Arnold Chiari Malformation (ACM) type 1 is a clinical condition in which cerebellar tonsils extends to the upper cervical spinal canal through the foramen magnum. This form of ACM is considered to be adult type [1]. Older children or adults usually constitute patient population and patients are often asymptomatic [2]. Patients with ACM may present subtle and varying symptoms such as headache, extremity pain or weakness, vocal cord paralysis, vertigo, hypoesthesia. Nonspecific symptoms may cause delay in correct diagnosis [3]. Symptoms seen in ACM type 1 are well described in previous studies. In this case, a patient with ACM type 1 who applied with hypoesthesia is presented.

Purpose: the aim of this study was to assess the relationship of patient weight, height and body mass index (BMI) with the size of the quadrupled hamstring tendon used in anterior cruciate ligament (ACL) reconstruction. Methods: from patient records, we retrospectively assessed the weight, height, BMI and graft sizes of 126 patients who underwent ACL reconstruction using a quadrupled hamstring tendon autograft between January 2010 and January 2013 at our institution. The data obtained from perioperative measurements were studied using correlation analysis. Results: statistically significant relationships were found between patient height and graft diameter (p = 0.033, r = 0.19) and between patient weight and graft diameter (p < 0.0001, r = 0.33). No statistically significant relationships were found between graft diameter and BMI or between graft length and patient height, weight and BMI (p > 0.05). Conclusions: patient height and weight were found to be related to quadrupled hamstring graft diameter in our patient population. BMI was not related to the quadrupled hamstring graft size. The exact size of the graft cannot be predicted preoperatively on the basis of these variables. Level of evidence: Level IV, retrospective case series.

Dysphagia lusoria is a secondary condition caused by the compression of the esophagus with an aberrant right subclavian artery. This anomaly usually involves the right subclavian artery and occasionally the left subclavian artery. Most cases remain asymptomatic. Therefore, dysphagia lusoria is quite a rare phenomenon, which doctors may not face throughout their careers. In this report, the aberrant right subclavian artery of a patient suffering from underestimated dysphagia, which was incidentally diagnosed using chest computed tomography, is presented.

Dysphagia lusoria is a secondary condition caused by the compression of the esophagus with an aberrant right subclavian artery. This anomaly usually involves the right subclavian artery and occasionally the left subclavian artery. Most cases remain asymptomatic. Therefore, dysphagia lusoria is quite a rare phenomenon, which doctors may not face throughout their careers. In this report, the aberrant right subclavian artery of a patient suffering from underestimated dysphagia, which was incidentally diagnosed using chest computed tomography, is presented.

Aims: Plantar fasciitis (PF) is a degenerative disease of the plantar fascia caused from recurrent replicable micro-trauma of the radix part of the calcaneus. The comparison of the effectiveness of the intralesionary autologous venous blood injection (AVBI) and intralesionary steroid injection (ISI) was aimed with this study. Materials and methods: In this study, we included forty-nine patients with PF. AVBI was applied to 28 patients while the remaining 21 patients underwent ISI. Visual Analogue Scale (VAS) was used to measure the pain intensity of the patients. Results: Statistically significant differences were detected in both groups when baseline VAS scores compared with the ones collected during treatment at 6th week, 3" month and 6th month. While the changes in VAS scores of group ISI and group AVBI at the 6th month after treatment were respectively -44,52 +/- 2.51, -37,35 +/- 30,62; there was no statistically significant difference detected between groups (p=0.41). Conclusions: In this study, it is established that AVBI and ISI treatments could relieve the pain due to PE AVBI might be seen as a good alternative for ISI when disadvantages of the ISI like possible complications are thought.

Derginizin 2013 yılındaki 2. sayısında “Yoğun Bakım Hemşirelerinin İş Yükünün Belirlenmesi” başlıklı Sayın Göçmen Avcı ve ark.ları (1) tarafından yazılan makaleyi ilgi ile okuduk. Deneyimlerini bizlerle paylaştıkları için teşekkür ederiz. Yazarların çalışmanın yapıldığı örneklem grubunu açıklarken hata yaptıkları kanaatindeyiz ve bu noktaya temas etmek istiyoruz. Yazarlar çalışmalarında beş hastanenin genel, koroner, kardiyovasküler cerrahi yoğun bakım ünitesinde çalışan 150 hemşirenin çalışma evrenini oluşturduğunu, örneklemin ise oransız küme örnekleme yöntemi ile seçilen 38 hemşire olarak belirlendiğini belirtmişlerdir. Ancak bulgular kısmında hemşirelerin öğrenim düzeylerinden bahsederken lise 18 (%51,4), ön lisans 4 (%11,4), lisans 3 (%34,3), yüksek lisans 1 (%2,9) olarak çalışmanın yapıldığı örneklemi 26 hemşire şeklinde okuyucuya yansıtmışlardır. Toplam örneklem grubunun değişmesi anket sonuçlarını etkileyecek ve çalışmanın istatistiksel sonuçlarında değişikliklere neden olabileceğini düşünmekteyiz. Değerli sunumları için Göçmen Avcı ve arkadaşlarını kutlar, saygılarımızı sunarız.

•Guidance of a classification system helps to achieve better results.•Needle biopsy should be performed to confirm spinal tuberculosis diagnosis.•Triple-drug antituberculous chemotherapy has paradoxal responses.

We read with interest the article by Ibrahim et al. (2014) on the factors that influence British medical students’ career intentions. In particular, we noted the finding that clinical attachments in many specialities, including General Practice, did not appear to increase the desire to pursue that speciality. We have collected data over the last 10 years of cohorts of final year medical students at one university suggesting otherwise. We found that completing a primary care rotation had a strongly positive effect on students’ stated intention to pursue a GP career. Over the 10-year period we asked 2563 students, after their final year primary care rotation, what their intentions had been before and after their attachment. On average, 37% (range 31–44%) of students every year had not considered GP as an option before the rotation, but did so afterwards. Conversely, only 2% of students’ GP career intentions changed negatively. The remaining students’ intentions were unchanged, with 20% intending to pursue a GP career, 16% not intending to, and 25% remaining undecided. Overall, our results show that prior to the final year primary care attachment 20% of medical students intended to pursue a career in general practice, compared to 57% of medical students afterwards. Reasons given by the students for their positive change in career intention as a result of the primary care attachment included personal factors (such as developing skills in dealing with uncertainty), GP career related factors (such as job flexibility), and factors related to experiences at their specific attachment practice (such as positive atmosphere). This area is crucial, as Health England have set a target of 50% of graduates becoming General Practitioners, with the current figure being static at roughly 35% (General Medical Council 2014). Our findings suggest that a rotation in primary care positively influences students’ stated intention to become General Practitioners. Further work is imperative to explore why the willingness of students to become General Practitioners appears to decline between final year at medical school and the time of choosing their career options.

Objectives: To evaluate the role of pentraxin-3 (PTX-3) in determining the presence and severity of coronary atherosclerosis in patients with coronary artery disease (CAD). Subjects and Methods: Ninety-five patients (77 males and 18 females) who underwent elective coronary angiography were enrolled in this study. Patients with heart failure, renal failure, diabetes and thyroid disease were excluded. The study population was divided into 3 groups: individuals with normal coronary arteries, patients with critical CAD (n = 35) and patients with noncritical CAD (n = 36). The association of PTX-3 levels with the presence and severity of CAD and the number of involved vessels were analyzed. Results: The mean age was 53.40 ± 10.25 years. The PTX-3 levels were significantly higher in patients with CAD than without CAD (146.48 ± 48.52 vs. 109.83 ± 49.06 pg/ml, p < 0.001). A statistically significant difference was found among the 3 groups regarding the severity of CAD (165.66 ± 49.10, 127.83 ± 40.51 and 109.83 ± 49.06 pg/ml, p < 0.001, respectively). The serum PTX-3 levels in normal arteries were 110.4 ± 48.11 pg/ml, in single-vessel disease 132.35 ± 32.96 pg/ml, in 2-vessel disease 142.57 ± 55.88 pg/ml, in 3-vessel disease 156.07 ± 50.53 pg/ml, and in 3-vessel disease 160.50 ± 30.41 pg/ml. After adjusting for baseline confounders, older age (OR = 1.107, 95% CI = 1.027-1.193, p = 0.008) and higher PTX-3 levels (OR = 1.017, 95% CI = 1.003-1.032, p = 0.021) were detected as significant predictors for the presence of CAD. Conclusions: Higher PTX-3 levels were associated with the presence of CAD and its increased severity in clinically stable patients. Higher PTX-3 levels may be regarded as a novel diagnostic predictor and may offer therapeutic options in the clinic.

Background: Premature ventricular complexes (PVC) are a relatively common electrocardiographic abnormality presenting in individuals without overt cardiovascular disease. There is no clear mortality benefit from VPB suppression in asymptomatic patients. In addition, It has been showed that evidence for structural heart disease consistent with non-ischemic scarring possibly due to inflammation in patients with premature ventricular beats . This situation suggests that the mechanisms by which VPBs can be also generated with include clinical and subclinical inflammation. The neutrophil–lymphocyte ratio (NLR) is an easy, cheap, noninvasive, and universally available laboratory marker used to evaluate clinical and subclinical systemic inflammation.We investigated the NLR in asymptomatic healty young men with PVC(structural heart disease excluded with cardiac magnetic resonance imaging) compared with controls. Methods: The study group consisted of 21 asymptomatic(or atypical complaint) healty young men with PVC ( mean age 22.7 ± 2.0 years. Results:There were no significant differences between the 2 groups with respect to age, gender, body mass index, smoking, as well as glucose, creatinine, total cholesterol, triglyceride, LDL-C, HDL-C, hemoglobin levels, white blood cell count, and red cell distribution width. The NLR was significantly higher among the men with PVC than that of the control group (2.7 ±0.7 vs 1.5 ± 0.4, respectively; P < .001). Conclusions: We found that the NLR is significantly elevated in asymptomatic healty young men with PVC compared with control participants. The increased NLR values might indicate subclinical and clinical inflammation in asymptomatic healty young men with PVC ,and we must consider that there

Derginizin 2014-3. sayisindaki “Lise Ogrencilerinin Hepatit B Hastaligi Konusunda Bilgi Duzeyleri” (1) baslikli Sayin Keten ve arkadaslari tarafindan yazilan makaleyi ilgi ile okuduk. Deneyimlerini bizlerle paylastiklari icin tesekkur ederiz. Yazarlarin arastirdiklari HBV hastaligina ait bilgi duzeyleri konusunda calismanin bazi kisitliliklarindan bahsederek arastirmaya katkida bulunmak istiyoruz.

Background: The aim of the study is to find out the factors that make the first-graders and newly graduates on probation in 2012-2013 educational calendar to choose military medical faculty and to determine the precedence that they take into account in choosing a profession. Methods: After having necessary authorizations, this cross-sectional study was conducted in Gulhane Military Medical Academy in Turkey between March 2013 and April 2013. Ninetyfive students who completed their first year education and 58 newly graduated physicians joined the study. The form of survey had two parts. The first part deals with the socio-demographic features of participants and second part has questions that try to find the reasons of their preferences of medical science and military medical faculty and the reasons of not being chosen of military medical faculty and the questions related with their professional career. Results: When the factors that effects participants working life is examined, the rate of people who wants to work continuously in primary care centers is 9,2% (n=14). When first graders and new graduates are examined whether they want to work in other institutions different from Turkish Armed Forces (TAF), a significant difference is found (p

Cutaneous melanoma is a malignancy which has an increasing incidence in all over the world especially due to increased UV exposure. Although it builds only 4% of all skin cancers, it is the major cause of death appears to be associated with skin cancer. As the disease progresses both cost of the treatment and worsening of the prognosis increases. Local excision of melanomas detected at an early stage may provide over 90% cure on the other hand despite surgery and chemotherapy 5-year survival rate of treatment of advanced-stage melanomas is about 20%. Melanoma staging is important in determining treatment planning and prognosis of patients. Different systems have been developed for staging melanoma to date but most of them considered inadequate. In parallel with developments in science, innovations in imaging and genetic studies brought a number of changes in the treatment and staging of melanoma. Some drugs which has been tried in the early nineties, now taken its place today as part of the treatment. Prognostic factors and treatment regimens considered to be effective on survival have uncovered with a number of studies. In this article it is intended to increase awareness of health care workers about cutaneous melanoma. In addition, the current staging system for melanoma, treatment modalities and factors thought to be effect on prognosis will be mentioned.

Resistin, A Potential Actor in Coronary Artery Disease" (1) başlıklı

Background/PurposeIt was aimed to investigate the ideal narrowband ultraviolet B (NB UVB) phototherapy protocol that has the maximal efficacy, minimal side effect profile, minimal cumulative UVB dose, and a shorter duration of therapy.MethodsFifty-one patients with psoriasis vulgaris were included in the study. The patients were divided into the percentage dose (group 1) and the fixed dose groups (group 2). In group 1, the initial NB UVB dose was 50% of the minimal erythema dose and 20% of the previous dose increase made in the next sessions, and in group 2, the starting dose and the dose increases were determined based on the skin types and applied with fixed doses.ResultsPsoriasis Area and Severity Index (PASI) 90 was achieved in 22 out of 27 (81.5%) patients in group 1, and in 19 out of 24 (79.2%) patients in group 2. The difference was not statistically significant (P=0.82). No statistically significant difference was found between the two regimens in the cumulative NB UVB dose, side effect profile, and the number of sessions with improvement of the initial PASI score by 90% (for all data, P>0.05).ConclusionThese two treatment protocols were not superior to each other in terms of cumulative NB UVB dose, efficacy, total number of treatment sessions, and side effect profiles.

Background: The aim of the study is to find out the factors that make the first-graders and newly graduates on probation in 2012-2013 educational calendar to choose military medical faculty and to determine the precedence that they take into account in choosing a profession. Methods: After having necessary authorizations, this cross-sectional study was conducted in Gulhane Military Medical Academy in Turkey between March 2013 and April 2013. Ninetyfive students who completed their first year education and 58 newly graduated physicians joined the study. The form of survey had two parts. The first part deals with the socio-demographic features of participants and second part has questions that try to find the reasons of their preferences of medical science and military medical faculty and the reasons of not being chosen of military medical faculty and the questions related with their professional career. Results: When the factors that effects participants working life is examined, the rate of people who wants to work continuously in primary care centers is 9,2% (n=14). When first graders and new graduates are examined whether they want to work in other institutions different from Turkish Armed Forces (TAF), a significant difference is found (p