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Aim: This study aimed to retrospectively investigate causes of umbilical discharge (UD), its clinical course, treatment modalities and follow-up in infants with UD complaints in a major teaching hospital in Turkey. Material and Method: Infants with an UD complaint who were referred to our clinic by a pediatrician or a family physician from January 2013 to June 2014 were investigated. Results: The study included 291 infants between the ages of 3 and 114 days. Of these infants, 194 (67%) had an umbilical granuloma, 83 (28.3%) had an umbilical polyp, and 14 (4.8%) had omphalitis. Among 14 infants with omphalitis who were treated with topical antibiotics, six infants had refractory or recurrent discharge and ultrasonography (US) was performed which revealed a 1-3 mm sized cystic appearance with no connection to the peritoneum or other tissues. These infants received systemic antibiotics in addition to topical antibiotics. During the follow-up period, cystic appearance was not present in US in three of these six patients and in the remaining three patients who did not present for follow-up we learned via phone calls that their complaints had not recurred. Discussion: Cauterization using a silver nitrate pencil was sufficient in the umbilical granuloma. Ligating, excising and cauterizing the base of the lesions was sufficient in an umbilical polyp. In cases with persistent or recurrent UD, high-resolution US should be primarily performed, which may direct the subsequent management.

Carcinoma of unknown primary origin is defined as metastatic disease in which the primary tumor site is not detected despite all detailed examinations performed. CUP accounts for 3-5% of all cancer cases. The annual incidence is 7-12 in 100,000. It is the 7-8th most prevalent cancer and has the 4th highest mortality. The average age of diagnosis is 60-65 years. In children, it accounts for less than 1% of all cancers. A 71-year-old male applied to our clinic with the complaint of cough and shortness of breath during exercise for the last 4 months. In thoracic CT, an irregularly margined, 17x27 mm diameter, mass lesion was seen in the superior part of the left lower lobe of the lung, adjacent to a fissure. Transthoracic fine needle aspiration biopsy performed on the lesion showed an adenocarcinoma. PET-CT showed no metastatic lesion and the patient was operated on. The pathology report showed a metastatic character of the tumor, yet the primary origin could not be detected.

A full-term, vaginally delivered, 7-day-old boy presented with poor feeding, tachypnea, and color change on his leg. His prenatal and family histories were unremarkable. Lethargy, decreased neonatal reflexes, respiratory distress, and a necrotic appearance on the distal left foot were observed. Left femoral pulse was absent. Laboratory examination revealed metabolic acidosis, hypernatremia, increased serum creatinine and acute phase reactants, and prolonged coagulation parameters. Doppler ultrasound and computerized tomographic angiography revealed decreased calibration in the left external iliac artery, monophasic weak blood flow in the superficial femoral and popliteal arteries, and absence of blood flow in the dorsalis pedis artery. Thrombophilia and congenital metabolic disorders were excluded. Low molecular weight heparin and antibiotic therapy led to resolution of the clinical picture except for his leg. Amputation below the knee was performed after demarcation of the gangrene became clear . He was discharged after an uneventful postoperative period.

Aim: Sore throat is one of the most predominant symptoms of the human population. The aim of the study was to define the efficacy of low-concentration hypochlorous acid (HOCl) in patients with sore throat. Low-concentration hypochlorous acid (HOCl) is an antiviral and antibacterial agent which is produced endogenously. Material and Method: 50 patients over the age of 18 were included in this study. The patients were randomly chosen to receive oropharyngeal mouthwash with either low-concentration HOCl (n= 24) or placebo saline solution (n= 26) for 4 days. We evaluated the sore throat relief using the 7-point Sore Throat Relief Scale (STRS). Results: The STRS scores were significantly lower in the HOCl group than in the placebo group after 4 days of treatment (p<0.05). Discussion: This study showed that low-concentration HOCl spray provided better improvement in sore throat symptoms when compared to placebo saline spray.

Aim: Pilonidal sinus is a common disease that affects generally younger patients and occurs mostly in the sacro-coccygeal region. The main treatment of pilonidal sinus is still controversial. This study aimed to evaluate the usefulness and surgical results of Limberg flap reconstruction in pilonidal sinus disease. Material and Method: Between January 2012 and January 2017, 78 patients were operated on electively and rhomboid excision with Limberg flap reconstruction was performed for pilonidal sinus disease in our clinic. Demographic features, clinical data, operative findings, postoperative complications, and patient follow-up were retrospectively analyzed. Results: The mean age of the patients was 27.91± 6.49 years. Out of the 78 patients, 59 (75.6%) were male and 19 (24.4%) were female. The mean duration of symptoms was 5.38 months (2-13 months) and the mean operative time was 68.4 ± 18.7 min. The median amount of blood loss during surgery was 75 ml (range from 30 to 200 ml). The mean hospital stay was 7.79 ± 1.85 days. In the postoperative period, recurrences were noted in only 2 (2.56%) patients in the follow-up period, which ranged from 1 to 6 years. Discussion: Limberg flap is an efficient and easy technique with less complication. It is especially useful in patients with large diseased pilonidal sinus tissue and multiple sinuses with lateral openings. This technique results in a reduced hospital stay and recurrence rate which means that the patients can go back to their daily lives sooner.

Aims: The extension of spinal anesthesia by extradural injection has been identified as a modification of the combined spinal-epidural anesthesia. Epidural volume extension (EVE) is a rescue strategy that can raise the level of insufficient post-spinal sensory block. Material and Method: After approval of Adnan Menderes University Ethics Committee (Decision 2016/834/37), the data of 455 patients who had undergone insufficient simultaneous combined spinal epidural without catheter between 2010 and 2016 were retrospectively analyzed in terms of ASA scores; demographic and hemodynamic data; surgery type; preoperative and postoperative sensory and motor block levels; operation onset times after anesthesia; need for peroperative additional anesthesia, vasopressor (ephedrine) and atropine; and postoperative pain onset times. Results: Of the 455 patients, there were two groups. In the first group, there were 238 patients who had undergone cesarean section and in the second group there were 217 patients who had undergone surgery for inguinal hernia. There was no mortality and morbidity in any group. There was a statistically significant decrease in heart rate, systolic, diastolic, and mean arterial pressures during the peroperative period in both groups (p<0.05). Discussion: The simultaneous combined spinal-epidural technique (sCSEA) without catheter may be considered as an alternative to conventional methods for appropriate surgeries. It can be safely used with local anesthetic combinations instead of saline for EVE. The advantages and disadvantages of EVE compared to the conventional method should be demonstrated with clinical randomized studies.

Aim: Laparoscopic colorectal surgery has become widely performed in many centers today. We planned to present the first 65 cases in our clinic. Material and Method: Sixty-five patients who underwent laparoscopic colorectal surgery between September 2014 and March 2018 were retrospectively reviewed. Cases returning open surgery despite laparoscopic onset were excluded from the study. Demographic data, operative types, duration, tumor stages were recorded. Results: 65 cases were included, 39 were male (60%), 26 were female (40%), mean age was 63.2 (40-81). Low anterior resection (LAR) in 20 cases (%30.7), anterior resection (AR) in 19 cases (29,2%), right colectomy in 18 cases (27,6%), abdomino-perineal resection (APR) in 5 cases (7,7%), colloanal anastomosis in 2 cases, total colectomy in 1 case (1.6%) were performed. It have been showed anastomotic leakage in 3 cases (4,6%), wound infection in 10 cases (15.3%), 3 patient incisional hernia (4,6%), ureter injury in a patient (1.5%) and urethra injury in a patient (1.5%). There was no mortality. Discussion: Although our experience with laparoscopic colorectal surgery is compatible with the literature and is not yet gold standard, we think that it gives better results than open surgery due to its advantages.

Aim: In this retrospective report, the foreign body findings in adult patients with chronic cough were aimed to explore. Material and Method: Between October 2011 and May 2017, patients with bronchial foreign body aspirations mistakenly diagnosed as COPD or asthma in outside centers were collected. The bronchoscopic and clinical findings of four patients with chronic cough were found from the archieve of the hospital. Results: The age of the patients who applied to our clinic ranged from 27 to 64 years. Endobronchial foreign bodies were successfully removed with FOB in all patients. The extracted foreign bodies were stone, headscarf needle, a needle-like object and a foil paper. Discussion: In adults with chronic cough foreign body aspiration should be immediately taken into account.

Aim: Sepsis is a clinical problem that still has high mortality and morbidity despite advances in supportive care in intensive care. The study’s aim was to investigate  the protective effect of Bacillus clausii, an important probiotic with a strengthening effect on the gastrointestinal barrier, on septicemia. Material  and Method: Twenty-four rats were divided into three randomized and double-blind groups, as Group 1 (control group, n=8), Group 2 (sepsis group, n=8), and  Group 3 (sepsis+probiotic group, n=8). Lipopolysaccharide extracted from serotypes (0111:B4) of Escherichia coli (E.coli ) was injected intraperitoneally to  all group for sepsis model at a dose of 15 mg/kg and rats were sacrificed at 48 hours. Serum oxidant and antioxidant parameters were measured. Results:  The C-Reactive Protein (CRP) value of Group 1 was significantly lower than Group 2 [CI:(-44.16)-(-28.52), p=0.000], whereas the CRP values of Group 3 were  significantly lower than Group 2 [CI:(7.4)-(34.7), p=0.005]. MDA values were found to be significant between Groups 1 and 2, CI:(-0.3)-(-0.7), p=0.045. The thiol  values of Group 2 were significantly lower than Group 1 [CI:(9)-(366), p=0.041], whereas the thiol (SH) values of Group 3 were significantly higher than those  of Group 2 [CI:(-659)-(-98), p=0.016]. Discussion: B. clausii is one of a group of probiotics that is inexpensive and effective. Sepsis is still a high-risk clinical  problem. Our study showed that B. clausii has a protective effect against sepsis.

Aim: Having multiple?disabled child?is stressful for parents because they continue to carry out demanding care procedures in everywhere. In this context, we planned to investigate the health conditions and problems of the families with quantitative method. Matherial and Method: The universe of the study consists of the families of 10 disabled children registered in Counseling and Research Center affiliated with Mugla Provincial Directorate of National Education in Turkey. No sampling was executed in this study, and 10 parents accepting to participate into the study voluntarily were involved. An exploratory, qualitative study was conducted, including individual interviews with parents focus groups. Results: %u2018%u2018Concerns for the?child%u2019s well-being%u201D was central for the parents and focussed on the areas of their %u201CDevelopment%u201D. They devoted themselves entirely to their children. Even his illnesses were focused for their children. They are protecting their children, but sometimes they are feeling burnout themselves. They did not think their health, also they did not think even could do something for their health. Discussion: Parents work hard to safeguard the well-being of their disable child?first. And of course, they need professionals care sometimes. Becuse, still they do not know, how will live their own lifes.

Aim: Epidemiological studies are important for the prevention and resolution of health problems. We carried out this study to evaluate the incisional and excisional biopsies applied to the nasal skin in the Kirsehir region. Material and Method: Between December 2014 and October 2017, 354 patients and 354 lesions were evaluated with a mass on the nasal skin retrospectively. The mean age of the patients, gender distribution, localization of lesions and histopathological type were investigated. These masses were classified as non-neoplastic, benign, premalignant, and malignant. Results: The number of females were 226, and the number of males were 128. Age distribution ranged from 9 to 90. There were 20 cases under 18 years old. Premalignant and malignant lesions were not observed in adolescent/pediatric age group. Eighty-two cases over 60 years of age were identified, and 60% of them had a malignant tumor. Nasal skin lesions were more common in the 31-40 age range (24.9%). The most common lesion group was benign tumors (65.2, n=231), followed by malignant tumors (20.1%, n=71), non-neoplastic lesions (9.6%, n=34) and premalignant lesions (5.1%, n=18). Nevus (175), basal cell carcinoma (67) and chronic nonspecific inflammations (21) were the most common diagnoses. Among the malignant tumors, basal cell carcinoma was diagnosed (67) (M/F:1.09, mean age:65.8) more than squamous cell carcinoma (4). In the patient group with benign tumors, there were vascular tumors (13: capillary hemangioma; 10, hemangioma; 3), verruca vulgaris (12), skin appendage tumors (11: trichoepithelioma; 4, trichofolliculoma; 2, steatocystoma; 1 hydradenoma papilliferum; 1, chondroid syringoma; 3), seborrheic keratosis (8), fibroepithelial polyp (7), fibroma (4) and dermatofibroma (1) respectively after nevus. In 18 premalignant lesions, 11 cases were diagnosed as actinic keratosis, and 7 cases were diagnosed as keratoacanthoma. Discussion: The literature on demographic and histopathological evaluation of nasal lesions is limited. The increase in epidemiological studies can offer a comparative advantage over other studies and can be a guide for health management. Patients with a mass on the nose are required to undergo differential diagnosis with a biopsy.?

The role of tobacco use in development of diabetes can easily be missed possibly in possibly in presence of other widely known risk factors. The following manuscript examines selected studies that explore the relationship between tobacco use and development of diabetes or glucose intolerance. The paper also describes the possible social factors relating to the issue while mentioning associated physiological and biochemical mechanisms that could connect diabetes with tobacco use or exposure. Furthermore, the aim is also to share the importance of different types of research methodologies e.g. quantitative or mixed/pragmatic types etc. in assessing a health issue.

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