Fırat Üniversitesi Hastanesi

OBJECTIVES: This study was designed to determine the utility of semiquantitative strain elastography in differential diagnosis of solid liver masses. METHODS: A total of 103 patients with focal liver masses underwent abdominal sonographic examinations and freehand elastography of focal hepatic lesions. Eighty-two patients (79.7%) with 93 focal hepatic lesions were included in the study. Twenty-one patients (20.3%) were excluded from the study because of technical limitations of semi-quantitative strain elastography and difficulty in detection of normal liver parenchyma on gray-scale sonography. We evaluated different focal hepatic lesions such as hemangiomas, focal nodular hyperplasia, nodular regenerative hyperplasia, adenomas, hepatocellular carcinomas, metastases, and cholangiocarcinomas. The stiffness of the lesions was determined by measurement of strain values on semiquantitative strain elastography. The strain index value (strain ratio of liver parenchyma and focal lesions) of each lesion was calculated. Mean strain index values of benign and malignant liver lesions were compared. RESULTS: The mean strain index value of malignant liver lesions ± SD (2.82 ± 1.82) was significantly higher than that of benign liver lesions (1.45 ± 1.28; P< .0001). Hemangiomas had a significantly lower mean strain index value than other benign lesions (P < .0034). There was no statistically significant difference between strain index values of different types of malignant lesions (P > .05). CONCLUSIONS: Semiquantitative strain elastography may be helpful for differentiating benign and malignant liver masses. The substantial overlap between strain index values of benign and malignant liver masses limits clinical usefulness of this technique.

OBJECTIVE: Very few data are presented in the literature about selenium (Se) in human fetal development. The aim of this paper was to study the relationship between maternal and neonatal Se status and neural tube defects (NTDs). PATIENTS AND METHODS: Serum and hair samples were obtained from 20 nonpregnant women, 32 healthy mothers with normal newborns, and 28 mothers who had a newborn with NTD, and their newborns at delivery. Serum Se levels, as ng/mL, and hair Se levels, as microgram/g, were determined on a Perkin-Elmer 1000 spectrophotometer (United Kingdom) by fluorometry. RESULTS: The mean maternal serum and hair Se concentrations in the NTD group (42.9 +/- 1.75 ng/mL, 277 +/- 7.73 ng/g, respectively) were significantly lower than those of the control healthy mothers (50.2 +/- 2.35 ng/mL, 300 +/- 6.10 ng/g, respectively) and the nonpregnant women (58.1 +/- 3.12 ng/mL, 315 +/- 7.64 ng/g, respectively). A significant decrease in concentrations of Se in serum and hair was observed in newborns with a NTD (26.0 +/- 1.55 ng/mL, 181 +/- 3.71 ng/g, respectively) compared with healthy newborns (32.6 +/- 1.70 ng/mL, 204 +/- 4.43 ng/g, respectively). CONCLUSIONS: Maternal Se deficiency during pregnancy was thought to be one of the factors responsible for NTDs. However, the lowered serum and hair Se concentrations may be secondary manifestations of an abnormal pregnancy and did not contribute to its production. More studies on maternal Se status during the antenatal period, especially early gestation and neonatal Se status including normal newborns and NTD infants, are needed.

AIM: The aim of this study was to investigate ELABELA (ELA) expression in benign and malignant renal tissues and expression differences in different nuclear grades of clear cell carcinomas. MATERIALS AND METHODS: Patients that underwent surgery due to renal masses between the years of 2007 and 2017 were used. Control renal tissues (n = 23), papillary RCC (n = 23), clear cell RCC (CcRCC) [Fuhrman Grade1 (n = 23), Fuhrman Grade2 (n = 23), Fuhrman Grade3 (n = 23), Fuhrman Grade4 (n = 23)], and chromophobe RCC (n = 23) were included to the study. The Independent samples t-test was used for 2-point intergroup assessments and the one-way analysis of variance and posthoctukey test was used for the others. Values of P < 0.05 were considered statistically significant. RESULTS: ELA immunoreactivity was observed in proximal and distal tubules in the kidney, but not in glomeruli in control tissues. When compared with control kidney tissue, a statistically significant increase was observed in ELA immunoreactivity in renal oncocytoma. In the chromophobe RCC, ELA immunoreactivity was significantly lower than control kidney tissue, whereas papillary RCC did not show ELA immunoreactivity. However, compared with control kidney tissue, ELA immunoreactivity was not observed in Fuhrman Grade 1 and Grade 2 CcRCC. Also, there was a significant decrease at Fuhrman Grade 3 and Grade 4 CcRCC compared with control kidney tissues. In the statistical analysis of ELA immunoreactivity among the Fuhrman nuclear grades of CcRCCs, The ELA immunoreactivity was higher at Grade 4 CcRCC than Grade 1, Grade 2, and Grade 3. CONCLUSION: ELA is a usefull molecule to differentiate benign and malign renal tumors. But further broad and comprehensive studies are needed to investigate cellular and molecular mechanisms of ELAs on malign transformation.

OBJECTIVE: Colon adenocarcinomas are the most common malignancy of the gastrointestinal tract. Many factors are described in the prognosis. Herein we aimed to determine the relationship between signal transducer and activator of transcription 3(STAT3), B-cell lymphoma-extra large (Bcl-xL) and matrix metalloproteinase-2 (MMP-2) expression in colon adenocarcinomas and their relationship with prognostic factors. MATERIAL AND METHOD: A total of 45 colon adenocarcinomas (15 well, 15 moderately, 15 poorly differentiated) and 15 normal colon mucosa samples were selected randomly. The STAT3, Bcl-xL and MMP-2 immunohistochemicals were applied to the samples. RESULTS: There was a significant difference between the normal mucosa and carcinoma group regarding the STAT3 staining diffuseness and intensity (p < 0.05), but not for Bcl-xL (p > 0.05). The intensity of MMP-2 significantly differed between the normal mucosa and the carcinoma group (p < 0.05). The diffuseness of STAT3 and the intensity of MMP2 showed a significant association with the degree of differentiation (p < 0.05). The intensity and diffuseness of BcL-xL did not show a relationship with the degree of differentiation (p > 0.05). Evaluation of the diffuseness and intensity of the three markers with lymph node metastasis and tumor size revealed that only MMP2 diffuseness had a negative correlation with tumor size (r= -0.318). CONCLUSION: We observed that Bcl-xL does not have a role in the diagnosis of colon adenocarcinomas or the detection of the degree of differentiation, a prognostic factor, but such a relationship was observed for STAT3 and MMP-2.

A 39-year-old female patient presented to our hospital with epigastric pain lasting for two months. Laboratory results showed impaired glucose tolerance. Ultrasonography of the patient showed a hypoechoic, diffusely enlarged pancreas. CT revealed a large pancreas, with multiple calcifications. On MRI, a diffusely enlarged pancreas was seen hypointense on both T1- and T2-weighted images with heterogeneous enhancement after gadolinium administration. A biopsy of the pancreas revealed primary amyloidosis of islet cells. Decreased signal on T1-weighted images without inflammation findings on CT and MRI were clues for the diagnosis.

AIM: To determine gastric tissue lactoferrin (Lf) levels of Helicobacter pylori- (Hp-) positive and -negative patients and its effect on anemia. METHODS: Cases in which initial presentation was of abdominal pain and that were Hp-positive at endoscopy were included. Hp-positive cases and -negative controls were divided into two groups. RESULTS: The study included 64 cases (average: 10.2 ± 0.4 years, 39 male and 25 female). Lf levels were subsequently studied on 61 cases. 45 (73.8%) of these were Hp-positive, while 16 (22.2%) were Hp-negative. In Hp-positive cases, mean staining percentages and density of glands in the antral mucosa were 45.5 ± 4.7% and 1.9 ± 0.1, respectively. Hp-negative cases showed significantly different values of 17.8 ± 4.5% and 1.3 ± 0.2, respectively. Hemoglobin and serum ferritin values of Hp-positive cases were 12.7 ± 0.2 g/dL and 32.5 ± 2 ng/mL, but these were comparable with Hp-negative cases (12.6 ± 0.1 g/dL and 30.7 ± 4.4 ng/mL). CONCLUSIONS: Tissue Lf was significantly higher in Hp-positive cases compared to Hp-negative cases, but no difference was observed between the two groups with regards to hemoglobin and ferritin level. As a result, it is difficult to say that this rise in Lf plays a role in the development of iron deficiency anemia in Hp-positive patients.

Department of Neurology, Faculty of Medicine, Fırat Üniversitesi Hastanesi, Nöroloji Servisi, Elazig, Turkey [email protected]

OBJECTIVE: Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) enzyme levels were investigated in patients with epilepsy, epileptic seizure, remission period, and healthy individuals. METHODS: Three main groups were evaluated, including epileptic seizure, patients with epilepsy in the non-seizure period, and healthy volunteers. The patients having a seizure in the Emergency department or brought by a postictal confusion were included in the epileptic attack group. The patients having a seizure attack or presenting to the Neurology outpatient department for follow up were included in the non-seizure (remission period) group. RESULTS: The UCH-L1 enzyme levels of 160 patients with epilepsy (80 patients with epileptic attack and 80 patients with epilepsy in the non-seizure period) and 100 healthy volunteers were compared. Whereas the UCH-L1 enzyme levels were 8.30 (IQR=6.57‒11.40) ng/mL in all patients with epilepsy, they were detected as 3.90 (IQR=3.31‒7.22) ng/mL in healthy volunteers, and significantly increased in numbers for those with epilepsy (p<0.001). However, whereas the UCH-L1 levels were 8.50 (IQR=6.93‒11.16) ng/mL in the patients with epileptic seizures, they were 8.10 (IQR=6.22‒11.93) ng/mL in the non-seizure period, and no significant difference was detected (p=0.6123). When the UCH-L1 cut-off value was taken as 4.34 mg/mL in Receiver Operating Characteristic (ROC) Curve analysis, the sensitivity and specificity detected were 93.75 and 66.00%, respectively (AUG=0.801; p<0.0001; 95%CI 0.747‒0.848) for patients with epilepsy. CONCLUSION: Even though UCH-L1 levels significantly increased more in patients with epilepsy than in healthy individuals, there was no difference between epileptic seizure and non-seizure periods.

The study was done in order to determine stigmatization level of young women in sexual health and reproductive health.

Ama: Reprodktif adaki kadnlarda riner inkontinans (UI) prevalansn, UI'nn alt tipleri olarak stres (SUI), urge (UUI) ve miks (MUI) inkontinans oranlarn ve buna etki eden faktrleri aratrmak.

Amaç: Yoğun bakım ünitelerinde yatan hastaların çeşitli klinik örneklerinden izole edilen Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa ve Acinetobacter baumannii’nin dağılımlarının, ilaç direnç oranlarının ve bu oranların yııllara göre değişiminin saptanması, böylece akılcı antibiyotik uygulaması ve direncin önlenmesine katkı sağlanması amaçlanmıştır. Gereç ve Yöntemler: İzole edilen suşların kolistin, tigesiklin, meropenem, imipenem ve trimetoprim-sülfametoksazol direnç oranları retrospektif olarak incelenmiştir. Üreyen bakterilerin identifikasyonu ve antibiyotik duyarlılık testleri VITEK 2 Compact ve MicroScan WalkAway 96 otomatize sistemi (kolistin için mikrotüp dilüsyon ) kullanılarak belirlenmiş ve Clinical and Laboratory Standards Institute (CLSI) önerilerine göre değerlendirilmiştir. Bulgular: Yoğun bakım ünitelerinde en sık gözlenen mikroorganizma A. baumannii (%57.2) olarak saptanmıştır. Hastane enfeksiyonu olarak ventilatörle ilişkili pnömoni (%94.1), santral venöz kateterle ilişkili kan dolaşım enfeksiyonu (%45.2) ve kateter ilişkili üriner sistem enfeksiyonu (%44) görülmüştür. A.baumannii, P.aeruginosa ve K.pneumoniae’da meropenem, imipenem ve trimetoprim-sülfametoksazol direnç oranları yüksek bulunmuştur. Tüm mikroorganizmalara karşı en düşük direnç oranına sahip antibiyotiğin kolistin olduğu saptanmıştır. Sonuç: En yüksek duyarlılığa sahip antimikrobiyalin kolistin olması nedeniyle özellikle çok ilaca dirençli suşlara karşı kolistin tek başına veya diğer antibiyotiklerle kombine olarak kullanılabilir. E.coli’de karbapenemler ve trimetoprim-sülfametoksazol duyarlı suşlarda kullanılabilir. Antibiyotik duyarlılık test sonuçlarına göre tedavi başlanması ve düzenli sürveyans takibinin yapılması, yoğun bakım ünitelerinde uygun antibiyotik kombinasyonları seçilmesine ve dirençli mikroorganizmaların azaltılmasına katkı sağlayacaktır.

INTRODUCTION: We describe upper-extremity reconstruction after proximal humeral bone loss by means of glenohumeral arthrodesis using a vascularized fibular graft and double plate fixation. STEP 1 PREOPERATIVE EVALUATION AND PLANNING: Use preoperative imaging to estimate the length of the humeral defect, the absence or presence of a glenoid defect, and the available length of fibular graft. STEP 2 POSITION THE PATIENT: Place the patient in the beach-chair position, securing him/her with side supports. STEP 3 EXPOSE AND PREPARE THE SHOULDER: The approach is a typical anterior approach to the shoulder following an anterolateral approach to the humeral shaft. STEP 4 HARVEST THE FIBULAR GRAFT: Harvest the full length of the fibula, after leaving 6 cm proximally and distally for ankle and knee stability. STEP 5 PREPARE THE HUMERUS AND RECIPIENT VESSELS IN THE UPPER ARM: Ream the humeral medullary canal by hand to avoid fracture and prepare the profunda brachii or brachial artery as recipient vessels. STEP 6 INSERT THE FIBULA INTO THE PROXIMAL PART OF THE HUMERUS AND COMPLETE THE VASCULAR ANASTOMOSIS: Insert the bare osseous fibula into the humeral canal, pass the graft pedicle through the loose tunnel, and anastomose the vessels. STEP 7 DOUBLE PLATE FIXATION: It is very important to bend the lateral plate to match the contour of the osseous surfaces. STEP 8 FOLLOW-UP AND REHABILITATION: Immobilize the shoulder until union is achieved and then start scapula-thoracic exercises. RESULTS: We recently reported on a retrospective series of nine shoulder arthrodeses performed with use of a free vascularized fibular graft. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.

Olfactory reference syndrome (ORS) is a rare disorder in which the affected person is excessively preoccupied by the concern that their body emits very unpleasant odors and believes people have negative reactions to this perceived fault. In literature, several ORS cases, successfully treated by pimozide and risperidone, have been reported, though no report was found about quetiapine-treated ORS. Here, we report a case treated with quetiapine involving a man who believed that he emitted the odor of feces. Ketiyapin ile tedavi edilen olfaktör referans sendromlu bir olgu sunumu Olfaktör referans sendromu (ORS) kişinin kendi bedeninin çok kötü bir koku yaydığına ve bu kötü koku yüzünden insanların kendisi hakkında olumsuz fikirler taşıdığına inandığı, bununla ilgili aşırı bir zihinsel meşguliyet içinde olduğu, nadir görülen bir ruhsal bozukluktur. Literatürde pimozid ve risperidon ile tedavi edilmiş ORS’li olgular bildirilmektedir. Ancak ketiyapin ile tedavi edilen bir olguya rastlanılmamıştır. Olgumuzda vücudundan gaita kokusu yayıldığı ile ilgili hezeyanı bulunan bir hastanın ketiyapin ile tedavisi sunulmuştur.

Introduction: Spinal anesthesia is usually preferred for short-time surgery; the side effects of the process can show difference with techniques. We aimed to compare early and late complications of median and paramedian techniques in spinal anesthesia.Methods: Eighty patients with American Society of Anesthesiologists (ASA) I–III were allocated into the following two groups: Group M (median) and Group P (paramedian). Demographic data of the patients, ASA score, number of spinal anesthesia application, total surgery time, discharge time from the hospital, heart rate, mean arterial blood pressure, and early complications were recorded from the medical records of patients. Late complications of patients were learned by calling.Results: The number of applying spinal anesthesia number and the duration of anesthesia were longer in Group P than in Group M, and the difference was statistically significant (p<0.05). Fifty-two early complications and 23 late complications were observed. The common early complication (21%) was hypotension, and late complication (8.7%) was post-spinal headache (Group P, six patients; Group M, one patient); there was no difference between the groups.Conclusion: There was no significant difference in complications of spinal anesthesia applied via both technical approaches and discharge in short-continuance surgical cases. Although we defined a tendency for post-spinal headache in Group P, there was no statistically significant difference in our study.

The rate of deaths due to firearms is gradually increasing in our country and worldwide. Considering all medicolegal deaths, deaths due to firearms constitute a significant proportion. The purpose of our study is to determine general characteristics of death cases due to firearms and to compare them with similar studies.120 cases (14.3%) who were determined to be died due to firearms out of 838 cases that were undergone death examination and autopsy between 2010-2012 in Fırat University Hospital, Department of Forensic Medicine in Elazig were retrospectively evaluated. These cases were assessed based on the parameters such as age, sex, origin, type of gun used, shooting distance, number of entry, localization of wound, place of event and time of the event. 102 (85%) of the cases were men and 18 (15%) were women. Mean age was 31.58±14.34, including 9 years as the youngest and 86 as the oldest. It was observed that deaths occurred within 20-29 age group (45.8%), during May (14.2%) and summer (30.8%) more often. While the most frequent origins were terror (32.2%) and suicide (32.2%), other reasons were murder (27.3%) and accidental death. It was also observed that 81 of the cases (66.1%) had single entry hole and deaths were mostly due to head-neck injury (37.5%).Deaths due to firearms constitute an important part of criminal deaths occurring in our region. When compared with the data from Turkey and the world, some differences associated with regional factors are observed such as terror and sociocultural characteristics. We suggest that use of unlicensed guns should be avoided, special care should be given to medical examination and licensing criteria before the issue of gun licences and society should be educated in order to decrease death rates due to firearms.Key words: Firearm injury, autopsy, suicide

Objective: This study was aimed to evaluate the parasitic diseases in patients brought to Firat University Animal Hospital (FUAH) between 1972 and 2019. Methods: Patient records between 03.31.1972 and 06.02.1982 and between 04.24.2012 and 15.09.2019 in the archive of FUAH were checked. Results: In the mentioned period, 50.17% of the patients that applied to FUAH were cattle, 18.42% were dogs, 13.04% were horses, 10.7% were sheep, 3.26% were cats, 3.18% were goats, and 1.2% were other animals (rabbit, ornamental birds, donkey, and chicken). In this period, various parasitic diseases were detected in 1.411 (3.83%) of a total of 36,763 patients brought to FUAH. Considering the distribution of parasitic diseases according to animal species, the most ascariosis cases (46.19%) were detected in horses, followed by strongylosis and strongylosis+ascariosis mixed infections. In the second phase, dogs had the highest cases of ascariosis (43.07%), followed by scabies and coccidiosis. While ectoparasites, such as lice, fleas, and ticks, were encountered in a lesser ratio, leishmaniasis, a zoonotic infection, was also observed. In cattle, 41.95% of the parasitic diseases diagnosed were theileriosis, followed by coccidiosis, babesiosis, and leech cases. Conclusion: The results of this study reveal that the variety of parasitic diseases changes with season and that control strategies should be diversified with this situation. Amaç: Bu çalışmada, 1972-2019 yılları arasında Fırat Üniversitesi Hayvan Hastanesi’ne (FÜHH) getirilen hastaların paraziter hastalıklar yönünden değerlendirilmesi amaçlanmıştır. Yöntemler: Bu amaçla, FÜHH arşivindeki, 31.03.1972 ile 02.06.1982 tarihleri ve 24.04.2012 ile 15.09.2019 tarihleri arasındaki hasta kayıtları kontrol edilmiştir. Bulgular: Bahsi geçen dönemde FÜHH’ne başvuran hastaların %50,17’si sığır, %18,42’si köpek, %13,04’ü at, %10,7’si koyun, %3,26 kedi, %3,18’i keçi ve %1,2’si diğer hayvanlardan (tavşan, süs kuşları, eşek, tavuk) oluşmaktadır. Bu süreçte FÜHH’ne getirilen 36.763 hastanın 1,411’inde (%3,83) çeşitli paraziter hastalıklar tespit edilmiştir. Hayvan türlerine göre paraziter hastalıkların dağılımına bakıldığında atlarda en çok ascariosis (%46,19) olgusu tespit edilmiş olup, bunu strongylosis ve strongylosis+ascariosis miks enfeksiyonları takip etmiştir. İkinci sırada en yüksek ascariosis (%43,07) olgusuna sahip olan tür köpekler olup bunu uyuz ve coccidiosis takip etmiştir. Daha az oranda da bit, pire ve kene gibi ektoparazitlere rastlanırken, az da olsa zoonoz bir enfeksiyon olan leishmaniasis de görülmüştür. Sığırlarda teşhis edilen paraziter hastalıkların ise %41,95 oranında theileriosis olduğu tespit edilmiş ve bunu coccidiosis, babesiosis ve sülük olguları izlemiştir. Sonuç: Çalışmanın sonuçları göstermektedir ki, mevsimsel değişikliklerle birlikte paraziter hastalıkların çeşitliliği de değişmektedir ve bu durumla birlikte kontrol stratejileri de çeşitlendirilmelidir.

Purpose:The aim of this study was to determine the fear of birth and coping methods of pregnant women. Patients and Methods:Methods : The study was descriptive and the sample of the study consisted of 619 pregnant women who applied to XXXXX State Hospital on 15 April-20 September 2019. The data of the study was collected with descriptive characteristics form, Wijma Delivery Expectancy/Experience Questionnaire and Brief COPE scale. Data were evaluated with numerical value, percentage, One-Way ANOVA, Indentpendent Samples t-test, and Pearson correlation. Level of significance was accepted as p <0.05. Results:It was found that 96.0% of the women stated that they willingly became pregnant. Mean Wijma Delivery Expectation/Experience Questionnaire of the pregnant women who participated in the study was 41.53±12.49. It was found that 40.1% of pregnant women had low level of birth fear and 56.5% had moderate level of birth fear. It was found that the mean scores of Wijma Expectation/Experience Scale of pregnant women who were unwillingly pregnant were significantly higher than the mean scores of pregnant women who were willingly pregnant. Positive reinterpretation, using instrumental social support, inclination to religion, acceptance and planning were found to be negatively correlated with Wijma Birth Expectation/Experience Scale-A Version. Conclusion:It was found that more than half of the pregnant women had moderate and severe birth fear. In the study, a negative relationship was found between the fear of birth and some sub-dimensions of the Coping Styles Scale

Abstract Purpose: To evaluate the effect of digoxin on oxygen-induced retinopathy (OIR) model and compare the results with bevacizumab treatment. Methods: Twenty-eight newborn Sprague-Dawley rats were randomly divided into four groups:control group, normoxia+intraperitoneal (ip) normal saline (NS); OIR group, OIR+ip NS; OIR+digoxin group, OIR+ip 0.1 mg/kg of digoxin; and OIR+bevacizumab group, OIR+ip 2.5 mg/kg of bevacizumab. The rats were exposed to 50% oxygen for 24 h, followed by 10% oxygen for 24 h, to induce OIR. This cycle was repeated seven times until 14 days postnatal (P). In all groups, single-dose injections were administered on P15 th day. Histopathological and immunohistochemical examinations were performed at the end of the study. Results: The mean neovascular cell nuclei counts (NVCN) of the four groups were 9.00±3.16, 41.80±11.44, 19.38±2.20, and 16.00±2.62. The mean NVCN count was significantly reduced in the treatment groups compared to the OIR group (p&lt;0.001). The mean NVCN count was similar between the treatment groups (p=0.078). In immunohistochemical staining, the immunoreactivity values of the vascular endothelial growth factor (VEGF) were 0.01±0.00, 1.65±0.30, 0.09±0.08, and 0.04±0.02, and the tumor necrosis factor alpha (TNF-α) values were 0.10±0.00, 1.12±0.18, 0.18±0.13, and 0.14±0.05. In the OIR group, VEGF and TNF-α immunoreactivity increased markedly compared to the control group (p&lt;0.001). VEGF and TNF-α immunoreactivity of the treatment groups decreased significantly compared to the OIR group (p&lt;0.001). VEGF and TNF-α immunoreactivity were similar between the treatment groups (VEGF:p=0.752; TNF-α:p=0.099). Conclusions: Retinal neovascularization was significantly suppressed by digoxin treatment, and this effect was comparable to bevacizumab in the OIR model.

Auto-vampirism is a rare behavioral disorder in which a person sucks her/his own blood. The remarkable finding occurring in psychotic disorders such as schizophrenia but it can be seen in other psychiatric diseases. Personality disorders are also one of these diseases. Borderline personality disorder is a personality disorder characterized by imbalance in interpersonal relationships and mood, suicidal behavior, self-confusion and impulsivity. Impulsivity is one of the diagnostic criteria of borderline personality disorder. In this article we aimed to mention a patient, applying to us with complaints of self mutilation and after giving pleasurable blood sucking behaviour, diagnosed with borderline personality disorder accompanied by auto-vampirism and improvement in her clinical course with psychotherapy and psychopharmacological treatment method.

Background: In cerebral ischemia; there are many factors which start cases which cause the cell death. Major mechanism which is involved in hypoxic-ischemic brain injury (HIBI) is glutamate receptor-mediated neurotoxicity. Memantine is non-competitive NMDA antagonist blocker. Clopidogrel is agent that is used because of the characteristics of the antiplatelet in the treatment of ischemic stroke. Our aim is to investigate the effect of clopidogrel and combination of memantine on HIBH. Methods: Study was made the five groups of 7 rats in each group. Sprague-Dawley rats for 10 minutes were exposed to hypoxia by ligation of bilateral common carotid artery. Afterwards, as randomized it was divided into; control, ischemia, memantine (IM), clopidogrel (IC) and memantine + clopidogrel (IMC). Drugs were administered for a period of five days and all the rats were sacrificed. In brain tissue, malondialdehyde (MDA), total antioxidant status (TAS), total oxidant (TOS) values were determined and oxidative stress index (OSI) was detected. Results: In the group which was performed ischemia, MDA and TOS values were significantly higher than the control group. Treatment groups, MDA, TOS and OSI values were significantly lower in the group of ischemia. However, it was not statistically significant although the effect of combined treatment on TOS and OSI was less than IM and IC groups. Conclusions: We found that memantine and clopidogrel treatment reduces oxidative stress in HIBH but the combined treatment is less effective in reducing oxidative stress. Because of the potential pharmacokinetic mechanisms, combined therapy is less effective in reducing oxidative stress.