• ÖZ

Objective: The aim of this study is to examine the associations between white blood cell (WBC), hemoglobin (Hb), neutrophil, lymphocyte, platelet, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels in patients with recurrent aphthous stomatitis (RAS). Materials and Methods: For this study, 137 patients with RAS and 137 healthy controls were recruited. The study participants had no systemic diseases except RAS. Serum WBC, Hb, neutrophil, lymphocyte, platelet, MPV, PLR, NLR, ESR, and CRP levels were recorded in the active period for all patients with RAS and controls. Results: There was no statistically significant difference in the WBC, Hb, neutrophil, lymphocyte, platelet, MPV, NLR PLR, ESR, and CRP levels between patients with RAS and controls. Conclusion: No differences were observed for WBC, Hb, neutrophil, lymphocyte, platelet, MPV, NLR, PLR, ESR, and CRP levels between patients with RAS and controls. These parameters therefore cannot be used as markers for inflammation or inflammation severity in patients with RAS.

• ÖZ

Objective: We aimed to investigate the relationship between the use of fluoro-2-deoxyglucose (FDG)- positron emission tomography (PET)/computed tomography (CT), maximized standardized uptake value (SUVmax) values of tumors, and tumor differentiation and tumor markers during the initial staging of patients with gastric cancer. Materials and Methods: The study included 50 patients (14 women and 36 men; mean age: 63±11 years; age range: 31-80 years) who had undergone initial staging with FDG-PET/CT after the diagnosis of gastric cancer with endoscopic biopsy between January and June 2013. Serum alpha fetoprotein (AFP), carcinogenic antigen 19-9 (CA 19.9), carcinoembryonic antigen (CEA), and C-reactive protein (CRP) levels were measured in patients prior to imaging. PET/CT images were evaluated for primary tumors, locoregional spread, and distant organ metastases, and classified by tumor-node-metastasis staging. Semiquantitative data were collected by SUVmax measurements in pathological regions of involvement. Data were analyzed statistically. Results: FDG-PET/CT showed primary gastric cancer with a sensitivity of 87%. Imaging findings were normal in 3 patients (1/3; mucinous adenocarcinoma, 2/3; signet-ring cell adenocarcinoma). With FDG-PET/CT, 3/50 patients were classified into Stage 1B, 3/50 patients into Stage 2, 5/50 patients into Stage 3A, 5/50 patients into Stage 3B, 5/50 patients into 3C and 29/50 patients into Stage 4. The mean SUVmax was calculated as 11.35±4.3 (poorly differentiated adenocarcinoma: 5.4±1.7; moderately differentiated adenocarcinoma: 10.3±4.8) for the primary tumor and 14.9±6.3 for tumor metastasis. A positive correlation was evident between the measured SUVmax and stage and the grade of primary tumor (p<0.05). While the relationship between SUVmax and levels of serum AFP and CRP was statistically significant (p<0.05), the relationship between SUVmax and levels of serum CA 19-9 and CEA was not statistically significant (p>0.05). Conclusion: The SUVmax of primary tumors was associated with the degree of differentiation of primary tumors and the biochemical tumor markers CRP and AFP. The fact that SUVmax of primary tumors is high supplies clues about the presence of the factors affecting prognosis of the disease.

• ÖZ

Objective: This retrospective study aimed to compare the clinical characteristics and trauma scores of Intensive Care Unit (ICU) trauma patients 65 years and older with the patients under 65 years old. Materials and Methods: Trauma patients (n=161) who stayed at least 24 hours in ICU were included. Patients younger than 65 years were included into Group 1 (n=109) and patients aged ≥65 years (n=52) were included into Group 2. Patient characteristics and trauma index scores (GCS; APACHE II score, ISS; TRISS and RTS) at ICU admission were calculated. Results: The patients in Group 2 had more comorbid disease compared with Group 1 (61.5%, 6.4%) (p=0.001). The Trauma-related Injury Severity Score score were higher in Group 1 (49.76±33.75) compared with Group 2 (35.38±34.93) (p=0.006). The APACHE II score were higher in Group 2 (20.08±7.60) compared with Group 1 (17.00±6.90) (p=0.007). The need for invasive mechanical ventilation and tracheostomy were more frequent in Group 2 trauma patients compared with those of patients in Group 1 (92.3%, 73.4%; p=0.003; 26.9%, 8.3%; p=0.002; respectively). The need for transfusion of packed red blood cell suspension (PRBC) was more frequent in Group 2 compared with Group 1 (92.3%, 55.0%; respectively) (p=0.001). The mortality rate was found to be higher in Group 2 compared with Group 1 (48.1%, 19.3%; respectively) (p=0.001). Conclusion: The elderly trauma patients have more comorbid disease, higher scores for APACHE II and lower scores for TRISS, more mechanical ventilation and tracheostomy requirements and higher mortality rate compared with young trauma patients.

• ÖZ

Objective: Since initial description by Forero for thoracic region, ultrasound guided erector spinae plane (ESP) block has experienced several surgeries for postoperative pain management, chronic pain or surgical anesthesia. Although ESP block has been reported to provide effective analgesia in the thoracic region, its effect in lumbar region still unclear. In this study we aimed to showed our successful experience with lumbar ESP block as a main anesthetic technique in fifteen high risk elderly patients undergoing hip surgery with mild propofol sedation. Materials and Methods: In this observational study high risk elderly fifteen patients received lumbar ESP block as a main anesthetic technique with mild propofol sedation. 40 mL of local anesthetic mixture (20 mL bupivacaine 0.5%, 10 mL lidocaine 2%, and 10 mL normal saline) was administered between the erector spinae muscles and transverse process at the level of the 4th lumbar vertebra. Also we demonstrate magnetic resonance images and discuss the anatomic basis of lumbar ESP block. Results: All patients’ surgeries were completed without requirement for general anesthesia or local anesthesia infiltration of the surgical site. All patients’ pain scores were <2/10 in the recovery room. Significant contrast spread was observed between the Th12 and L5 transverse process and erector spinae muscle and between multifidus muscle and iliocostal muscle at the L2-4 levels. Contrast material was observed at the anterior of the transverse process spreading to the paravertebral, foraminal and partially epidural area/spaces and also in the areas where the lumbar nerves enter the psoas muscle. Conclusion: Lumbar ESP block when combined with mild sedoanalgesia provides adequate and safe anesthesia in high risk elderly patients undergoing hip surgery.

• ÖZ

Objective: Complex regional pain syndrome (CRPS) is a syndrome usually occurs in one extremity and characterized by pain, tenderness with palpation, and symptoms of autonomic nervous system dysfunction. An essential factor in the etiology of CRPS is immobilization of the extremity as a result of a fracture. Delaying the start of physical medicine and rehabilitation program after removal of the plaster or splint may increase the rates of CRPS development in patients with fractures. This study aims to determine a direct relationship between delay time in rehabilitation and CRPS development. Materials and Methods: Patients admitted to our physical therapy and rehabilitation outpatient clinic within the last 3 years (January 2016 to January 2018) for orthopedic rehabilitation following fractures were retrospectively analyzed. CRPS development status, the delay time for the rehabilitation program was determined in 38 CRPS patients of 91 patients with fractures. Probit regression was used to reveal the relationship between delay time for rehabilitation and CRPS development. Results: CRPS development rates were decreased by years (48.71% in 2016, 43.47% in 2017, and 31.03% in 2018). When cases in 2016 were taken as a reference, it was seen that cases in 2017 and 2018 were exposed to CRPS approximately 0.03% and 16.00% lower than the reference year, 2016. A delay of one day exposes the patient to approximately 0.35% more CRPS. Conclusion: As the delay time for rehabilitation in our clinic decreased, the incidence of CRPS decreased. The awareness of physicians and patients about the importance of early rehabilitation should be improved.