INTRODUCTION: Women with endometriosis often experience symptoms of pain and infertility. Endometriosis was typically confirmed only by laparoscopic examination, causing delayed identification and continued symptom progression. This phenomenon can lead to impair the quality of life. This study aimed to compare the intensity of chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, and dyschezia between women who diagnosed with stage I/II of endometriosis and those with stage III/IV of endometriosis.
METHODS: This is a cross-sectional study, including 64 subjects selected by purposive sampling technique. The subjects were grouped into 32 women with stage I/II endometriosis and 32 women with stage III/IV endometriosis, based on the American Society for Reproductive Medicine (ASRM) endometriosis staging criteria. The Numeric Pain Rating Scale (NRS) and a questionnaire are used to evaluate the intensity of chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, and dyschezia. Data were analyzed with SPSS 25.
RESULTS: The result demonstrated that there is no significant relationship between the intensity of chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, and dyschezia and the stage of endometriosis with P-values >0.05.
DISCUSSION AND CONCLUSION: In conclusions, the intensity of chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, and dyschezia cannot be applied to diagnosing either the severity or stages of endometriosis.

INTRODUCTION: The aim of this research was to evaluate the short-term effects of initial periodontal treatment (IPT) with occlusal adjustment (OA) on lower incisors on Oral Health Impact Profile-14 (OHIP-14), clinical parameters such as probing depth (PD), bleeding on probing (BoP), gingival index (GI), clinical attachment loss (CAL), and tooth mobility using the periostest device in 30 patients with periodontitis.
METHODS: The patients were randomly divided into two equal groups as the test and control groups. The control group received IPT alone, while the test group received IPT+OA. The OA was applied to only four lower incisors (42,41,31,32) and data were recorded at baseline (T0) and at one month after treatment (T1).
RESULTS: There was no significant difference in the total OHIP-14 scores between the groups. The inter-group comparison revealed a significant difference in the GI of 42 teeth and in the CAL of 41 teeth (p<0.05). A significant difference was observed in the periotest value of 42 teeth between the time points (p<0.05). There was a significant difference in the clinical periodontal parameters in both groups at T0 and T1, while there was a significant difference in the tooth mobility of 42 teeth in the test group (p<0.05).
DISCUSSION AND CONCLUSION: In conclusion, IPT yields positive effects on clinical periodontal parameters in both groups in both time points. However, IPT combined with OA seems not to be superior to IPT only as evidenced by OHIP-14 scores, periodontal parameters, and tooth mobility in the short-term. Further long-term studies are needed to draw more reliable conclusions.

INTRODUCTION: Due to increasing population of refugees, rapid alterations have been experienced in the racial and ethnic composition of our country. Such alterations have increased health services to those from different races/ethnic origins, especially in emergency departments (ED). Here, we aimed to compare health services administered to refugees and Turkish citizens and give recommendations regarding health policies.


METHODS: Data were obtained from the hospital database, and one-year admissions to the pediatric ED were retrospectively analyzed. Such criteria as race, sex, and age of refugees and Turkish citizens were investigated through waiting time before the examination, length of stay in ED, findings of computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography (USG), and way of quitting ED.
RESULTS: Refugees were observed to take boys more to ED, apply to ED more during the daytime, be admitted more often with green zone and polyclinic diagnoses, and undergo imaging techniques at a lower rate (p<0.001). However, refugees were also seen to stay in ED for a shorter time and have lower waiting times (p<0.001).
DISCUSSION AND CONCLUSION: Refugees were detected to benefit ED as visits to outpatient clinics, take younger children and boys more, stay in ED shorter, and undergo imaging techniques less due to such challenges as health insurance and language barriers and inability to access to medical call centers. Although statistically significant differences are considered to be mostly due to the use of ED, more studies are needed to elucidate ethnic/racial differences and implicit biases.

INTRODUCTION: Maternal vascular hypoperfusion is the most common cause of fetal growth restriction. Maternal oxidative status features are identifiable on placental pathology, and antepartum diagnostic methods are rapidly evolving. The current study was constructed to determine the maternal oxidative status by measuring serum ischemia modified albumin (IMA) levels in pregnancies complicated with idiopathic intrauterine growth restriction (IUGR).
METHODS: The current study was designed as a descriptive and cohort trial. A total of 87 pregnant women; 45 healthy controls and 42 pregnancies complicated with idiopathic IUGR were included to the study population. Maternal serum IMA concentration was measured prior to the administration of any medication. The perinatal outcomes of patients were also recorded.
RESULTS: Maternal serum IMA concentration in pregnancies complicated by idiopathic IUGR was higher than in healthy controls. There was no significant difference between the groups (0.54±0.04 versus 0.55±0.06 ABSU, p: 0.314).
DISCUSSION AND CONCLUSION: IUGR is a significant pregnancy complication. Elevated oxidative stress which leads to an ischemic microenvironment is associated with IUGR. Maternal serum IMA which is a possible marker for oxidative stress is not increase in pregnancies complicated with idiopathic IUGR.

INTRODUCTION: Spinal cord ischemia and subsequent neurologic deficit are among the most devastating complications of thoracoabdominal aortic surgery. In this study, the role of Erythropoietin in ischemic spinal cord injury model was evaluated. The protective role of erythropoietin in alleviating neuronal damage in the spinal cord following this type of ischemia in rats was investigated.
METHODS: Twenty-five rats were used and divided into three groups: Sham, only spinal ischemia (control group), spinal ischemia + erythropoietin (erythropoietin group). After spinal ischemia induced by temporary cross-clamping of the abdominal aorta, intraperitoneal saline was given in group 1 (control group), Erytropoietin was administered intraperitoneally as a single dose in group 2 (erytropoietin group). In group 3 (sham group), abdominal aorta was surgically accessed, but was not clamped, and no substance was applied. SEPs were recorded at preoperative and postoperative 24th hour intervals in all rats. Neurological condition was analysed based on Tarlov score at 24 and 48 hours after surgery in all groups. Following sacrification of the rats, histopathological examinations were investigated.


RESULTS: It was determined that group 2 showed a significant improvement in both Tarlov neurological scores and SEPs after reperfusion than that of group 1 (p<0,001). Histopathological studies revealed less ischemic findings in group 2 than in group 1 (p<0,001).
DISCUSSION AND CONCLUSION: This study showed that Erythropoietin may hold promise an improvement in clinical, neurophysiological and histological outcomes of ischemia-reperfusion injuries in spinal cord.

INTRODUCTION: This study aimed to compare the results of open Lichtenstein repair (OLR) and laparoscopic total extraperitoneal (TEP) repair methods in inguinal hernia (IH).
METHODS: Between January 2017 and December 2018, 201 patients who underwent TEP and OLR methods for IH in our hospital were retrospectively analyzed. TEP was performed in 98 of these patients and OLR was performed in 103 patients. The patients were evaluated in terms of age, gender, hernia type, operation time, early and late postoperative complications, length of hospital stay and accompanying diseases.
RESULTS: One hundred forty-five (72.5%) of 201 patients had right IH and 56 (27.5%) had left IH. TEP group and OLR group were similar in terms of age, gender, hernia type and comorbidity. Our mean follow-up period was 24(18-36) months. The average operation time was 61.2 (40-80) minutes in TEP and 55.4 (45-70) minutes in the OLR group; It was significantly longer in the TEP group (P<0.05). Postoperative early complications were 7 (7.1%) in TEP and 10 (9.8%) in OLR, the difference was not significant. Postoperative recurrence was detected in 2(2.04%) cases in TEP and in 2(1.94%) cases in OLR, and no significant difference was found. The length of hospitalstay is equal in both groups.
DISCUSSION AND CONCLUSION: In our study, although the operative time was longer in the TEP group than in the OLR, no difference was observed between the length of hospital stay, postoperative complications and recurrence rates. We believe that TEP method will be applied in a shorter time as experience and experience increase.

INTRODUCTION: The present study aimed to evaluate the diagnostic performance of the chemical dipstick protein measurement method, which can be used for screening purposes, in the detection of proteinuria.

METHODS: The results from 795 individuals were retrospectively scanned. In order to evaluate the urine dipstick’s accuracy in detecting proteinuria, the current study accepted protein/creatinine ratio (PCR) as the reference value, and three different criteria were used according to different age groups [PCR: ≥ 0.2 g/g (>2 years), ≥ 0.5 g/g (6 months-2 years), and ≥ 0.8 g/g (0-6 months)]. While evaluating diagnostic sensitivity, specificity, positive predictive value, and negative predictive value, two cut-off values [trace and 1(+)] were evaluated. Area under the curve (AUC) by Receiver operating characteristic analysis were analyzed.


RESULTS: The calculated sensitivity levels were lower than 70% for all age groups, with an AUC of 0.680 ± 0.237, 0.780 ± 0.07, and 0.768 ± 0.018 for the age groups of 0–6 months, 6 months–2 years, and > 2 years, respectively.

DISCUSSION AND CONCLUSION: When the PCR was taken as a reference for proteinuria, the chemical dipstick test only proved suitable for screening proteinuria in the >6 months age group. Nonetheless, its performance could benefit from further improvement. Although the use of dipsticks is fast, simple, and inexpensive, this research indicates that they cannot replace PCR and 24-hour urine protein amount tests in the diagnosis and follow-up of renal diseases, which are generally known to be asymptomatic until their progression and complications are detected.

INTRODUCTION: In this study, it was aimed to determine the accompanying organ injuries and their frequencies in trauma patients diagnosed with vertebral fracture in the emergency department.
METHODS: In this study, trauma patients aged 18 years and older and with at least one vertebral corpus fracture who applied to the Emergency Department of Manisa Celal Bayar University Hospital between January 2016 and December 2020 were retrospectively analyzed. In addition to vertebral fractures, the mechanism of trauma, accompanying organ injuries, the intervention and the prognosis of the patients were examined.
RESULTS: Of the patients, %72 were male and the mean age was 46,07. The two most common trauma mechanisms causing vertebral fracture were falling from height and traffic accident. The vertebral region most affected by trauma was the thoracolumbar (28.7%) region. Compression fracture was detected in 52% of the patients, and burst fracture was detected in 19,3% of the patients. Thoracic injuries were detected in 41.3% of the patients, and extremity injuries in 26%, and these were the most common injuries accompanying vertebral fractures. In our study, concomitant cranial and maxillofacial injuries in cervical vertebral fractures and concomitant thoracic injuries in thoracic vertebral fractures were found to be significantly higher.
DISCUSSION AND CONCLUSION: Traffic accidents and falling from a height were determined as the two most common causes of vertebral fracture and were thought to be preventable causes. In addition, although distant traumas accompanied the affected vertebral region in vertebral fractures, it was observed that traumas of nearby structures were more common in general.

INTRODUCTION: The aim of this case-control study is to evaluate whether there is a difference between individuals with hypertension and healthy individuals in terms of orthorexia nervosa and eating attitudes
METHODS: This case-control study was conducted with hypertension patients (n=218) and healthy individuals (n=226) who met the research criteria in an internal medicine clinic and outpatient clinics of a university hospital between April and June 2021. The data were collected with face-to-face interview method by using “Descriptive Information Form”, “Orthorexia Nevrosa-11 (ORTO-11) Scale” and “Eating Attitude Scale (EAT-26)”.
RESULTS: ORTO-11 score of HT patients was found as 26.39±4.96, while ORTO-11 score of healthy individuals was found as 27.58±4.26. EAT-26 score of HT patients was found as 9.87±7.88, while EAT-26 score of healthy individuals was found as 8.31±7.31. Statistically significant difference was found between mean ORTO-11 and EAT-26 scores of groups (p<0.05). Mean scores of 59% of HT patients and 41% of healthy individuals were found to be below ORTO-11 ≤ 27. Mean scores of 14.2% of HT patients and 10.1% of healthy individuals were found to be above EAT-26 ≥20. In the regression analysis, EAT-26 (β=-0,401, p<0,001) variable was found to have a negative and significant effect on ORTO-11
DISCUSSION AND CONCLUSION: Higher orthorexia and eating disorder risk was found in hypertension patients when compared with healthy individuals. In addition, it was found that abnormal eating behavior caused individuals to show more orthorectic behavior

INTRODUCTION: This study aimed to evaluate the predictive value of the MAPH score, a novel score that includes blood viscosity biomarkers such as hematocrit, mean platelet volume (MPV), age, and total protein, on the extent of vegetation in infective endocarditis.
METHODS: This study was retrospective. Fifty-four patients older than 18 years who were diagnosed with infective endocarditis (IE) between June 2017 and June 2023 were included. The study included patients from three different tertiary healthcare centers. Hematocrit, C-reactive Protein (CRP), MPV, total protein, serum albumin, kidney and liver function tests were analyzed on the first day of hospitalization. The Youden Index was used to determine the cut points for predicting age and MPV, hematocrit and total protein values for vegetation size. The MAPH score has been calculated as a total of 0 or 1 point with the cutoff in each ratio, and values above the cutoff were considered 1 point.
RESULTS: Forty-eight patients (58.2%) were found to have large vegetations (>10 mm). The mean age of the patients was 54.78 ± 17.32 years. The other clinical characteristics and demographic data were similar to each other. MPV, total protein level and MAPH score were significantly higher in the vegetation size >10 mm group than in the vegetation size <10 mm group (p=0.014, p=0.032, p=0.005) when analyzing the clinical laboratory characteristics of the study.
DISCUSSION AND CONCLUSION: The MAPH score can be used to predict vegetation size according to the results of our study.

INTRODUCTION: Osteoporosis a consequence of menopause in the biological cycle of women,emerges with the conclusion of reproductive capabilities.Hormonal changes during this phase contribute to the development of the disease.The study evaluated the relationship between stress,salivary cortisol levels,and Osteocalcin in postmenopausal women with osteoporosis.
METHODS: The study involved 60 postmenopausal volunteers diagnosed with osteoporosis.Stress levels were assessed using the NIH stress score system to validate cortisol levels.Saliva and blood samples were analyzed using LC-MS/MS and ELISA methods.Statistical analyses,including the Wilcoxon Signed Rank test paired samples t-tests, and correlation analyses,were conducted using IBM SPSS Statistics 21.0.A significance level of p<0.05 was considered.
RESULTS: In comparing stress scores between the 1st/2nd weeks,a statistically significant difference was observed(z=4.795,p<0.001),indicating a higher mean stress score in the 2nd week.Cortisol levels showed a significant increase from the 1st week(27.58±3.97) to the 2nd week(29.99±2.44)(t=4.412,p<0.001).Osteocalcin values exhibited a significant difference between the 1st week(21.04±0.98) and the 2nd week(24.22±1.44)(t=9.656, p<0.001). Examining participant variations, the mean difference in stress scores was 7.73±2.23, the mean difference in cortisol levels was 2.41±2.99, and the mean difference in osteocalcin levels was 3.18±1.81.A weak positive statistically significant relationship was found between stress score difference and Cortisol difference(r=0.363, p=0.049).In contrast, an intermediate-level positive statistically significant relationship was observed between Osteocalcin difference and Cortisol difference(r=0.586, p=0.001).Findings highlight the intricate relationships between stress,cortisol levels,and Osteocalcin.
DISCUSSION AND CONCLUSION: Contrary to some existing findings,our study suggests that menopause,as a stress-inducing factor,leads to an increase in bone metabolism markers,including Cortisol.Insights contribute to a more comprehensive understanding of the interplay between stress,hormonal changes,and osteoporosis in postmenopausal women.

INTRODUCTION: Lupus induced by a tumor necrosis factor-alpha inhibitor (anti-TNF-α) can be termed "Anti-TNF-α Induced Lupus (ATIL)" and it is usually seen in patients with Crohn's disease and Rheumatoid Arthritis; however, it is rarely seen in axial Spondyloarthropathy (SpA). Here, four cases of ATIL in patients with axial SpA are presented and discussed in the light of literature data.
METHODS: The files of the patients who used anti-TNF-α drugs regularly for at least one year due to axial SpA were reviewed retrospectively.
RESULTS: Four patients with ATIL were analysed based on clinical features and biochemical investigations. When ATIL developed, the first case was using Adalimumab for 6 years, the second was using Infliximab for 5 years, the third was using Infliximab for 7 years, and the fourth was using Adalimumab for 16 months. In all four cases, antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA) values were positive, while none of the cases had hypocomplementemia. ATIL aymptoms were acute mesenteric thrombosis, fever and pleuritis in the first case, arthritis in the small joints of the hand in the second case, deep vein thrombosis, fever, pleuritis and peritoneal fluid accumulation in the third case and malar rash in thr fourth one. Anti-TNF-α drug was stopped in all patients and prednisolone was added. Only the third case was switched to another anti-TNF-α agent.
DISCUSSION AND CONCLUSION: While Anti-TNF-α is an effective and common treatment option in SpA patients, one should keep in mind that these patients may develop ATIL; and these patients should be carefully monitored.

The transient receptor potential melastatin 2 (TRPM2) is a Ca2+ permeable cation channel that is a cellular redox sensor. It has been determined that the TRPM2 channel plays an important role in various neurological disorders such as Alzheimer's and Parkinson's. So far, however, theme trends and knowledge structures for TRPM2 have yet to be studied bibliometrically. This research mainly aims to compare the scientific production of TRPM2 in the research area between countries and to evaluate the publication trend between 1997 and 2022. All publications are from the Web of Science Core Collection database from 1997 to 2022. Journals, countries, regions, institutions, authors, and research points were included. A total of 824 publications related to TRPM2 were reviewed in this report. The Journal of Biological Chemistry ranked top for publishing 31 articles. The United States had the highest number of publications (203). Nazýroðlu M. from Süleyman Demirel University was the most prolific author with 91 publications among the authors who have TRPM2-related publications worldwide during the indicated period. Our study also combined bibliometric work with a systematic review of TRPM2, highlighting the four research limits of TRPM2. This is the first study to show trends and future developments in TRPM2 publications and to provide a clear and intuitive profile for contributions in this field.

INTRODUCTION: Primary Sjogren's syndrome (pSS) is a chronic autoimmune disease that causes vaginal dryness and dyspareunia secondary to lymphocytic infiltration of exocrine glands. This study aimed to evaluate the sexual functions of premenopausal and postmenopausal women with pSS and to investigate the effects of using polycarbophil-containing vaginal moisturizing gel on sexual function.
METHODS: The study included 24 female patients (mean age 45.1 ± 6.1, range 33 to 54 years) with pSS, who had an active sex life and reported vaginal dryness. The patients were asked to use 1 g of polycarbophil-containing vaginal gel twice per week for 12 weeks. Patients were assessed using the Female Sexual Function Index (FSFI) and Beck Depression Inventory (BDI) before and after vaginal lubricant use. All patients underwent full gynecologic examinations.
RESULTS: After treatment with vaginal lubricants, significant improvements were observed in the lubrication scores, satisfaction, and pain during intercourse (p=0.032, p=0.002, and p=0.006, respectively). The total post-treatment FSFI score was detected to be higher than the values of pre-treatment [median 22.5 (range, 15.1-32.4) vs. 20 (range, 12.3-28.5), respectively; p=0.004]. Considering the sum and sub-parameters of FSFI in postmenopausal women before and after lubricant treatment, there were significant differences in premenopausal satisfaction, pain reviews, and total FSFI scores (p=0.014, p=0.014, and p=0.032, respectively).
DISCUSSION AND CONCLUSION: The use of polycarbophil-containing vaginal moisturizing gel improved sexual symptoms in women with Sjögren's syndrome, especially in the premenopausal period, without serious adverse effects; therefore, we concluded that non-hormonal polycarbophil-based gel could be used in the treatment of patients with this condition.

INTRODUCTION: Active eating is considered an effortful activity for patients with chronic obstructive pulmonary disease (COPD). Aim of study was to determine the effect of active eating on pulmonary functional capacity, dyspnea level and oxygen saturation in COPD patients.
METHODS: 40 clinically stable COPD patients who were hospitalized in Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital were enrolled. All patients were in group D according to 2016 GOLD guide. Demographic data, smoking status, body mass index, medications and additional diseases of patients were noted. The degree of dyspnea was assessed using the Modified BORG scale before and after active eating for all participants and was also measured in obese and non-obese subgroups. Spirometric parameters and oxygen saturation (SpO2) were analyzed one hour before and after active eating.
RESULTS: In general, there was no significant difference in FVC, FEV1, FEV1/FVC and SpO2 values compared to initial measurements (p>0.05). However, significant difference was observed in BORG scale evaluations for all participants (p<0.05). According to subgroups, there was no significant difference in FEV1/FVC and SpO2 results (p<0.05), but difference was found in FEV1, FVC and BORG values in non-obese group (p<0.05). In obese group, we found no difference in any of evaluated parameters (p <0.05).
DISCUSSION AND CONCLUSION: In conclusion, we observed no change in spirometric parameters and SpO2 level in total but there was a change in FEV1, FVC and dypnea level in non-obese goup.

INTRODUCTION: Triple negative breast cancer (TNBC), an aggressive subgroup of breast cancer that exhibits a highly complex and heterogeneous character has led researchers to seek for new and effective therapeutic agents due to the inadequacy of current treatment options. In the literature, there are benzimidazole derivatives whose antiproliferative effects have been investigated in many cell line and animal studies. For present study, a benzimidazolium salt (BS), namely 1-(anthracen-10-ylmethyl)-3-(2-cyanobenzyl)-1H-benzo[d]imidazol-3-ium chloride was prepared from 2-((1H-benzo[d]imidazol-1-yl)methyl) benzonitrile (1 mmol) and 10-(chloromethyl) anthracene (1 mmol).
METHODS: In our trial it was aimed to investigate the anticarcinogenic effects of above mentioned BS, which waspreviously shown to be more effective than cisplatin(the chemotherapy agent being used in the treatment of TNBC)on 4T1 cells. Cell viability (2D and 3D), colony forming, 3D spheroid formation, wound healing scratch and Annexin V/Propidium Iodide (PI) staining analyzes were used to determine cell growth/proliferation, migration and apoptozis respectively.
RESULTS: According to the results, BS significantly reduced viability/proliferation, colony formation and migration in 4T1 cells, even at low doses. It also induced apoptosis.
DISCUSSION AND CONCLUSION: It was concluded that, BS is a potential antiproliferative agent that reduces the carcinogenic properties of 4T1 cells through inhibiting cell proliferation, migration as well as inducing apoptozis. Its mechanism of action should be elucidated with further studies.

INTRODUCTION: Intravenous (IV) patient-controlled analgesia (PCA) is frequently used to optimize postoperative analgesia in many surgeries. In recently, ultrasound-guided erector spinae plane block (ESPB) has begun to be widely used. Does ease of application, fewer complications and providing effective analgesia with a single injection make it more advantageous in postoperative pain management? The aim of this study is to compare the postoperative analgesic efficacy of the ultrasound-guided ESPB with that of the IV PCA in percutaneous nephrolithotomy surgery.
METHODS: Sixty participants selected for elective percutaneous nephrolithotomy were included in this study. The patients were randomized into two groups using a closed-envelope method. An ultrasound-guided ESPB was applied with 20 mL of the local anesthetic mixture at the T-7 level in group ESPB. In the PCA group a loading dose of 50 mg tramadol was administered 10 minutes before extubation. Following the extubation, PCA was initiated with a 20 mg bolus, a 30minute lockout period, with a 4hour tramadol limit of 200 mg, and a basal infusion rate of 5 mg/hour.
RESULTS: Demographic data and ASA scores of the groups were similar. In the ESPB group, VAS scores, and analgesic requirement were significantly lower, and patient satisfaction were higher in the first 6hours postoperatively. However, in the PCA group, VAS score and analgesic requirement were lower than group ESP at the 12th hour postoperatively.
DISCUSSION AND CONCLUSION: ESP block and iv PCA are effective in PNL surgery. We believe that the ESP block performed under USG guidance is more effective and advantageous in the first 6 hours.

Background: Follicular lymphoma (FL) originating from germinal center B cells constitutes 35% of all non-Hodgkin lymphomas. Patients usually present with asymptomatic peripheral lymphadenopathy (LAP) at the time of diagnosis and approximately 70% of them have bone marrow involvement. Leukemic phase of FL is a rare condition and associated with a poor prognosis.
Case Report: In this report we presented a 29-year-old male patient with a diagnosis of leukemic phase of FL which is a rare condition. We initiated R-CHOP chemotherapy and he is still being followed in complete remission after 6 course.
Conclusion: Leukemic phase is a rare clinical presentation of FL and it can be confused with chronic lymphocytic leukemia. Flowcytometric examination is very valuable in diagnosis. Leukemic phase of FL is associated with poor prognosis independent of FLIPI score. Therefore detecting circulating leukemic cells in patients with FL is necessary.