Yazar "Günal, Yasemin Dere" seçeneğine göre listele

Listeleniyor 1 - 12 / 12
  • [ X ]
    Öğe
    AMYAND’S HERNIA IN PEDIATRIC AGE:A SINGLE SURGEON EXPERIENCE
    (2020) Günal, Yasemin Dere
    Objective Amyand's hernia is the presence of appendix in thehernia sac and rarely seen. The diagnosis is mostlymade incidentally during the operation performed dueto the incarcerated inguinal hernia. It is aimed to pre sent the experience about this rare pathology.Materials and Methods A retrospective analysis of 10 children with Amyand'shernia operated by a single pediatric surgeon betwe en 2011 and 2017 was performed. Demographic fea tures (age, gender), complaints, treatment methods,histopathological findings and postoperative resultswere evaluated. Results All patients were male. The average age of patientswas 12.02 months (17 days-8 years) and all had aright inguinal hernia. Emergency surgery was perfor med in 4 of the patients with an initial diagnosis ofincarcerated inguinal hernia. The remaining 6 patientswere diagnosed incidentally during elective herniop lasty. While 9 patients were treated with conventionalhernia repair, only one underwent laparoscopy. Surgi cal findings included 7 normal appendices ve 3 infla med appendices. Of the 3 patients with appendix ad hered to the hernia sac, 2 has appendicitis and 1 haslymphoid hyperplasia. Appendectomy was performedduring inguinal hernia repair in 4 patients and herniarepair was performed in 6 patients without appende ctomy. Recurrent hernias were not observed in anypatients. Conclusion Amyand's hernia should be kept in mind in the diffe rential diagnosis of patients with right inguinal hernia.The inflammation status of appendix adhering to thehernia sac should be carefully evaluated for an ap propriate treatment decision.
  • [ X ]
    Öğe
    Can Thiol/Disulphide Homeostasis Help in The Differential Diagnosis of Appendicitis in Children?
    (2020) Demir, Sabri; Günal, Yasemin Dere; Özmen, İsmail; Badem, Nermin Dindar; Neselioglu, Salim; Erel, Özcan
    Objective: We aimed to investigate the potential of assessing thiol/disulfide homeostasis as novel oxidative stressmarkers to improve the challenging diagnosis of acute appendicitis in children.Material and Methods: A total of 60 pediatric patients (0-18 years) were enrolled in the study, 30 of which were inthe control group and 30 in the acute appendicitis group. Native thiol, total thiol, dynamic disulfide, dynamic thiol,ischemia modified albümin, albumin, White blood cell, hemoglobin, hematocrit, and platelet counts of both groups weremeasured. The results of both groups were compared using the SPSS (Statistical Package for Social Sciences) version17 (Chicago, USA) program. For all variables, p <0.05 was considered significant.Results: Total thiol (p<0.001), native thiol (p<0.001), and albümin (p<0.001) levels were significantly decreased whiledynamic disulfide, dynamic thiol (p=0.003), and ischemia modified albümin (p<0.001) levels those indicating oxidantside were increased in acute appendicitis group compared to control. White blood cell counts in acute appendicitisgroup were higher (p<0.001), and platelet counts were lower (p=0.03) than the control group.Conclusion: In the differential diagnosis of acute appendicitis, especially in case that are difficult to diagnose, besides aphysical examination, imaging, and current laboratory tests, quantification of thiol/disulfide homeostasis may be helpfulin diagnosing. In addition, evaluating albumin and IMA levels may increase the specificity of the test. This test can bemore helpful in cases diagnosis is difficult such as children small in their ages and mental retardation.
  • Küçük Resim
    Öğe
    The effects of ozone on the acute phase of intestinal ischemia-reperfusion injury in rats
    (2020) Günal, Yasemin Dere; Türer, Özlem Boybeyi; Atasoy, Pınar; Kısa, Üçler; Aslan, Mustafa Kemal
    BACKGROUND: In this study, we aimed to examine the therapeutic effects of ozone on the acute phase of intestinal ischemia-reperfusion (I/R) injury in rats to resemble clinical practice. METHODS: Eighteen Wistar albino rats were assigned to control (CG, n=6), sham (SG, n=6) and ozone groups (OG, n=6). A midline laparotomy was performed and a superior mesenteric artery (SMA) in the SG and OG was occluded with a 0/0 catgut suture, but in the CG, the incision was closed without any intervention. Tissue oxygenation was monitored with a tissue oxygenation monitor to achieve the same grade during intestinal ischemia. The incision was closed and, in the OG, ozone/oxygen mixture (0.7 mg/kg) was injected intraperitoneally, 20 minutes before reperfusion. Surgical incision was reopened and reperfusion was achieved after 60 minutes of ischemia in the SG and OG. After 60 minutes of reperfusion, 2 cm small intestine segment was sampled for histopathological assessment of the intestinal mucosal damage (Chiu score) and biochemical assessment of oxidative stress markers (nitric oxide: NO, malondialdehyde: MDA, superoxide dismutase: SOD) in all groups. RESULTS: The Chiu scores of the SG and OG were statistically increased than that of the CG (p=0.002; and p=0.002, respectively). Chiu score in the OG was higher compared to that in the SG, but not statistically significant (p=0.175). MDA levels were statistically higher in the SG and OG than that of the CG (p=0.004; and p=0.010, respectively). However, the difference between the SG and OG was not statistically significant (p=0.522). SOD and NO levels were not significantly different between groups (p=0.451 and p=0.056, respectively). CONCLUSION: Contrary to the literature, single-dose ozone therapy did not reduce the oxidative stress or improve the ischemic damage in intestinal I/R injury in rats. Further evaluation with different doses in different time periods is needed for potential clinical use.
  • Küçük Resim
    Öğe
    Evaluation of intraabdominal hypertension and genitofemoral nerve motor conduction
    (2016) Türer, Özlem Boybeyi; İnal, Elem; Günal, Yasemin Dere; Aslan, Mustafa Kemal; Aydın, Gülümser; Soyer, Tutku
    Background/aim: The aim of this study was to electrophysiologically evaluate the effect of increased intraabdominal pressure (IAP) on genitofemoral nerve (GFN) motor conduction. Materials and methods: Seven Wistar albino rats were included. After anesthetization, latency and duration of GFN conduction was recorded with a needle-probe at rest. IAP was increased to 15 mmHg by insufflating atmospheric air with a percutaneous intraperitoneal needle. At 30 min of IAP, GFN motor conduction was recorded. Abdominal pressure was then increased to 20 mmHg. At 60 min, GFN motor conduction was recorded again. The consecutive recordings of latency and duration of GFN conduction (rest, 30 min, 60 min) were evaluated statistically. Results: There was a significant difference between latencies at rest (1.90 ± 0.22 ms), at 30 min (2.3 ± 0.36 ms), and at 60 min (2.74 ± 0.57 ms) (Friedman test, P = 0.001). The latency was significantly increased at 60 min compared to rest (post hoc Tukey test, P = 0.003). No similar difference was detected between the recordings at 30 and 60 min. The duration of GFN motor conduction showed no difference between consecutive recordings (P = 0.067). Conclusion: Both increased and prolonged IAP causes prolonged latency of GFN conduction, probably due to a compression effect on GFN. Neuropraxial consequences of increased IAP are thought to be related to the compression effect of peripheral nerves.
  • [ X ]
    Öğe
    Evaluation of the Reliability of Pediatric Appendicitis Score and Ultrasonography Findings in the Diagnosis of Acute Appendicitis in Children
    (2020) Günal, Yasemin Dere; Polat, Dilek; Gökçe, Erkan; Yörübulut, Serap
    Objective: Acute appendicitis is the most common surgical emergency in childhood. Early diagnosis is essential toprevent perforation-related morbidity. In this study, we aimed to evaluate the effectiveness of pediatric appendicitisscore (PAS) and ultrasonography (USG) findings in the diagnosis of acute appendicitis.Material and Methods: Patients who presented with acute abdominal pain and who were followed up or operated witha pre-diagnosis of appendicitis were analyzed retrospectively. The patients were divided into two groups as operated(n = 288) and non-operated (n = 161). PAS value of all patients was calculated and 1-4 negative (low risk), 5-6 suspect(moderate risk), 7 and above were considered positive (high risk). Patients who underwent USG were included in thestudy. The definitive diagnosis of the patients undergoing surgery was confirmed by histopathological evaluation.Results: With the pre-diagnosis of acute appendicitis, 449 patients (171 girls, 278 boys) were hospitalized.Appendectomy was performed in 288 (64 %) of the patients. The remaining 161 patients (36 %) who recovered after theobservation were discharged without any surgery. Histopathological diagnosis of patients undergoing appendectomywas acute appendicitis in 217 patients (75.3 %), perforated appendicitis in 67 patients (23.2 %) and normal appendixin 4 patients (1.4 %). Patients undergoing appendectomy had a significantly higher PAS value (p < 0.001). PAS valuewas significantly higher in the patients diagnosed with perforated appendicitis (p < 0.05). The sensitivity of USG andPAS were 81.59 % and 82.98 %, and their specificity was 88.81 % and 95.03 %, respectively, in the diagnosis ofappendicitis. The sensitivity decreased significantly (67.70 %), and the specificity increased (100 %) when the patientswith appendicitis in USG and PAS 7 and above were evaluated together. The sensitivity was 32.29 % and the specificitywas 83.85 % when USG positivity or high-risk PAS value was used alone.Conclusion: PAS is a useful clinical guide in determining the risk group for appendicitis and the use of additional imaging,and supports the diagnosis even in the high-risk group without additional imaging. However, in cases of incompatibilitybetween USG and PAS values, we believe that close observation, repeated physical examination and, if necessary, furtherimaging are necessary to reduce the rate of negative appendectomy
  • Küçük Resim
    Öğe
    HİDROSEFALİLİ BİR HASTADA VENTRİKÜLOPERİTONEAL ŞANT KATETERİNİN DİSTAL UCUNUN İNGUİNAL HERNİ KESESİNE MİGRASYONU
    (2017) Yüksel, Ulaş; Akgül, Mehmet Hüseyin; Günal, Yasemin Dere; Özmen, İsmail; Bakar, Bülent
    Literatürde ventriküloperitoneal (VP) şant kataterinin intestinal perforasyon, inguinal herni, peritonit gibi abdominal komplikasyonlara neden olabileceği bildirilmiştir. Hidrosefali nedeniyle VP şant takılmış 2 aylık erkek hastanın klinik takibinde, şant ameliyatından otuz gün sonra sol kasığında şişlik saptandı. Yapılan abdominal ultrasonografi ve direkt grafi tetkiklerinde hastanın sol skrotumu içerisinde VP şant kateterinin distal ucunun izlenmesi üzerine hasta Çocuk Cerrahisi Bölümü tarafından değerlendirildi. Hastaya sol inguinoskrotal herni tanısı koyularak ameliyat edildi. Kateter ucu karın içerisine redükte edilerek yüksek ligasyon ile inguinal herni onarımı yapıldı. Hastanın ameliyat sonrası üç aylık takibi sonunda nüks ve/veya komplikasyon izlenmedi. Sonuç olarak VP şant takılan hastalarda inguinoskrotal komplikasyonlar akılda tutulmalıdır. VP şant ameliyatı sonrası kasık bölgesindeki şişlikler inguinal herni açısından değerlendirilmeli ve erken tanı ve tedavi için aile bilgilendirilmelidir.
  • Küçük Resim
    Öğe
    Hirschsprung Hastalığında Transanal Endorektal Pull-through ve Martin-modifiye Duhamel Ameliyatlarının Sonuçlarının Karşılaştırılması
    (2019) Günal, Yasemin Dere; Aslan, Mustafa Kemal; Karaman, Ayşe; Karaman, İbrahim; Erdoğan, Derya; Çavuşoğlu, Yusuf Hakan
    Amaç: Hirschsprung hastalığı (HH) tanısıyla transanal endorektal pull-through (TEPT) ve Martin-modifiye Duhamel ameliyatları yapılmış olan hastalarımızın sonuçlarının karşılaştırması. Gereç ve Yöntem: Kliniğimizde 2002-2007 yılları arasında HH nedeniyle TEPT (grup 1, n=24), transanal yolla başlanıp laparotomi gerektiren endorektal pull-through (grup 2, n=12) ve Martin modifiye Duhamel (grup 3, n=17) uygulanan 53 hasta değerlendirildi. Bu hasta grupları yaş, cinsiyet, aganglionik segment uzunluğu, intraoperatif detaylar, postoperatif erken dönem komplikasyonlar ve uzun dönem fonksiyonel sonuçlar açısından değerlendirildi ve karşılaştırıldı. Bulgular: Çalışmamızda grup 1 hastaların ortalama ameliyat yaşı, ameliyat süresi, oral beslenmeye başlama zamanı, ilk gaita çıkarma zamanı ve hastanede kalış süresi grup 2 ve grup 3 hastalarla karşılaştırıldığında anlamlı olarak az veya kısa bulundu (p<0,001). Ameliyat sırasında kan transfüzyonu ihtiyacı yüzde olarak grup 1 hastalarda daha az olmasına rağmen aradaki bu fark istatistiksel olarak anlamlı bulunmadı (p>0,05). Serimizde postoperatif enterokolit oranı grup 3’te yüzde olarak daha yüksek bulunmasına rağmen aralarındaki bu fark anlamlı bulunmadı (p>0,05). Her üç düzeltici tekniğin uzun dönem fonksiyonel sonuçları (kontinans, fekal soiling, kabızlık) değerlendirilip karşılaştırıldığında aralarında anlamlı bir fark bulunmadı (p>0,05). Sonuç: TEPT tekniği kolay uygulanabilen güvenli bir tekniktir. Özellikle erken dönemde tanı konmuş, enterokolit öyküsü olmayan, henüz bağırsak dilatasyonu gelişmemiş, rektosigmoid tutulumlu HH’lerde TEPT ilk tercih olabilir
  • [ X ]
    Öğe
    Olgu Sunumu: Adölesan Dönemde over Torsiyonu ile Gelen Nadir bir Over Tümörü
    (Kırıkkale Üniversitesi, 2010) Günal, Yasemin Dere; Aslan, Mustafa Kemal; Boybeyı, Özlem; Pınar, Pınar; Özmen, İ.; Soyer, Tutku
    Kız çocuklarında over tümörleri torsiyone olarak akut karın tablosuna neden olabilir. Son yıllarda over torsiyonunda iskemik hasara rağmen overin korunması ve ooferektomi veya salpingoooferektomi yapılmaksızın konservatif tedavi yapılabileceği önerilmektedir. Over kistadenofibromları çocuklarda nadir görülmektedir. Burada kistadenofibrom nedeniyle over torsiyonu olan 16 yaşında kız olgu adölesanlarda over kistadenofibromlarının klinik özellikleri ve tedavi yöntemleri tartışılmak üzere sunulmuştur.
  • Küçük Resim
    Öğe
    Oxidative and histopathological effects of the application of electrosurgical devices to the penile tissue of rats
    (ELSEVIER SCI LTD, 2020) Günal, Yasemin Dere; Boybeyi, Özlem; Atasoy, Pınar; Kısa, Üçler; Aslan, Mustafa Kemal; Bakar, Bülent; Soyer, Tutku
    Introduction This study was performed to evaluate the oxidative and histopathological changes that occur following the application of electrosurgical devices (monopolar or bipolar cautery) to penile tissue. Material and methods Eighteen Wistar albino male rats were randomly distributed into three groups. In the control group (CG, n = 6), all penile tissues were sampled without any additional process following the administration of anesthesia. In the monopolar cautery group (MPG, n = 6), a 15-W cauterization process lasting 5 s was performed on an approximately 2 mm(2) area of the ventral side of the penile shaft, 0.5 cm proximal to the edge of the glans in the midline. Bipolar cautery was practiced in the third group (BPG, n = 6) using the same techniques outlined in the previous statement. Penile tissues consisted of the cautery application area, the edge of the glans, and dorsal side of the penis and were sampled after 90 min; then, histopathological evaluation and biochemical examination involving malondialdehyde (MDA), nitric oxide (NO), and superoxide dismutase (SOD) measurements were performed. Results and discussion Histopathologically, the MPG and BPG demonstrated increased inflammation, fibrosis, and epithelial loss in the urethra in the areas to which cautery was applied as compared to the CG (P < 0.05). The vascular structures of the corpus cavernosa were significantly decreased in the cautery application area of both the MPG and the BPG as compared to the CG (P < 0.05). In the Masson's trichrome stained samples, significant collagen deposition was observed in the cautery application area both in the MPG and the BPG as compared to the CG (P < 0.05). However, S-100 staining was decreased in these groups as compared to the CG (P < 0.05). S-100 staining was also decreased in the MPG as compared to the BPG on the edge of the glans (P < 0.05). Biochemically, MDA values were significantly increased in the MPG as compared to the CG and the BPG (P < 0.05). Conclusion Monopolar and bipolar cautery both did cause oxidative changes and triggered inflammatory, vascular, and peripheral nerve alterations in the cautery application area while bipolar cautery did not cause any distant effects.
  • [ X ]
    Öğe
    The impact of bone marrow-derived mesenchymal stem cells on experimental testiculartorsion in rats
    (NLM (Medline), 2022) Ertürk, Ahmet; Demir, Sabri; Günal, Yasemin Dere; Zengin, Mehmet; Çınar, Miyase; Yıldız, Dinçer; Karahan, Siyami
    BACKGROUND: The aim of this study was to investigate the healing effects of bone marrow-derived mesenchymal stem cells (BMMSCs) on experimental testicular torsion in rats. METHODS: Three groups consisting of 10 Wistar albino rats were created. In Group I, the left testicle was explored and relocated in the scrotum without any attempt to modify it. In Group II, the left testicle underwent torsion for three h and then was detorsed and relocated. In Group III, in addition to torsion and detorsion, BM-MSCs were administered intratesticularly. The rats were sacrificed on the seventh day, and the healing status of the testicles was investigated with histopathological and biochemical analyses. BM-MSC involvement was investigated by immunofluorescence microscopy. Statistical analysis was performed using SPSS 15.0. A p-value < 0.05 was considered statistically significant for all variables. RESULTS: Immunofluorescence microscopy showed that BM-MSCs were located around the Leydig cells in Group III. Under light microscopy, the mean Johnsen Score of Group III was significantly higher than that of Group II (p = 0.035). The interleukin-10 (IL-10) level was significantly higher in Group III compared to Group II (p = 0.003). While the malondialdehyde (MDA) values in Group I (the control group) were lower than in the other groups (p = 0.037), the superoxide dismutase (SOD) values were similar (p = 0.158). Although there was no statistically significant difference between Group II and Group III in terms of MDA, it was lower in Group III. Although the tissue SOD levels were higher in Group III than in Group II, the difference was not statistically significant. DISCUSSION: : This study has demonstrated that BM-MSCs significantly corrected the Johnsen Score and increased anti-inflammatory cytokine levels after testicular torsion. BM-MSCs can be used in testicular torsion as supportive therapy to minimize tissue damage.
  • [ X ]
    Öğe
    ÜÇÜNCÜ BASAMAK BİR HASTANEYE BİR YIL İÇİNDE KÜNT TRAVMA NEDENİYLE BAŞVURAN ÇOCUK HASTALARIN İNCELENMESİ
    (2020) Günal, Yasemin Dere
    Amaç: Bu çalışmanın amacı, künt travma nedeniylehastanemize getirilen bölgemizdeki çocuk hastaların demografiközelliklerini, radyoloji bulguları ve laboratuvar değerleri ileetkilenen organ ya da organlar arasındaki ilişkiyideğerlendirmektir.Gereç ve Yöntemler: Bir yıllık sürede künt travma nedeniylebaşvuran çocuk olguların geriye dönük dosyalarının taranmasısonucu çalışma verileri elde edildi. Olgular yaş, cinsiyet, travmaşekli, yaralanan vücut bölgesi, radyolojik bulgular, yatış sürelerive laboratuvar sonuçları ve mortalite oranları açısındandeğerlendirildi.Bulgular: Çalışmaya künt travma nedeniyle dahil edilen 0-18yaş arası 304 çocuktan 188’i (%62) erkek, 116’sı (%38) kızdı.Yaş grupları içerisinde künt travmaya maruz kalma oranı 1-6yaş aralığında en yüksekti (%36,8). En sık temmuz ve ağustosaylarında başvuru oldu. Yaralanma nedenleri arasında araç içitrafik kazaları ilk sıradaydı ve bunu yüksekten düşme takip etti.Kafa travmasının eşlik ettiği multi-travmalı 6 hasta kaybedildi.Toraks travmaları içinde en sık akciğer kontüzyonu tespit edildi.Pnömotoraks nedeniyle 3 hastaya tüp torakostomi uygulandı.Künt batın travmasında sırasıyla en sık karaciğer, dalak veböbrek yaralanması izlendi. AST ve ALT yüksekliği ileetkilenen organ ve yaralanmanın ciddiyeti arasında istatistikselolarak anlamlı bir ilişki bulunmadı (p>0,05). Hastaların takibisırasında laparotomi ihtiyacı olmadı. Hastaların ortalama yatışsüresi 3,26±0,40 gündü (1 –21 gün). Özellikle kafa travması vetoraks travması birlikte olan hastalarda yatış süresinin uzadığıgörüldü, ancak istatistiksel olarak anlamlı bir fark izlenmedi(p>0,05).Sonuç: Çocuk yaş gruplarında künt travmaların oluş nedenleribölgelere göre farklılıklar göstermektedir ve trafik kazalarınınsık görüldüğü bölgelerde çoklu organ yaralanmalı olgularamüdahale edebilecek ileri travma merkezlerine ihtiyaçduyulmaktadır. Künt karın travmalı hastaların yakın takibigereksiz tanısal girişimler ve eksplorasyonları azaltmaklabirlikte bu hastaların yönetimi için daha ileri travmaprotokollerine ihtiyaç vardır.
  • Küçük Resim
    Öğe
    Yeni Açılan Enürezis Polikliniğinden Ön Çalışma Sonuçları
    (2014) Türer, Özlem Boybeyi; Soyer, Tutku; Özmen, İsmail; Günal, Yasemin Dere; Aslan, Mustafa Kemal
    Amaç: Enürezis (EN) polikliniğinde son bir yılda izleme alınan ve Türkiye Enürezis Kılavuzu (TEK) rehberliğinde tedavisi yapılan hastaların sonuçlarını değerlendirmek amacıyla ileriye dönük bir çalışma planlanmıştır. Gereç ve Yöntemler: EN polikliniğimize başvuran hastaların demogra? k özellikleri, şikayetleri, ? zik inceleme-laboratu- var tetkik sonuçları, uygulanan tedaviler ve takip sonuçları ileri dönük olarak kaydedilmiştir. Bulgular: Olguların yaş ortalaması 8.592.53dır (N59). Erkek/kız oranı 2,9/1dir. Tüm olgular primer ENdir. 38 olguda yalnız gece altını ıslatma şikayeti varken, 21 olguda (%35.6) gündüz semptomu da vardır. Haftada ortalama altını ıslatma sıklığı 5.541.7 gündür. Olguların 21i (%35.6) günde 8den fazla, 7si (%11.9) 3den az idrar yapıyorlardı. Olguların %57.6sında (n34) yetişememe, %49.2sinde (n29) idrar tutma manevrası, %6.8sinde (n4) zorlanma, %18.6sında (n11) idrar yolu enfeksiyonu (İYE) öyküsü, %32.2inde (n19) kabızlık vardı. Fizik inceleme bir olgu dışında normaldi. Tümünde idrar tetkiki normaldi. USG istenen 20 olgunun hiçbirinde patolojik bulgu saptanmadı. Ürodinami yapılan 9 olgunun 4inde aşırı aktif detrusör, 5inde düşük kapasite, 2inde artmış kapasite, 4ünde artmış detrüsör aktivitesi vardı. Üro? ovmetre yapılan 12 olgunun birinde kesintili işeme, birinde Crede manevrası ile işeyebilme vardı. Tüm olgularda davranış düzenlenmesi yapılmış; olguların 20ine desmopressin, 4üne oksibutinin, 1ine alarm, 1ine temiz aralıklı kate- terizasyon, 14üne kombine tedavi başlanmıştır. Tedavinin 15. gününde yapılan ilk kontrolde 18 olgu görülmüş, tedavi cevabı %6625.3 bulunmuştur. Bunların yarısında tedaviye devam edilirken, yarısında desmopressin dozu arttırılmıştır. Birinci ayda kontrolüne gelen 16 olgunun 12sinde tedaviye devam edilmiş, 2inde desmopressin dozu arttırılmış, 2inde tedaviye oksibutinin eklenmiştir. Üç ay tedavisi tamamlanan 7 olgunun 1inde nüks nedeniyle kombine tedaviye yeniden başlanmıştır. Sonuç: Enürezis tedavisi, aile uyumunun önemli rol oynadığı zahmetli bir süreç gerektirmektedir. Çalışmamızdaki olgu- ların yalnız %30.5i takiplere gelebilmiştir. Tedavi etkinliğini değerlendirmek için randomize-kontrollü çalışmalar gerek- mektedir.