The nutcracker syndrome (NCS) depends on mesoaortic compression of the left renal vein. It has different clinical entities.
This study aimed to examine different clinical aspects of NCS.
This was a retrospective and descriptively designed study. The patients with abdominal pain, flank pain, or scrotal pain
admitted to the Urology and General Surgery outpatient clinic between January 2014 and May 2016 were reviewed. All
data were examined descriptively. Urologic and general surgical examinations were performed individually by a urologist
and a general surgeon. The abdominal ultrasonography and computed tomography findings, blood pressure, white blood
cell count, bilirubin tests, and urine tests were recorded.
Patients with inconsistent diagnostic data or missing outcomes were excluded. Five patients were diagnosed with NCS
on scanning 134 patients. The mean age was 24 years (20–33 years). The first patient had left lower quadrant pain. The
second patient also had left lower quadrant pain with microscopic hematuria and a mild increase in the total bilirubin level
(1.84 mg/dL). The third patient presented left testicular pain and hypertension (160/100 mm Hg). Consequently, left side
varicocele was found on physical examination and Doppler ultrasound. The fourth patient had leukocytosis (11,900), a
mild increase in total bilirubin level (1.73 mg/dL), and left and right lower quadrant pain.
The radiological and laboratory entities must be taken into consideration with clinical findings for correct diagnosis
because NCS may have different symptoms.

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Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative hematological malignancy accompanied by a
Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative hematological malignancy accompanied by a
monoclonal proliferation of mature B lymphocytes. Vitamin D is vital in calcium hemostasis in serum and skeletal system
and is involved in several other cellular processes such as differentiation, proliferation, apoptosis, and angiogenesis.
Vitamin D receptors were also demonstrated in normal or malignant hematopoietic cells. The correlation of low serum
vitamin D levels with colorectal, breast, and other solid-organ neoplasms is well known. With regard to CLL, vitamin D
inadequacy is related to bad prognosis, bad overall survival, and necessity to start treatment early. This study aimed to
compare vitamin D levels of patients with early-stage CLL and controls and to examine its relationship with prognostic
indicators.
The study included 33 patients with early-stage CLL treated at Atatürk Training and Research Hospital Hematology Clinic
between 2015 and 2017 and 34 healthy controls. Age and gender distribution in both groups was similar. Patients with <20
ng/mL vitamin D level were considered as vitamin D deficient.
Vitamin D deficiency was detected in 26/33 patients with CLL and 16/34 controls. A statistically significant difference in
vitamin D deficiency was found between these two groups (P = 0.003). CLL cases were compared in terms of RAI stage,
splenomegaly, hepatomegaly, and presence of B symptoms. However, no significant difference was observed.
This study demonstrated that vitamin D levels of patients with early-stage CLL were significantly low in comparison with
those of healthy population, in line with the literature. More comprehensive studies are required for assessing the effects
of low vitamin D levels on the prognosis of patients with early-stage CLL.

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The most important risk factor for morbidity and mortality among patients with cardiovascular diseases undergoing
surgery under anesthesia is hypertension (HT). Objective: This study aimed to investigate the prevalence and awareness
of HT during preoperative evaluation. It was a descriptive and cross-sectional study. A total of 392 patients aged more
than 30 years were included in the preoperative evaluation of the study. Results: The blood pressure levels of the patients
were 8.1% optimum, 10.1% normal, 14.9% higher normal, 15.4% Stage 1 HT, 15.9% Stage 2 HT, 15.9% Stage 3 HT, and
18.7% isolated systolic HT. It was found that 63.6% of the 261 patients with high blood pressure were not diagnosed with
HT and did not use any antihypertensive drugs. Hence, it was accepted that these patients were not aware of HT. Further,
it was found that 42% of the patients were diagnosed with HT and received antihypertensive treatment. It was assumed
that these patients were aware of HT.
Conclusions: Optimal clinical evaluation in the preoperative period in patients requiring surgical intervention may
contribute to the reduction of perioperative morbidity through early diagnosis and treatment of HT and end-organ damage.

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Iron is an important mineral for the human body. In case of iron deficiency, problems in energy production and utilization
occur. The energy required during exercise, and therefore the performance, is related to body iron levels. This study
was performed to determine the relationship between isokinetic muscle strength and serum iron and ferritin levels. A
total of 278 nonanemic elite athletes were included in the study. Serum iron and ferritin levels were determined, and
the relationship between these levels and the results of isokinetic muscle strength measurements was investigated using
Spearman correlation test. The relationship between the serum iron levels and isokinetic muscle strength was found to
be statistically negligible (P > 0.05). However, ferritin levels were correlated with isokinetic muscle strength values (P <
0.05). In conclusion, iron was found to be associated with performance in athletes without anemia.

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Rhabdomyolysis is an acute progressing disorder that may cause acute kidney injury due to the release of muscle
breakdown products into the bloodstream. Muscle breakdown caused by multiple trauma, crush injury, infection, drugs,
or epilepsy can lead to rhabdomyolysis. A delayed diagnosis or treatment may result in adverse outcomes and even death.
This study aimed to present a case of rhabdomyolysis following intense exercise.

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Axillary artery pseudoaneurysms are extremely rare. A 25-year-old male patient presented with pulsatile swelling that
occurred 1 year after the injury of the left underarm, and left-sided pain, weakness, and difficulty in controlling the left
hand. He had left axillary region with 7 x 5 x 3 cm3 pulsatile firm consistency, left hand 4/5 and left arm 3/5 power loss,
left hand holding no objects, and left arm not lifting up to the shoulder level. Color Doppler ultrasonography revealed
left axillary artery pseudoaneurysm with dimensions of 56 x 33 mm2 and luminal thrombosis about 40%. Axillary artery,
vein, and nerve suspension were taken after the left axillary artery was found and rotated. The organized thrombus within
the sac was removed. Subsequently, aneurysmectomy and axillary artery primer repair were completed. This study aimed
to discuss successful surgical repair and physiotherapy that started in the early period in the case that the arm and hand
movement limitations were eliminated.

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