Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Granülomatöz Mastit Tedavisi Sonrası Nükslerin Öngörülmesinde Tedavi Öncesi Nötrofil-Lenfosit Oranının Rolü
Role of Pre-treatment Neutrophil-Lymphocyte Ratio in the Prediction of Recurrences After Granulomatous Mastitis Treatment
Süleyman KARGINa, Ersin TURANb, Hacı Hasan ESENc, Nisa ÇETİN KARGINd
aKTO Karatay Üniversitesi Tıp Fakültesi, Genel Cerrahi ABD, Konya, TÜRKİYE
bBeyhekim Devlet Hastanesi, Genel Cerrahi Kliniği, Konya, TÜRKİYE
cKonya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Tıbbi Patoloji ABD, Konya, TÜRKİYE
dKonya Numune Hastanesi, Aile Hekimliği Kliniği, Konya, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2020;40(1):46-51
doi: 10.5336/medsci.2019-66835
Article Language: TR
Full Text
ÖZET
 Amaç: Granülomatöz mastit, hem tanısı zor hem de ideal tedavi yöntemi olmayan kronik inflamatuar bir hastalıktır. Nadir görülen bir antite olması nedeni ile prognostik faktörler ve tedavi kalsifikasyonu üzerine araştırmalar kısıtlıdır. Son zamanlarda sistemik inflamasyonun biyobelirteci olarak kullanılan nötrofil-lenfosit oranı (NLO) nın popülerliği giderek artmaktadır. Bu çalışmada, kronik inflamatuar hastalık olması nedeni ile granülomatöz mastitte tedavi sonrası nükslerin öngörülmesinde tedavi öncesi NLO'nun rolünün araştırılması amaçlanmıştır. Gereç ve Yöntemler: Biyopsi sonuçlarına göre granülomatöz mastit hastalığı tespit edilen ve tedavi edilen 62 hastanın verileri retrospektif olarak incelendi. Hastalar, medikal tedavi ve cerrahi tedavi olmak üzere 2 gruba ayrıldı. Demografik verilerinin yanında tedavi öncesi NLO'ları hesaplandı. Her iki grupta da tam kür sağlanmış olan hastalar çalışmaya dâhil edildi. Tedavilerin tamamlanmasından en az 6 ay sonra hastalar telefon yoluyla aranarak nüks durumları, tekrar tedavi alıp almadıkları sorgulandı. Bulgular: Toplam 59 hasta çalışmaya dâhil edildi. Hastalar tedavi sonrası en az 6 ay takip edilmiş olup, ortalama takip süresi 52,44±27,29 (6-103) ay idi. Steroid tedavisi alan hastaların 4 (%20)'ünde nüks gelişirken, cerrahi tedavi alan hastaların 3 (%7,9)'ünde nüks gözlendi. Cerrahi ve medikal takip edilen hasta grupları arasında, tedavi öncesi NLO ile nüks açısından anlamlı farklılık izlenmedi (p>0,05). Ancak yapılan tedaviye bakılmaksızın incelendiğinde, nüks olan hastaların NLO'ları nüks olmayanlara göre daha yüksekti (p=0,00). Sonuç: Granülomatöz mastit hastalarında tedavi öncesi NLO değeri uzun dönemde nüksü öngörmede fikir verici olabilir.

Anahtar Kelimeler: Granülomatöz mastit; nötrofil infiltrasyonu; nüks; prognoz
ABSTRACT
 Objective: Granulomatous mastitis is a chronic inflammatory disease that is both difficult to diagnose and not the ideal treatment method. It is due to a rare entity studies on prognostic factors and treatment calcification are limited. Recently, neutrophil-lymphocyte ratio (NLR), which is used as biomarker of systemic inflammation, is increasing in popularity. In this study, we aimed to investigate the role of pre-treatment NLR in the prediction of recurrences after granulomatous mastitis treatment due to chronic inflammatory disease. Material and Methods: According to biopsy results detected and treated that 62 patients with granulomatous mastitis disease were viewed retrospectively. The patients were divided into two groups as medical treatment and surgical treatment. In addition to demographic data, pretreatment NLR were calculated. Patients who obtained complete cure were included in the study in both group too. At least 6 months after the completion of the treatments, the patients were searched by telephone and they were asked whether they had relapses and need any treatment or not. Results: A total of 59 patients were included in the study. The patients were followed up for at least 6 months after the treatment and the mean follow-up period was 52.44±27.29 (6-103) months. Recurrence was observed in 4 (20%) of the patients who received steroid treatment and 3 (7.9%) of the patients who received surgical treatment had recurrence. There was no significant difference between groups with pre-treatment NLR to recurrence rates (p>0.05). Regardless of the treatment option, NLR was higher patients with relaps than patients without relapse (p=0.00). Conclusion: Pre-treatment NLR may be an idea for predicting long-term recurrence after treatment in patients with granulomatosis mastitis.

Keywords: Granulomatous mastitis; neutrophil infiltration; recurrence; prognosis
REFERENCES:
  1. Shin YD, Park SS, Song YJ, Son SM, Choi YJ. Is surgical excision necessary for the treatment of granulomatous lobular mastitis? BMC Womens Health. 2017;24;17(1):49. [Crossref]  [PubMed]  [PMC] 
  2. Tauch A, Fernández-Natal I, Soriano F. A microbiolog and clinical review on Corynebacterium kroppenstedti. Int J Infect Dis. 2016;48:33-9. [Crossref]  [PubMed] 
  3. Going JJ, Anderson TJ, Wilkinson S, Chetty U. Granulomatous lobular mastitis. J Clin Pathol. 1987;40(5):535-40. [Crossref]  [PubMed]  [PMC] 
  4. Dixon JM, Chetty U. Diagnosis and treatment of granulomatous mastitis. Br J Surg. 1995;82(8):1143-4. [Crossref]  [PubMed] 
  5. Templeton AJ, Ace O, McNamara MG, Al-Mubarak M, Vera-Badillo FE, Hermanns T, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1204-12. [Crossref]  [PubMed] 
  6. Mallappa S, Sinha A, Gupta S, Chadwick SJ. Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer. Colorectal Dis. 2013;15(3):323-8. [Crossref]  [PubMed] 
  7. Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2009;58(1):15-23. [Crossref]  [PubMed] 
  8. Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K, et al. Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology. 2012;79(5):1085-91. [Crossref]  [PubMed] 
  9. Dirican A, Kucukzeybek BB, Alacacioglu A, Kucukzeybek Y, Erten C, Varol U, et al. Do the derived neutrophil to lymphocyte ratio and the neutrophil to lymphocyte ratio predict prognosis in breast cancer? Int J Clin Oncol. 2015;20(1):70-81. [Crossref]  [PubMed] 
  10. George D, Mallery M. SPSS for Windows Step by Step: A Simple Guide and Reference, 17.0 update. 10th ed. Boston: Pearson; 2010. p.386.
  11. Kuba S, Yamaguchi J, Ohtani H, Shimokawa I, Maeda S, Kanematsu T. Vacuum-assisted biopsy and steroid therapy for granulomatous lobular mastitis: report of three cases. Surg Today. 2009;39(8):695-9. [Crossref]  [PubMed] 
  12. Heer R, Shrimankar J, Griffith CDM. Granulo­matous mastitis can mimic breast cancer on clinical, radiological or cytological examina­tion: a cautionary tale. Breast. 2003;12(4):283-6. [Crossref] 
  13. Lai EC, Chan WC, Ma TK, Tang AP, Poon CS, Leong HT. The role of conservative treatment in idiopathic granulomatous mastitis. Breast J. 2005;11(6):454-6. [Crossref]  [PubMed] 
  14. Skandarajah A, Marley L. Idiopathic granulomatous mastitis: a medical or surgical disease of the breast? ANZ J Surg. 2015;85(12):979-82. [Crossref]  [PubMed] 
  15. Yılmaz TU, Gürel B, Güler SA, Baran MA, Erşan B, Duman S, et al. Scoring idiopathic granulomatous mastitis: an effective system for predicting recurrence? Eur J Breast Health. 2018;14(2):112-6.
  16. Kahramanca S, Ozgehan G, Seker D, Gökce EI, Seker G, Tunç G, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2014;20(1):19-22. [Crossref]  [PubMed] 
  17. Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97(4):299-304. [Crossref]  [PubMed]  [PMC] 
  18. Ljungström L, Pernestig AK, Jacobsson G, Andersson R, Usener B, Tilevik D. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PloS One. 2017;12(7):e0181704. [Crossref]  [PubMed]  [PMC] 
  19. Faria SS, Fernandes PC Jr, Silva MJ, Lima VC, Fontes W, Freitas-Junior R, et al. The neutrophil-to-lymphocyte ratio: a narrative review. Ecancermedicalscience. 2016;10:702. [Crossref]  [PubMed]  [PMC] 
  20. Kargin S, Çakır M, Gündeş E, Yavuz Y, Esen HH, Sinan İyisoy M, et al. Relationship of preoperative neutrophil lymphocyte ratio with prognosis in gastrointestinal stromal tumors. Ulus Cerrahi Derg. 2015;31(2):61-4. [Crossref]  [PubMed]  [PMC] 
  21. Balta S, Ozturk C, Yildirim AO, Aparci M, Demir M, Celik T. The relation between neutrophil-lymphocyte ratio and hypertension. Am J Hypertens. 2015;28(11):1386. [Crossref]  [PubMed] 
  22. Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol. 2016;36:94-9. [Crossref]  [PubMed] 
  23. Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol. 2009;16(3):614-22. [Crossref]  [PubMed] 
  24. Schmidt H, Suciu S, Punt CJ, Gore M, Kruit W, Patel P, et al. Pretreatment levels of peripheral neutrophils and leukocytes as independent predictors of overall survival in patients with American Joint Committee on Cancer Stage IV Melanoma: results of the EORTC 18951 Biochemotherapy Trial. J Clin Oncol. 2007;25(1):1562-9. [Crossref]  [PubMed] 
  25. Uslu AU, Küçük A, Şahin A, Ugan Y, Yılmaz R, Güngör T, et al. Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis. 2015;18(7):731-5. [Crossref]  [PubMed] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com