected groups respectively (p<0.0001). Most children and their families infected with H. pylori were living in an urban area. The findings suggest that infection due to H. pylori is a problem for this district area, and all children having any gastrointestinal complaints should be examined whether H. pylori was prevalent among their family members

Evaluating Views of Teacher Trainees on Teacher Training Process in Turkey

The views of the teacher trainees who have recently started the teaching profession on teacher training process are of great value because they are new graduates and they are in their first year in the profession. Since the teachers in their first year in the profession do not have any experience, they have to pursue the educational tasks based on the knowledge and skills they acquired in their faculties. The main purpose of the study is to evaluate the views of the teacher trainees on the process of teacher training in Turkey.Being qualitative in nature, the current research was a descriptive study. The study group involved 58 newly-appointed teacher trainees from different branches who began their teaching profession in Kastamonu in 2010. An “Interview Form” was used for data collection. The data collected from the participants were analysed through Nvivo 9 software package. As a result of the study, the teacher trainees indicated that they felt insufficient especially related to curriculum and content knowledge and that teaching practice and school experience courses do not adequately contribute to their profession

Assessment of the Effects of Access Count in Percutaneous Nephrolithotomy on Renal Functions by Technetium-99m-Dimercaptosuccinic Acid Scintigraphy

Objective. To determine the effects of percutaneous nephrolithotomy on renal functions by using DMSA scintigraphy while considering access counts. Material and Methods. A total of 37 patients who had undergone percutaneous nephrolithotomy were included. Preoperative DMSA scans were performed a day before the surgery, whereas postoperative scans were randomized by evaluating them before (n = 25) and after (n = 12) the 6th postoperative month. Twenty-six of 37 cases underwent percutaneous nephrolithotomy with a single access site and 11 with multiple access sites. Results. There were no significant changes of total renal functions in the whole study group (P = 0.054). In the single access group, total functions were significantly elevated (P = 0.03) In the multiple access group, while treated site functions were significantly decreased (P = 0.01), total functions did not change significantly (P = 0.42). There was an insignificant decrease in those evaluated before the 6th postoperative month (P = 0.27) and an insignificant increase in the others (P = 0.11). Conclusion. We could not find a superiority of single access over multiple accesses. There is a temporary functional loss in the treated site

Perineal and Abdominal Approaches in the Surgical Treatment of Rectal Prolapse: Our 10-year Clinical Experience

Objective:Rectal prolapse is a rare condition characterized by protrusion of the rectum with all its layers from the anus. It is a disease that causes social and functional problems. In this study, it was aimed to investigate the abdominal and perineal approaches together with postoperative early and late results in our patients who underwent surgical treatment for rectal prolapse.Method:The records of 39 patients who were operated on with the diagnosis of rectal prolapse between 2010 and 2020 in the Department of General Surgery, Dicle University Faculty of Medicine were evaluated retrospectively. Demographic and physical examination findings of the patients, surgical methods applied, early and late postoperative complications, recurrence and mortality rates were recorded.Results:The most common complaints on admission to the hospital were gas control disorder, difficulty in defecating and getting wet with mucus. On physical examination, stage 1 rectal prolapse was found in 12.8% of the patients, and full-thickness prolapse was found in the other patients. The mean age of 39 patients included in the study was 36 (14-88) years. Of the patients included in the study, 14 (35.9%) were female and 25 (64.1%) were male. Surgery was performed with an abdominal and perineal approach in 53.8% of the patients, while laparoscopy was performed in 46.2%. The most frequently used abdominal surgical technique was Notaras (35.8%). The most common perineal approach technique was Altemeier (5.1%). Patients who underwent the perineal approach were older and had a shorter hospital stay, and it was often performed under regional anesthesia. Complications developed in the early postoperative period in 10.4% of the patients. The median hospital stay was 5 days (2-19) and the follow-up period was 13 months (9-19). Postoperative mortality did not occur in any of the patients. Hospital stay was significantly shorter in patients who underwent laparoscopic surgery. There was no statistical difference in terms of early postoperative complications and recurrence.Conclusion:Although more than a hundred surgical procedures have been described to date for the treatment of rectal prolapse, the ideal treatment method is still unclear. In terms of surgical treatment, the results of abdominal or perineal approaches to be applied are similar, considering the risk factors, patient findings and surgeon’s experience

Fractures of the bilateral distal radius and scaphoid: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Coexistence of hyperthyroidism and thyroid cancer

Objective: Thyroid cancer can be associated with thyrotoxicosis caused by Graves' disease, toxic multinodular goiter, or toxic nodular goiter. The aim of this study was considered to be endemic in our region have received the diagnosis of hyperthyroidism, thyroid cancer is detected thyroidectomy performed and patients were retrospectively evaluate. Methods: We retrospectively studied 69 patients assessed for hyperthyroidism between 2006 and 2012. Clinical hyperthyroidism was diagnosed by elevated tri-iodothyronine/thyroxine (T3/T4) ratios and low thyroid-stimulating hormone (TSH) levels, with clinical signs and symptoms. The criteria for surgery were cytological evidence of malignancy, a goiter causing symptoms of tracheal or esophageal compression, side effects of antithyroid drug therapy, or Graves’ disease with multiple relapses after therapy withdrawal or responsiveness to antithyroid drugs. Results: Totally 69 patients were included. In 20 (28.9%) patients there was toxic multinodular goiter, in 28 (40.6%) Graves’s disease, and in 21 (30.5%) patients there was toxic nodular goiter. Of these patients, 12 (17.4%) had thyroid cancer. Conclusions: As a result; low likelihood of malignancy in patients with hyperthyroidism, though suspicious lesions detected in the lymph nodes and neck adenopathies be examined in detail

The utility of acoustic radiation force impulse imaging in diagnosing acute appendicitis and staging its severity

PURPOSEThe aim of this study was to investigate the feasibility of using acoustic radiation force impulse (ARFI) imaging to diagnose acute appendicitis.METHODSAbdominal ultrasonography (US) and ARFI imaging were performed in 53 patients that presented with right lower quadrant pain, and the results were compared with those obtained in 52 healthy subjects. Qualitative evaluation of the patients was conducted by Virtual Touch™ tissue imaging (VTI), while quantitative evaluation was performed by Virtual Touch™ tissue quantification (VTQ) measuring the shear wave velocity (SWV). The severity of appendix inflammation was observed and rated using ARFI imaging in patients diagnosed with acute appendicitis. Alvarado scores were determined for all patients presenting with right lower quadrant pain. All patients diagnosed with appendicitis received appendectomies. The sensitivity and specificity of ARFI imaging relative to US was determined upon confirming the diagnosis of acute appendicitis via histopathological analysis.RESULTSThe Alvarado score had a sensitivity and specificity of 70.8% and 20%, respectively, in detecting acute appendicitis. Abdominal US had 83.3% sensitivity and 80% specificity, while ARFI imaging had 100% sensitivity and 98% specificity, in diagnosing acute appendicitis. The median SWV value was 1.11 m/s (range, 0.6–1.56 m/s) for healthy appendix and 3.07 m/s (range, 1.37–4.78 m/s) for acute appendicitis.CONCLUSIONARFI imaging may be useful in guiding the clinical management of acute appendicitis, by helping its diagnosis and determining the severity of appendix inflammation

Kocaeli’de evlerde, ofislerde ve okullarda iç ortam hava kalitesinin belirlenmesi

TÜBİTAK ÇAYDAG01.01.2008Bu çalışmada, Kocaeli’de farklı bölgelerde ve farklı mikroçevrelerde (ev, okul, ofis), iç ve dış ortamda yapılan örneklemeler ile aktif ve pasif örnekleme ve ölçüm teknikleri kullanılarak 2 farklı partikül fraksiyonunda (PM2.5 ve PM10) 16 ağır metal (Al, As, Ca, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb, S, Si, Ti, V ve Zn), uçucu organik bileşikler (UOB’ler), SO2, NO2 ve O3 konsantrasyonları belirlenmiştir. Ayrıca, iç ortamda ölçülen konsantrasyonlarla maruziyet arasındaki ilişkiyi kurabilmek için, kişisel örnekleyiciler kullanılarak kişisel maruziyet düzeyleri de belirlenmiştir. NO2 için İç Ortam/Dış Ortam konsantrasyon oranlarının evlerde her 2 mevsimde de okullar ve ofislere nazaran yüksek bulunması evlerin iç ortamlarında NO2 kirletici kaynaklarının ofis ve okullara oranla daha baskın olduğu göstermektedir. İç Ortam/Dış Ortam oranlarının 1’in çok altında bulunması O3 ve SO2’in dış ortam kaynaklı bir kirletici olduğunu ve iç ortamlarda önemli bir kaynağının bulunmadığını göstermektedir. PM2.5 fraksiyonundaki toprak kaynaklı elementlerin iç ve dış ortam konsantrasyonlarının yüksek düzeylerde bulunması bu elementlerin iç ortamlara taşınımının yüksek olduğunu göstermektedir. PM2.5 kişisel maruziyet düzeylerinin As, S, V, Cu ve Cr gibi yanma kaynaklı elementler için iç ortam maruziyet düzeylerinden 2–6 kat daha yüksek olması ve bazı mevsimsel farklılıklar bulunmasına rağmen İç Ortam/Dış Ortam oranlarının genellikle 0.3–0.7 aralığında bulunması gözlenen yüksek kişisel maruziyet düzeylerinde dış ortamların etkisini göstermektedir. PM10 partikül fraksiyonunda belirlenen ağır metallerin büyük bir bölümü için İç Ortam/Dış Ortam oranlarının 1’den küçük bulunması dış ortam kirletici kaynaklarının iç ortam kirletici kaynaklarına daha baskın olduğunu göstermektedir. En yüksek UOB kirlilik düzeylerine örneklenen kişilerde rastlanırken bunu iç ortam ve dış ortam UOB kirlilik düzeyleri takip etmiştir. Her 2 mevsimde de toluen ev, ofis ve okullardaki UOB kirlilik düzeylerine en çok katkıda bulunan bileşik olurken onu etilbenzen, m,p-ksilen, stiren, nonan, hegzan, benzen, o-ksilen ve heptan bileşikleri takip etmektedir. Kentsel alanlarda elde edilen toplam UOB konsantrasyonlarının endüstriyel alanlarda elde edilen değerlerle uyum içinde bulunmuştur. Trafiğin belirteci olan bileşikler (BTEX, 1,2,4-trimetilbenzen) kentsel alanlarda yüksek bulunurken petrokimyanın belirteci olan hexane ve heptane bileşikleri endüstrinin yoğun olduğu alanlarda yüksek bulunmuştur. Ayrıca kentsel ve endüstriyel alanlarda elde edilen UOB konsantrasyonlarının sanayii ve trafikten uzak alanlarda elde edilen konsantrasyonlardan yüksek olması trafik ve sanayiinin tesbit edilen UOBlere olan katkısının ne kadar yüksek olduğunu göstermektedir. İç ortam, dış ortam ve kişisel maruziyet kirlilik düzeylerine etki ederek hava kalitesine olumsuz yönde katkıda bulunan kirletici kaynakların belirlenmesi amacıyla Pozitif Matris Faktörizasyonu (PMF) reseptör modelleme tekniği kullanılmıştır. PMF modellemesi, korelasyon analizi, iç ortam/dış ortam oranları, mikroçevre karakteristikleri, anketler ve zaman aktivite çizelgeleri incelenen kirleticilerin en önemli emisyon kaynaklarının endüstri, trafik ve sigara kullanımı olduğunu göstermektedir. İç ortam, dış ortam ve kişisel maruziyet düzeylerinin dünyanın diğer bölgelerinde yapılan çalışmalarda raporlanan düzeyler ile kıyaslanabilir olduğu bulunmuştur. Kişisel maruziyet konsantrasyonları kullanılarak çalışmada incelenen inorganik ve organik kirleticilerden kaynaklanan sağlık riski değerlendirmesi yapılmıştır. Ev, ofis ve okullarda örneklenen kişiler için hesaplanan “Toplam Kanser Riski” ve “Toplam Tehlike İndeksi” değerleri hem ortalama konsantrasyonlar hem de en kötü senaryo göz önüne alınarak incelendiğinde en yüksek risk altında bulunan kişilerin ev hanımları olduğu bunları öğretmenler ve ofis çalışanlarının takip ettiği söylenebilir. Değerlendirme kentsel, endüstriyel, endüstri ve trafikten uzak alanlar için yapıldığında her 3 alanda da yaşayan kişilerin birbirine yakın ve yüksek kanser riski taşıdıkları söylenebilir. Aynı değerlendirme sigara kullanan ve kullanmayan kişiler için yapıldığında sigara kullanan kişilerin kullanmayanlara nazaran yaklaşık %50 daha fazla kanser riski taşıdıkları gözlenmiştir.In this study, indoor and outdoor environment samples were taken from different regions and microenvironments (home, school, office) in Kocaeli. Through active and passive sampling and measurement techniques, 16 heavy metals (Al, As, Ca, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb, S, Si, Ti, V and Zn) at 2 different particle fractions (PM2.5 and PM10), volatile organic compounds (VOCs), and SO2, NO2 and O3 concentrations were determined. Moreover, in an effort to establish the relationship between exposure and the indoor concentrations measured, personal samplers were used to determine personal exposure levels. Indoor/outdoor concentration ratios for NO2 were higher in homes than in schools or offices in both summer and winter, which shows that sources of NO2 pollutants in indoor environments of homes are more dominant than those found in offices or schools. The indoor/outdoor ratios were far below 1, indicating that O3 and SO2 are pollutants originating from outdoor environments and that they do not have significant sources in indoor environments. The presence of high levels of indoor and outdoor concentrations of crustal elements at PM2.5 fractions indicates that these elements are transported into indoor environments at high levels. PM2.5 personal exposure levels were 2–6 times higher than indoor levels for combustion-related elements such as As, S, V, Cu and Cr, and although there were some seasonal differences, the indoor/outdoor environment ratios generally ranged between 0.3–0.7 and indicated the effect of outdoor environments on the observed high personal exposure levels. The indoor/outdoor ratios for a major portion of the determined heavy metals at PM10 particle fractions were smaller than 1, showing that outdoor pollutants are more dominant than indoor pollutants. The highest VOC pollution levels were encountered in individuals in the sample, and this was followed by VOC pollution levels in indoor and outdoor environments. In both seasons, toluene levels were the highest pollutants for homes, offices and schools, followed by ethylbenzene, m/p-xylene, styrene, nonane, hexane, benzene, o-xylene and heptane. Total VOC concentrations obtained from urban areas were consistent with values obtained from industrial areas. Components that are indicators of traffic (BTEX, 1,2,4-trimethylbenzene) were measured at high levels in urban areas, while hexane and heptane components, which are indicators of petrochemistry, were recorded at high levels in high- industry areas. Moreover, VOC concentrations obtained from urban and industrial areas were higher than concentrations found in areas far from industry and traffic, which demonstrates the high contribution of traffic and industry to measured VOCs. This study investigated the summer and winter concentrations of selected pollutants and the relationship between indoor and outdoor environments. In order to determine pollutant sources that negatively contribute to air quality by affecting the degree of indoor, outdoor and personal exposures, the Positive Matrix Factorization (PMF) receptor modeling technique was used, which is a multivariate statistical analysis method. PMF, correlation analyses, indoor/outdoor ratios, microenvironment characteristics, responses to questionnaires, and time activity information suggested that industry, traffic and smoking represent the main emission sources of pollutants investigated. Indoor, outdoor and personal exposure concentration values were compared to values measured in different parts of the world, thereby evaluating consistency with the observed pollution level. Based on personal exposure concentrations, an assessment was conducted concerning the health risks associated with the inorganic and organic pollutants investigated in this study. When the calculated values for “Total Health Risk” and “Total Hazard Index” for people sampled in homes, offices and schools were examined by considering both the average concentrations and the worst scenarios, it was revealed that housewives are at the highest risk, followed by teachers and office workers. An examination of urban, industrial and far from urban, industrial and traffic areas revealed that people living in all of these three areas are subjected to high cancer risks, which are at similar levels. When the same evaluation was carried out for smokers and non-smokers, it was observed that smokers have a 50% higher risk of cancer compared to non-smokers