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Year 2013, Volume: 26 Issue: 1, 30 - 33, 30.09.2015

Abstract

Objective: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder of flexible joints with unknown etiology, which affects 1% of the world’s population. The aim of this 2010 study was to investigate the association between the level of education, tonsillectomy and appendectomy in the patients’ history with RA. The study was carried out in Hamedan City, in the West of Iran. Patients and Methods: As a patient-control study, information from 128 patients and 130 controls, matched for age and gender, was collected by questionnaires and physical exams with the consent of both patients and controls, followed by an SPSS statistical analysis (Pearson’s Chi-Square test). Results: In patient and control groups, there were 116 and 117 females, respectively, and the rest were males. Statistical analysis showed that there is no significant association between level of education or tonsillectomy with RA (p>0.05), whereas appendectomy was significantly associated inversely with the risk of RA (p < 0.05). Conclusion: Considering previous global investigations on this topic with different results and the results of our study, it seems that more studies are needed to determine the definitive association between level of education, tonsillectomy and appendectomy with the risk of RA

References

  • 1. Kallbeg H, Padyukov L, Plenge RM, et al. Gene–gene and gene– environment interactions involving HLA-DRB1, PTPN22, and smoking in two subsets of rheumatoid arthritis. Am J Hum Genet 2007; 80:867–75. doi: 10.1086/516736
  • 2. Kobayashi S, Momohara S, Kamatani N, Okamoto H. Molecular aspects of rheumatoid arthritis: Role of environmental factors. The FEBS J 2008;275:4456–62. D oi: 10.1111/j.1742-4658.2008.06581.x
  • 3. Padyukov L, Silva C, Stolt P, Alfredsson L, Klareskog L. A gene– environment interaction between smoking and shared epitope genes in HLA-DR provides a high risk of sero-positive rheumatoid arthritis. Artritis Rheum 2004;50:85–92. doi:10.1002/art.20553
  • 4. Stolt P, Bengtsson C, Nordmark B, et al. Quantification of the influence of cigarette smoking on rheumatoid arthritis: Results from a population based case-control study, using incident cases. Ann Rheum Dis 2003;62: 835–41. doi: 10.1136/ard.62.9.835
  • 5. Balandraud N, Meynard, JB, Auger I, et al. Epstein-Barr virus load in the peripheral blood of patients with rheumatoid arthritis: Accurate quantification using real-time polymerase chain reaction. Arthritis Rheum 2003;48:1223–8. doi: 10.1002/art.10933
  • 6. Balandraud N, Roudier J, Roudier C. Epstein-Barr virus and rheumatoid arthritis. Autoimmun Rev 2004;3: 362–7. doi:10.1016/j. autrev.2004.02.002
  • 7. Posnett DN. Herpes viruses and autoimmunity. Curr Opin Invest Dr 2008; 9: 505–14.
  • 8. Heliovaara M, Aho K, Knekt P, Impivaara O, Reunanen A, Aromaa A. Coffee consumption, rheumatoid factor, and the risk of rheumatoid arthritis. Ann Rheum Dis 2000;59: 631–5. doi:10.1136/ard.59.8.631
  • 9. Karlson EW, Mandl LA, Aweh GN, Grodstein F. Coffee consumption and risk of rheumatoid arthritis. Arthritis Rheum 2003;48:3055-60. doi:10.1002/art.11306
  • 10. Mikuls TR, Cerhan JR, Criswell LA, et al. Coffee, tea, and caffeine consumption and risk of rheumatoid arthritis: Results from the Iowa Women’s Health Study. Arthritis Rheum 2002;46: 83–91. doi: 10.1002/1529-0131(200201)46:1<83::AID-ART10042>3.0.CO;2-
  • 11. Cerhan JR, Saag KG, Criswell LA, Merlino LA, Mikuls TR. Blood transfusion, alcohol use, and anthropometric risk factors for rheumatoid arthritis in older women. J Rheumatol 2002;29:246–54.
  • 12. Symmons DP, Bankhead CR, Harrison BJ, et al. Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis: Results from a primary care-based incident case-control study in Norfolk, England. Arthritis Rheum 1997;40: 1955–61. doi: 10.1002/ art.1780401106
  • 13. Jawaheer D, Lum RF, Gregersen PK, Criswell LA. Influence of male sex on disease phenotype in familial rheumatoid arthritis. Arthritis Rheum 2006;54: 3087–94. doi:10.1002/art.22120
  • 14. Heikkilä R, Aho K, Heliövaara M, et al. Serum androgen-anabolic hormones and the risk of rheumatoid arthritis. Ann Rheum Dis 1996;57: 281–5. doi: 10.1136/ard.57.5.281
  • 15. Ariza-Ariza R, Mestanza-Peralta M, Cardiel MH. Omega-3 fatty acids in rheumatoid arthritis: an overview. Semin Arthritis Rheu 1998;27: 366–70. doi: 10.1016/S0049-0172(98)80016-4
  • 16. Cutolo M, Otsa K, Uprus M, Paolino S, Seriolo B. Vitamin D in rheumatoid arthritis. Autoimmun Rev 2007;7: 59–64. doi:10.1093/ rheumatology/ken394
  • 17. Okamoto H, Shidara K, Hoshi D, Kamatani N. Anti-arthritis effects of vitamin K(2) (menaquinone-4): A new potential therapeutic strategy for rheumatoid arthritis. The FEBS J 2007;274: 4588–94. doi:10.1111/ j.1742-4658.2007.05987.x
  • 18. Strusberg I, Mendelberg RC, Serra HA, Strusberg AM. Influence of weather conditions on rheumatic pain. J Rheumatol 2002; 29: 335–8.
  • 19. Vergés J, Montell E, Tomàs E, et al. Weather conditions can influence rheumatic diseases. Proc West Pharmacol Soc 2004;47:134–6.
  • 20. Eftekharian M M, Basiri Z, Mani Kashani KH. A study of the association between smoking and rheumatoid arthritis. J Smok Cess 2010;5: 1-6. doi: 10.1375/jsc.5.1.1
  • 21. Criswell LA, Merlino LA, Cerhan JR, et al. Cigarette smoking and the risk of rheumatoid arthritis among postmenopausal women: Results from the Iowa Women’s Health Study. Am J Med 2002;112: 465–71. doi:10.1016/S0002-9343(02)01051-3
  • 22. Heliövaara M, Aho K, Aromaa A, Knekt P, Reunanen A. Smoking and risk of rheumatoid arthritis. J Rheumatol 1993;20: 1830–5.
  • 23. Hutchinson D, Shepstone L, Moots R, Lear JT, Lynch MP. Heavy cigarette smoking is strongly associated with rheumatoid arthritis (RA), particularly in patients without a family history of RA. Ann Rheum Dis 2001;60: 223–7. doi:10.1136/ard.60.3.223
  • 24. Karlsson EW, Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH. A retrospective cohort study of cigarette smoking and risk of rheumatoid arthritis in female health professionals. Arthritis Rheum 1999;42: 910–7. doi:10.1002/1529-0131(199905)42:5<910
  • 25. Klareskog L, Stolt P, Lundberg K, et al. A new model for an etiology of rheumatoid arthritis: Smoking may trigger HLA-DR(shared epitope)- restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 2006;54: 38–46. doi:10.1002/art.21575
  • 26. Krishnan E, Sokka T, Hannonen P. Smoking-gender interaction and risk for rheumatoid arthritis. Arthritis Res Ther 2003;5:R158–62. doi:10.1186/ar750
  • 27. Mattey DL, Hutchinson D, Dawes PT, et al. Smoking and disease severity in rheumatoid arthritis: Association with polymorphism at the glutathione S-transferase M1 locus. Arthritis Rheum 2002;46: 640–6. doi:10.1002/art.10174
  • 28. Papadopoulos NG, AlamanosY, Voulgari PV, Epagelis EK, Tsifetaki N, Drosos AA. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clin Exp Rheumatol 2005;23:861–6.
  • 29. Reckner Olsson A, Skogh T, Wingren G. Comorbidity and lifestyle, reproductive factors, and environmental exposures associated with rheumatoid arthritis. Ann Rheum Dis 2001;60: 934–9. doi:10.1136/ ard.60.10.934
  • 30. Symmons DP. Epidemiology of rheumatoid arthritis: Determinants of onset, persistence and outcome. Best Practice & Research Clin Rheumatol 2002;16:707–22. doi:10.1053/berh.2002.0257
  • 31. Symmons DP. Environmental factors and the outcome of rheumatoid arthritis. Best Practice & Research Clin Rheumatol 2003;17: 717–27. doi:10.1016/S1521-6942(03)00063-9
  • 32. Eftekharian M M, Basiri Z, Mani Kashani KH. Obesity and rheumatoid arthritis: results from a case-control study. New Iraqi J Med 2011;7: 5-9.
  • 33. Eftekharian M M, Basiri Z, Mani Kashani KH. Do diabetes and family history influence the rheumatoid arthritis? results from a case-control study. Bang J Med Sci 2011;10: 230-4. doi:10.3329/bjms.v10i4.9492
  • 34. Pedersen M, Jacobsen S, Klarlund M, Frisch M. Socioeconomic status and risk of rheumatoid arthritis: a Danish case-control study. J Rheumatol 2006;33: 1069-74.
  • 35. Uhlig T, Hagen KB, Kvien TK. Current tobacco smoking, formal education, and the risk of rheumatoid arthritis. J Rheumatol 1999;26:1- 3.
  • 36. Linos AD, O’Fallon WM, Worthington JW, Kurland LT. The effect of Tonsillectomy and Appendectomy on the development of rheumatoid arthritis. J Rheumatol 1986;13: 707-9.
  • 37. Moens HB, Corstjens A, Boon C. Rheumatoid arthritis is not associated with prior Tonsillectomy or Appendectomy. Clin Rheumatol 1994;13:483-6. doi:10.1007/BFO2242947
  • 38. Vliet Vlieland TPM, Buitenhuis NA, van Zeben D, Vandenbroucke JP, Breedveld FC, Hazes JMW. Sociodemographic factors and the outcome of rheumatoid arthritis in young women. Ann Rheum Dis 1994;53: 803-6. doi:10.1136/ard.53.12.803
  • 39. Reckner Olsson A, Skogh T, Wingren G. Aetiological factors of importance for the development of rheumatoid arthritis. Scand J Rheumatol 2004;33: 300–6. doi:10.1080/03009740310004748
  • 40. Wolfe F, Young DY. Rheumatoid arthritis and antecedent tonsillectomy. J Rheumatol 1983;10:309-12.
  • 41. Fernandez-Madrid F, Reed AH, Karvonen RL, Granda JL. Influence of antecedent lymphoid surgery on the odds of acquiring rheumatoid arthritis. J Rheumatol 1985;12: 43-8.

Romatoid artritin risk faktörleri: Eğitim düzeyi, tonsillektomi ve apendektomi

Year 2013, Volume: 26 Issue: 1, 30 - 33, 30.09.2015

Abstract

Amaç: Romatoid artrit (RA) kronik, otoimmün, enflamatuvar
ve etiyolojisi tam olarak bilinmeyen bir eklem hastalığıdır.
Dünya nüfusunun %1’in de görülmektedir. Bu çalışmanın amacı,
RA hikayesi olan hastalarda eğitim düzeyi, tonsillektomi ve
apendektomi arasındaki ilişikiyi araştırmaktır. Çalışma Batı İran’da
Hamedan şehrinde yapılmıştır.
Hastalar ve Yöntem: Çalışma, yaş ve cinsiyet bakımından
uyumlu 128 hasta ve kontrol grubunu oluşturan 130 kişi üzerinde
yapılmıştır. Hasta-kontrollü çalışmada bilgiler, gruplara anket
uygulayarak elde edilmiştir. Fizik muayene, kişilerden izin alınarak
yapılmıştır. İstatistiksel analiz SPSS (Pearson’s Chi-Square test) ile
yapılmıştır.
Bulgular: Hasta grubunda 116, kontrol grubunda ise 117 kadın
bulunuyordu. Geri kalanlar erkek idi. İstatistiksel analiz RA riski
ile eğitim durumu veya tonsillektomi arasında belirgin bir ilişki
olmadığını göstermiştir (p > 0,05). Ancak RA riski ile apendektomi
arasında belirgin ters bir ilişki elde edilmiştir (p < 0,05).
Sonuç: Bu konuda daha önce yapılmış büyük araştırmalardan
elde edilen değişik sonuçlar ile bizim araştırmamızdan elde ettiğimiz
sonuçlar değerlendirildiğinde, eğitim durumu, tonsillektomi ve
apendektomi ile RA riski arasındaki kesin ilişkiye ulaşmak için daha
fazla araştırmalara gerek olduğu kanısına varılmıştır.

References

  • 1. Kallbeg H, Padyukov L, Plenge RM, et al. Gene–gene and gene– environment interactions involving HLA-DRB1, PTPN22, and smoking in two subsets of rheumatoid arthritis. Am J Hum Genet 2007; 80:867–75. doi: 10.1086/516736
  • 2. Kobayashi S, Momohara S, Kamatani N, Okamoto H. Molecular aspects of rheumatoid arthritis: Role of environmental factors. The FEBS J 2008;275:4456–62. D oi: 10.1111/j.1742-4658.2008.06581.x
  • 3. Padyukov L, Silva C, Stolt P, Alfredsson L, Klareskog L. A gene– environment interaction between smoking and shared epitope genes in HLA-DR provides a high risk of sero-positive rheumatoid arthritis. Artritis Rheum 2004;50:85–92. doi:10.1002/art.20553
  • 4. Stolt P, Bengtsson C, Nordmark B, et al. Quantification of the influence of cigarette smoking on rheumatoid arthritis: Results from a population based case-control study, using incident cases. Ann Rheum Dis 2003;62: 835–41. doi: 10.1136/ard.62.9.835
  • 5. Balandraud N, Meynard, JB, Auger I, et al. Epstein-Barr virus load in the peripheral blood of patients with rheumatoid arthritis: Accurate quantification using real-time polymerase chain reaction. Arthritis Rheum 2003;48:1223–8. doi: 10.1002/art.10933
  • 6. Balandraud N, Roudier J, Roudier C. Epstein-Barr virus and rheumatoid arthritis. Autoimmun Rev 2004;3: 362–7. doi:10.1016/j. autrev.2004.02.002
  • 7. Posnett DN. Herpes viruses and autoimmunity. Curr Opin Invest Dr 2008; 9: 505–14.
  • 8. Heliovaara M, Aho K, Knekt P, Impivaara O, Reunanen A, Aromaa A. Coffee consumption, rheumatoid factor, and the risk of rheumatoid arthritis. Ann Rheum Dis 2000;59: 631–5. doi:10.1136/ard.59.8.631
  • 9. Karlson EW, Mandl LA, Aweh GN, Grodstein F. Coffee consumption and risk of rheumatoid arthritis. Arthritis Rheum 2003;48:3055-60. doi:10.1002/art.11306
  • 10. Mikuls TR, Cerhan JR, Criswell LA, et al. Coffee, tea, and caffeine consumption and risk of rheumatoid arthritis: Results from the Iowa Women’s Health Study. Arthritis Rheum 2002;46: 83–91. doi: 10.1002/1529-0131(200201)46:1<83::AID-ART10042>3.0.CO;2-
  • 11. Cerhan JR, Saag KG, Criswell LA, Merlino LA, Mikuls TR. Blood transfusion, alcohol use, and anthropometric risk factors for rheumatoid arthritis in older women. J Rheumatol 2002;29:246–54.
  • 12. Symmons DP, Bankhead CR, Harrison BJ, et al. Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis: Results from a primary care-based incident case-control study in Norfolk, England. Arthritis Rheum 1997;40: 1955–61. doi: 10.1002/ art.1780401106
  • 13. Jawaheer D, Lum RF, Gregersen PK, Criswell LA. Influence of male sex on disease phenotype in familial rheumatoid arthritis. Arthritis Rheum 2006;54: 3087–94. doi:10.1002/art.22120
  • 14. Heikkilä R, Aho K, Heliövaara M, et al. Serum androgen-anabolic hormones and the risk of rheumatoid arthritis. Ann Rheum Dis 1996;57: 281–5. doi: 10.1136/ard.57.5.281
  • 15. Ariza-Ariza R, Mestanza-Peralta M, Cardiel MH. Omega-3 fatty acids in rheumatoid arthritis: an overview. Semin Arthritis Rheu 1998;27: 366–70. doi: 10.1016/S0049-0172(98)80016-4
  • 16. Cutolo M, Otsa K, Uprus M, Paolino S, Seriolo B. Vitamin D in rheumatoid arthritis. Autoimmun Rev 2007;7: 59–64. doi:10.1093/ rheumatology/ken394
  • 17. Okamoto H, Shidara K, Hoshi D, Kamatani N. Anti-arthritis effects of vitamin K(2) (menaquinone-4): A new potential therapeutic strategy for rheumatoid arthritis. The FEBS J 2007;274: 4588–94. doi:10.1111/ j.1742-4658.2007.05987.x
  • 18. Strusberg I, Mendelberg RC, Serra HA, Strusberg AM. Influence of weather conditions on rheumatic pain. J Rheumatol 2002; 29: 335–8.
  • 19. Vergés J, Montell E, Tomàs E, et al. Weather conditions can influence rheumatic diseases. Proc West Pharmacol Soc 2004;47:134–6.
  • 20. Eftekharian M M, Basiri Z, Mani Kashani KH. A study of the association between smoking and rheumatoid arthritis. J Smok Cess 2010;5: 1-6. doi: 10.1375/jsc.5.1.1
  • 21. Criswell LA, Merlino LA, Cerhan JR, et al. Cigarette smoking and the risk of rheumatoid arthritis among postmenopausal women: Results from the Iowa Women’s Health Study. Am J Med 2002;112: 465–71. doi:10.1016/S0002-9343(02)01051-3
  • 22. Heliövaara M, Aho K, Aromaa A, Knekt P, Reunanen A. Smoking and risk of rheumatoid arthritis. J Rheumatol 1993;20: 1830–5.
  • 23. Hutchinson D, Shepstone L, Moots R, Lear JT, Lynch MP. Heavy cigarette smoking is strongly associated with rheumatoid arthritis (RA), particularly in patients without a family history of RA. Ann Rheum Dis 2001;60: 223–7. doi:10.1136/ard.60.3.223
  • 24. Karlsson EW, Lee IM, Cook NR, Manson JE, Buring JE, Hennekens CH. A retrospective cohort study of cigarette smoking and risk of rheumatoid arthritis in female health professionals. Arthritis Rheum 1999;42: 910–7. doi:10.1002/1529-0131(199905)42:5<910
  • 25. Klareskog L, Stolt P, Lundberg K, et al. A new model for an etiology of rheumatoid arthritis: Smoking may trigger HLA-DR(shared epitope)- restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 2006;54: 38–46. doi:10.1002/art.21575
  • 26. Krishnan E, Sokka T, Hannonen P. Smoking-gender interaction and risk for rheumatoid arthritis. Arthritis Res Ther 2003;5:R158–62. doi:10.1186/ar750
  • 27. Mattey DL, Hutchinson D, Dawes PT, et al. Smoking and disease severity in rheumatoid arthritis: Association with polymorphism at the glutathione S-transferase M1 locus. Arthritis Rheum 2002;46: 640–6. doi:10.1002/art.10174
  • 28. Papadopoulos NG, AlamanosY, Voulgari PV, Epagelis EK, Tsifetaki N, Drosos AA. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clin Exp Rheumatol 2005;23:861–6.
  • 29. Reckner Olsson A, Skogh T, Wingren G. Comorbidity and lifestyle, reproductive factors, and environmental exposures associated with rheumatoid arthritis. Ann Rheum Dis 2001;60: 934–9. doi:10.1136/ ard.60.10.934
  • 30. Symmons DP. Epidemiology of rheumatoid arthritis: Determinants of onset, persistence and outcome. Best Practice & Research Clin Rheumatol 2002;16:707–22. doi:10.1053/berh.2002.0257
  • 31. Symmons DP. Environmental factors and the outcome of rheumatoid arthritis. Best Practice & Research Clin Rheumatol 2003;17: 717–27. doi:10.1016/S1521-6942(03)00063-9
  • 32. Eftekharian M M, Basiri Z, Mani Kashani KH. Obesity and rheumatoid arthritis: results from a case-control study. New Iraqi J Med 2011;7: 5-9.
  • 33. Eftekharian M M, Basiri Z, Mani Kashani KH. Do diabetes and family history influence the rheumatoid arthritis? results from a case-control study. Bang J Med Sci 2011;10: 230-4. doi:10.3329/bjms.v10i4.9492
  • 34. Pedersen M, Jacobsen S, Klarlund M, Frisch M. Socioeconomic status and risk of rheumatoid arthritis: a Danish case-control study. J Rheumatol 2006;33: 1069-74.
  • 35. Uhlig T, Hagen KB, Kvien TK. Current tobacco smoking, formal education, and the risk of rheumatoid arthritis. J Rheumatol 1999;26:1- 3.
  • 36. Linos AD, O’Fallon WM, Worthington JW, Kurland LT. The effect of Tonsillectomy and Appendectomy on the development of rheumatoid arthritis. J Rheumatol 1986;13: 707-9.
  • 37. Moens HB, Corstjens A, Boon C. Rheumatoid arthritis is not associated with prior Tonsillectomy or Appendectomy. Clin Rheumatol 1994;13:483-6. doi:10.1007/BFO2242947
  • 38. Vliet Vlieland TPM, Buitenhuis NA, van Zeben D, Vandenbroucke JP, Breedveld FC, Hazes JMW. Sociodemographic factors and the outcome of rheumatoid arthritis in young women. Ann Rheum Dis 1994;53: 803-6. doi:10.1136/ard.53.12.803
  • 39. Reckner Olsson A, Skogh T, Wingren G. Aetiological factors of importance for the development of rheumatoid arthritis. Scand J Rheumatol 2004;33: 300–6. doi:10.1080/03009740310004748
  • 40. Wolfe F, Young DY. Rheumatoid arthritis and antecedent tonsillectomy. J Rheumatol 1983;10:309-12.
  • 41. Fernandez-Madrid F, Reed AH, Karvonen RL, Granda JL. Influence of antecedent lymphoid surgery on the odds of acquiring rheumatoid arthritis. J Rheumatol 1985;12: 43-8.
There are 41 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Mohammad Eftekharıan This is me

Publication Date September 30, 2015
Published in Issue Year 2013 Volume: 26 Issue: 1

Cite

APA Eftekharıan, M. (2015). Romatoid artritin risk faktörleri: Eğitim düzeyi, tonsillektomi ve apendektomi. Marmara Medical Journal, 26(1), 30-33.
AMA Eftekharıan M. Romatoid artritin risk faktörleri: Eğitim düzeyi, tonsillektomi ve apendektomi. Marmara Med J. October 2015;26(1):30-33.
Chicago Eftekharıan, Mohammad. “Romatoid Artritin Risk faktörleri: Eğitim düzeyi, Tonsillektomi Ve Apendektomi”. Marmara Medical Journal 26, no. 1 (October 2015): 30-33.
EndNote Eftekharıan M (October 1, 2015) Romatoid artritin risk faktörleri: Eğitim düzeyi, tonsillektomi ve apendektomi. Marmara Medical Journal 26 1 30–33.
IEEE M. Eftekharıan, “Romatoid artritin risk faktörleri: Eğitim düzeyi, tonsillektomi ve apendektomi”, Marmara Med J, vol. 26, no. 1, pp. 30–33, 2015.
ISNAD Eftekharıan, Mohammad. “Romatoid Artritin Risk faktörleri: Eğitim düzeyi, Tonsillektomi Ve Apendektomi”. Marmara Medical Journal 26/1 (October 2015), 30-33.
JAMA Eftekharıan M. Romatoid artritin risk faktörleri: Eğitim düzeyi, tonsillektomi ve apendektomi. Marmara Med J. 2015;26:30–33.
MLA Eftekharıan, Mohammad. “Romatoid Artritin Risk faktörleri: Eğitim düzeyi, Tonsillektomi Ve Apendektomi”. Marmara Medical Journal, vol. 26, no. 1, 2015, pp. 30-33.
Vancouver Eftekharıan M. Romatoid artritin risk faktörleri: Eğitim düzeyi, tonsillektomi ve apendektomi. Marmara Med J. 2015;26(1):30-3.