The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommen... more The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative practice guidelines (Am J Kidney Dis 2001;37(1 Suppl. 1):S7-S64; Am J Kidney Dis 1997;30(4 Suppl. 3):S150-S191). Brachiobasilic arteriovenous fistula offers excellent access in difficult cases. Many surgical techniques have been described to create brachiobasilic fistula. The purpose of this study was to present and discuss the technique of superficialization of the basilic vein in brachiobasilic arteriovenous fistula with long-term results of 350 cases. A total of 375 brachiobasilic arteriovenous fistulas were constructed with superficialization of the basilic vein technique. Of these, 350 fistulas were used in hemodialysis (93.3%). One hundred fifty-five (44%) patients were male, 195 (56%) were female. Mean age was 57.8 (range, 18-88) years. A 2-cm longitudinal incision was made in antecubital fossa to expose brachial artery and basilic vein under local anesthesia. A separate second skin incision (4-6 cm) was done to explore proximal part of the basilic vein. Side branches of the basilic vein were isolated and ligated carefully using this second skin incision. The basilic vein was divided in antecubital fossa and brought over the fascia through the subcutaneous tunnel at the same anatomical position. Anastomosis was performed with end-to-side technique. Mean follow-up was 48 months (range, 2-84). The mean time to first puncture and use of the fistula time was 52 days (range, 25-75). Bleeding required surgical exploration which occurred in 3 (0.9%) patients. Primary patency of basilic vein superficialization fistulas was 92%, 78%, 64%, and 54% at 1, 2, 3, and 4 years, respectively. Secondary patency was 93%, 81%, 66%, and 56% at 1, 2, 3, and 4 years, respectively. Superficialization of the basilic vein technique is a logical alternative method of the basilic vein transposition. Superficialization requires less extensive skin incision and surgical dissection. Long-term patency was good.
Asso, 1801. 800 meagre (Argyrosomus regius) were fed with formulated diets including barium sulph... more Asso, 1801. 800 meagre (Argyrosomus regius) were fed with formulated diets including barium sulphate and 10 fish were sampled, killed and x-rayed every 2 hours starting 2 hours after feeding for total 30 hours. Gastric evacuation time at 20°C for meagre at 28±2.3gr weight was determined average for 9 hours, complete average digestive track evacuation time was determined for 21 hours by investigating x-ray.
The Journal of Heart and Lung Transplantation, Jun 30, 2003
Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart... more Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart transplantation. We report the second case of successful surgical treatment of aortic dissection confined to the donor aorta in a recipient of an orthotopic cardiac allograft. A 68-year-old patient was admitted with chest pain and shortness of breath 7 years after orthotopic heart transplantation. He previously had undergone twice coronary artery bypass grafting. Echocardiography revealed acute dissection of the donor aorta. The patient underwent urgent Bentall procedure with a prosthetic conduit. The post-operative course was uneventful. The heart donor was a 40-year-old man with known arterial hypertension and who had received long-term ergotamine tartrate therapy for migraine. This case demonstrates that heart-transplant recipients with arterial hypertension and donor-related risk factors are prone to aortic complications and require careful follow-up.
SUMMARY - Although feed manufacturers provide feeding tables for marine fish according to water t... more SUMMARY - Although feed manufacturers provide feeding tables for marine fish according to water temperature, these should be tested under local conditions. A feeding table proposal was tested for ad libitum feeding of sea bass in a cage farm of Pinar Marine Company, Izmir, Turkey. Fingerlings were divided into 3 groups (1.83 g, 1.80 g and 1.87 g) and were
We present endovascular treatment of abdominal aortic aneurysm in a 26-year-old man with a 10-yea... more We present endovascular treatment of abdominal aortic aneurysm in a 26-year-old man with a 10-year follow-up. A young patient presenting with an abdominal aortic aneurysm is extremely rare and data describing this population are limited. Open aneurysm repair (OAR) is the treatment of choice in these patients. However since its introduction, endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. The long-term durability and late complications following EVAR may have more significance when considering the optimal treatment for young patients with a longer life expectancy. Our good long-term outcome will help to support the use of EVAR as a reasonable alternative to OAR in young patients with suitable anatomic findings.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2008
Spontaneous coronary artery dissection, which causes acute coronary syndrome and can result in su... more Spontaneous coronary artery dissection, which causes acute coronary syndrome and can result in sudden death, is rare; but its true incidence is underestimated, since most patients die suddenly, without diagnosis. The aim of this study was to show the importance of prompt diagnosis and treatment. In reviewing the records of 5,000 consecutive patients who underwent coronary angiography between January 2001 and August 2006, we found 6 cases of spontaneous coronary artery dissection (an incidence rate of 0.12%). Five patients presented with left main coronary artery dissection and 1 patient, with right coronary artery dissection. Angioplasty with stenting failed in the patient with right coronary artery dissection. Coronary artery bypass surgery was performed in all patients. The patient with right coronary artery dissection died of sepsis on the 30th postoperative day. The other 5 patients (83.3%) are still free of symptoms, and they had negative results on stress tests at the 6- and 1...
The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommen... more The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative practice guidelines (Am J Kidney Dis 2001;37(1 Suppl. 1):S7-S64; Am J Kidney Dis 1997;30(4 Suppl. 3):S150-S191). Brachiobasilic arteriovenous fistula offers excellent access in difficult cases. Many surgical techniques have been described to create brachiobasilic fistula. The purpose of this study was to present and discuss the technique of superficialization of the basilic vein in brachiobasilic arteriovenous fistula with long-term results of 350 cases. A total of 375 brachiobasilic arteriovenous fistulas were constructed with superficialization of the basilic vein technique. Of these, 350 fistulas were used in hemodialysis (93.3%). One hundred fifty-five (44%) patients were male, 195 (56%) were female. Mean age was 57.8 (range, 18-88) years. A 2-cm longitudinal incision was made in antecubital fossa to expose brachial artery and basilic vein under local anesthesia. A separate second skin incision (4-6 cm) was done to explore proximal part of the basilic vein. Side branches of the basilic vein were isolated and ligated carefully using this second skin incision. The basilic vein was divided in antecubital fossa and brought over the fascia through the subcutaneous tunnel at the same anatomical position. Anastomosis was performed with end-to-side technique. Mean follow-up was 48 months (range, 2-84). The mean time to first puncture and use of the fistula time was 52 days (range, 25-75). Bleeding required surgical exploration which occurred in 3 (0.9%) patients. Primary patency of basilic vein superficialization fistulas was 92%, 78%, 64%, and 54% at 1, 2, 3, and 4 years, respectively. Secondary patency was 93%, 81%, 66%, and 56% at 1, 2, 3, and 4 years, respectively. Superficialization of the basilic vein technique is a logical alternative method of the basilic vein transposition. Superficialization requires less extensive skin incision and surgical dissection. Long-term patency was good.
Comparing development of sea bream (Sparus aurata L., 1758) obtained from Homa Lagoon in off-shor... more Comparing development of sea bream (Sparus aurata L., 1758) obtained from Homa Lagoon in off-shore and in- shore net cage Turkey has a rich water potential and lots of fishponds area which has been constituting rather old cultivation and fishing potential except of classic studies as a more productive subject. For this purpose, sea bream has obtained from İzmir Homa
To evaluate the efficacy of the treatment of infected prosthetic grafts and mycotic aneurysms of ... more To evaluate the efficacy of the treatment of infected prosthetic grafts and mycotic aneurysms of the aorta with cryopreserved homografts. Between April 1994 and May 2002, 15 cryopreserved aortic homografts were used in 13 patients in the thoracic and abdominal aortic position with supplementary omental or pectoral muscle wrapping for infected grafts (n=11), and mycotic aneurysms (n=2) (mean age: 57.5). One patient died due to multiorgan failure and the other due to postoperative cerebral hemorrhage (15.38%). Another patient died four months after the operation due to septic arthritis, and coronary heart disease. Ten patients are still alive without evidence of infection (76.92%) during a follow up of 44+/-23.03 (range 4-71) months. The use of cryopreserved homografts with supplementary omentum and/or muscle flap coverage, assures an anatomical reconstruction with good results in this difficult group of patients.
The Journal of Heart and Lung Transplantation, 2003
Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart... more Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart transplantation. We report the second case of successful surgical treatment of aortic dissection confined to the donor aorta in a recipient of an orthotopic cardiac allograft. A 68-year-old patient was admitted with chest pain and shortness of breath 7 years after orthotopic heart transplantation. He previously had undergone twice coronary artery bypass grafting. Echocardiography revealed acute dissection of the donor aorta. The patient underwent urgent Bentall procedure with a prosthetic conduit. The post-operative course was uneventful. The heart donor was a 40-year-old man with known arterial hypertension and who had received long-term ergotamine tartrate therapy for migraine. This case demonstrates that heart-transplant recipients with arterial hypertension and donor-related risk factors are prone to aortic complications and require careful follow-up.
Background: The management of the apical multiple muscular ventricular septal defects (VSDs) rema... more Background: The management of the apical multiple muscular ventricular septal defects (VSDs) remains still controversial. There are various surgical techniques and approaches for closure of "Swisscheese" VSDs. In this study, we report the outcome of multiple muscular VSDs repair, using the septal obliteration technique. Methods: We used the septal obliteration technique in five "Swiss-cheese" ventricular septal defects cases through right atriotomy. Four of the cases had isolated multiple VSDs. One case also had an aortic arch interruption type A, which was repaired prior to cardiopulmonary bypass. Their ages varied between 43 days and 6 years. Results: We did not experience any mortality or serious morbidity. Tracheostomy was required in one patient. There was no important residual shunt in postoperative period, except a minimal shunt in one case. Conclusion: The closure technique of "Swiss-cheese" trabecular multiple VSDs using a large single patch was not troubling. Transatrial approach prevented postoperative problems of ventricular incision. Using a large needle with a large pledgett is the key, which provides deep tissue penetration to avoid residual shunt.
Özet: Son yıllarda önemi giderek artan su ürünleri yetiştiriciliğinde özellikle balık kültürü ön ... more Özet: Son yıllarda önemi giderek artan su ürünleri yetiştiriciliğinde özellikle balık kültürü ön plana çıkmıştır. Özellikle entansif yetiştiricilik konusunda araştırmalar yapılmasını gerektirmektedir. Entansif üretimde, balıkların besin madde ihtiyaçlarının optimal şekilde ...
Özet: Son yıllarda önemi giderek artan su ürünleri yetiştiriciliğinde, üretimin temel amacı olan ... more Özet: Son yıllarda önemi giderek artan su ürünleri yetiştiriciliğinde, üretimin temel amacı olan büyümenin, optimum değerlere taşınması düşüncesi de önem kazanmaktadır. Şüphesiz canlının en iyi şekilde büyümesini sağlamak yetiştiricilikte ana amaçtır. Bu ...
Microscopic analyses in fish feeds. Microscopic identifications of feed are based on comparisons ... more Microscopic analyses in fish feeds. Microscopic identifications of feed are based on comparisons of unknown materials to known standards. For investigated feed and ingredients, stereomicroscope at 8x to 50x was used. Ingredients samples were identified by their shape, color, particle size and texture.
Iatrogenic thrombosis within the heart is rare following intracardiac operations. We undertook su... more Iatrogenic thrombosis within the heart is rare following intracardiac operations. We undertook surgery to correct a 30-month-old girl with Fallot's tetralogy. After a period of 6 months following the operation, echocardiography revealed a thrombus measuring 16 by 12 millimetres attached to the tendinous cords supporting the antero-superior leaflet of the tricuspid valve. Medical treatment having failed, we proceeded to surgical excision so as to avoid pulmonary embolisation. Histological examination confirmed the thrombotic nature of the mass.
The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommen... more The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative practice guidelines (Am J Kidney Dis 2001;37(1 Suppl. 1):S7-S64; Am J Kidney Dis 1997;30(4 Suppl. 3):S150-S191). Brachiobasilic arteriovenous fistula offers excellent access in difficult cases. Many surgical techniques have been described to create brachiobasilic fistula. The purpose of this study was to present and discuss the technique of superficialization of the basilic vein in brachiobasilic arteriovenous fistula with long-term results of 350 cases. A total of 375 brachiobasilic arteriovenous fistulas were constructed with superficialization of the basilic vein technique. Of these, 350 fistulas were used in hemodialysis (93.3%). One hundred fifty-five (44%) patients were male, 195 (56%) were female. Mean age was 57.8 (range, 18-88) years. A 2-cm longitudinal incision was made in antecubital fossa to expose brachial artery and basilic vein under local anesthesia. A separate second skin incision (4-6 cm) was done to explore proximal part of the basilic vein. Side branches of the basilic vein were isolated and ligated carefully using this second skin incision. The basilic vein was divided in antecubital fossa and brought over the fascia through the subcutaneous tunnel at the same anatomical position. Anastomosis was performed with end-to-side technique. Mean follow-up was 48 months (range, 2-84). The mean time to first puncture and use of the fistula time was 52 days (range, 25-75). Bleeding required surgical exploration which occurred in 3 (0.9%) patients. Primary patency of basilic vein superficialization fistulas was 92%, 78%, 64%, and 54% at 1, 2, 3, and 4 years, respectively. Secondary patency was 93%, 81%, 66%, and 56% at 1, 2, 3, and 4 years, respectively. Superficialization of the basilic vein technique is a logical alternative method of the basilic vein transposition. Superficialization requires less extensive skin incision and surgical dissection. Long-term patency was good.
Asso, 1801. 800 meagre (Argyrosomus regius) were fed with formulated diets including barium sulph... more Asso, 1801. 800 meagre (Argyrosomus regius) were fed with formulated diets including barium sulphate and 10 fish were sampled, killed and x-rayed every 2 hours starting 2 hours after feeding for total 30 hours. Gastric evacuation time at 20°C for meagre at 28±2.3gr weight was determined average for 9 hours, complete average digestive track evacuation time was determined for 21 hours by investigating x-ray.
The Journal of Heart and Lung Transplantation, Jun 30, 2003
Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart... more Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart transplantation. We report the second case of successful surgical treatment of aortic dissection confined to the donor aorta in a recipient of an orthotopic cardiac allograft. A 68-year-old patient was admitted with chest pain and shortness of breath 7 years after orthotopic heart transplantation. He previously had undergone twice coronary artery bypass grafting. Echocardiography revealed acute dissection of the donor aorta. The patient underwent urgent Bentall procedure with a prosthetic conduit. The post-operative course was uneventful. The heart donor was a 40-year-old man with known arterial hypertension and who had received long-term ergotamine tartrate therapy for migraine. This case demonstrates that heart-transplant recipients with arterial hypertension and donor-related risk factors are prone to aortic complications and require careful follow-up.
SUMMARY - Although feed manufacturers provide feeding tables for marine fish according to water t... more SUMMARY - Although feed manufacturers provide feeding tables for marine fish according to water temperature, these should be tested under local conditions. A feeding table proposal was tested for ad libitum feeding of sea bass in a cage farm of Pinar Marine Company, Izmir, Turkey. Fingerlings were divided into 3 groups (1.83 g, 1.80 g and 1.87 g) and were
We present endovascular treatment of abdominal aortic aneurysm in a 26-year-old man with a 10-yea... more We present endovascular treatment of abdominal aortic aneurysm in a 26-year-old man with a 10-year follow-up. A young patient presenting with an abdominal aortic aneurysm is extremely rare and data describing this population are limited. Open aneurysm repair (OAR) is the treatment of choice in these patients. However since its introduction, endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. The long-term durability and late complications following EVAR may have more significance when considering the optimal treatment for young patients with a longer life expectancy. Our good long-term outcome will help to support the use of EVAR as a reasonable alternative to OAR in young patients with suitable anatomic findings.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2008
Spontaneous coronary artery dissection, which causes acute coronary syndrome and can result in su... more Spontaneous coronary artery dissection, which causes acute coronary syndrome and can result in sudden death, is rare; but its true incidence is underestimated, since most patients die suddenly, without diagnosis. The aim of this study was to show the importance of prompt diagnosis and treatment. In reviewing the records of 5,000 consecutive patients who underwent coronary angiography between January 2001 and August 2006, we found 6 cases of spontaneous coronary artery dissection (an incidence rate of 0.12%). Five patients presented with left main coronary artery dissection and 1 patient, with right coronary artery dissection. Angioplasty with stenting failed in the patient with right coronary artery dissection. Coronary artery bypass surgery was performed in all patients. The patient with right coronary artery dissection died of sepsis on the 30th postoperative day. The other 5 patients (83.3%) are still free of symptoms, and they had negative results on stress tests at the 6- and 1...
The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommen... more The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative practice guidelines (Am J Kidney Dis 2001;37(1 Suppl. 1):S7-S64; Am J Kidney Dis 1997;30(4 Suppl. 3):S150-S191). Brachiobasilic arteriovenous fistula offers excellent access in difficult cases. Many surgical techniques have been described to create brachiobasilic fistula. The purpose of this study was to present and discuss the technique of superficialization of the basilic vein in brachiobasilic arteriovenous fistula with long-term results of 350 cases. A total of 375 brachiobasilic arteriovenous fistulas were constructed with superficialization of the basilic vein technique. Of these, 350 fistulas were used in hemodialysis (93.3%). One hundred fifty-five (44%) patients were male, 195 (56%) were female. Mean age was 57.8 (range, 18-88) years. A 2-cm longitudinal incision was made in antecubital fossa to expose brachial artery and basilic vein under local anesthesia. A separate second skin incision (4-6 cm) was done to explore proximal part of the basilic vein. Side branches of the basilic vein were isolated and ligated carefully using this second skin incision. The basilic vein was divided in antecubital fossa and brought over the fascia through the subcutaneous tunnel at the same anatomical position. Anastomosis was performed with end-to-side technique. Mean follow-up was 48 months (range, 2-84). The mean time to first puncture and use of the fistula time was 52 days (range, 25-75). Bleeding required surgical exploration which occurred in 3 (0.9%) patients. Primary patency of basilic vein superficialization fistulas was 92%, 78%, 64%, and 54% at 1, 2, 3, and 4 years, respectively. Secondary patency was 93%, 81%, 66%, and 56% at 1, 2, 3, and 4 years, respectively. Superficialization of the basilic vein technique is a logical alternative method of the basilic vein transposition. Superficialization requires less extensive skin incision and surgical dissection. Long-term patency was good.
Comparing development of sea bream (Sparus aurata L., 1758) obtained from Homa Lagoon in off-shor... more Comparing development of sea bream (Sparus aurata L., 1758) obtained from Homa Lagoon in off-shore and in- shore net cage Turkey has a rich water potential and lots of fishponds area which has been constituting rather old cultivation and fishing potential except of classic studies as a more productive subject. For this purpose, sea bream has obtained from İzmir Homa
To evaluate the efficacy of the treatment of infected prosthetic grafts and mycotic aneurysms of ... more To evaluate the efficacy of the treatment of infected prosthetic grafts and mycotic aneurysms of the aorta with cryopreserved homografts. Between April 1994 and May 2002, 15 cryopreserved aortic homografts were used in 13 patients in the thoracic and abdominal aortic position with supplementary omental or pectoral muscle wrapping for infected grafts (n=11), and mycotic aneurysms (n=2) (mean age: 57.5). One patient died due to multiorgan failure and the other due to postoperative cerebral hemorrhage (15.38%). Another patient died four months after the operation due to septic arthritis, and coronary heart disease. Ten patients are still alive without evidence of infection (76.92%) during a follow up of 44+/-23.03 (range 4-71) months. The use of cryopreserved homografts with supplementary omentum and/or muscle flap coverage, assures an anatomical reconstruction with good results in this difficult group of patients.
The Journal of Heart and Lung Transplantation, 2003
Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart... more Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart transplantation. We report the second case of successful surgical treatment of aortic dissection confined to the donor aorta in a recipient of an orthotopic cardiac allograft. A 68-year-old patient was admitted with chest pain and shortness of breath 7 years after orthotopic heart transplantation. He previously had undergone twice coronary artery bypass grafting. Echocardiography revealed acute dissection of the donor aorta. The patient underwent urgent Bentall procedure with a prosthetic conduit. The post-operative course was uneventful. The heart donor was a 40-year-old man with known arterial hypertension and who had received long-term ergotamine tartrate therapy for migraine. This case demonstrates that heart-transplant recipients with arterial hypertension and donor-related risk factors are prone to aortic complications and require careful follow-up.
Background: The management of the apical multiple muscular ventricular septal defects (VSDs) rema... more Background: The management of the apical multiple muscular ventricular septal defects (VSDs) remains still controversial. There are various surgical techniques and approaches for closure of "Swisscheese" VSDs. In this study, we report the outcome of multiple muscular VSDs repair, using the septal obliteration technique. Methods: We used the septal obliteration technique in five "Swiss-cheese" ventricular septal defects cases through right atriotomy. Four of the cases had isolated multiple VSDs. One case also had an aortic arch interruption type A, which was repaired prior to cardiopulmonary bypass. Their ages varied between 43 days and 6 years. Results: We did not experience any mortality or serious morbidity. Tracheostomy was required in one patient. There was no important residual shunt in postoperative period, except a minimal shunt in one case. Conclusion: The closure technique of "Swiss-cheese" trabecular multiple VSDs using a large single patch was not troubling. Transatrial approach prevented postoperative problems of ventricular incision. Using a large needle with a large pledgett is the key, which provides deep tissue penetration to avoid residual shunt.
Özet: Son yıllarda önemi giderek artan su ürünleri yetiştiriciliğinde özellikle balık kültürü ön ... more Özet: Son yıllarda önemi giderek artan su ürünleri yetiştiriciliğinde özellikle balık kültürü ön plana çıkmıştır. Özellikle entansif yetiştiricilik konusunda araştırmalar yapılmasını gerektirmektedir. Entansif üretimde, balıkların besin madde ihtiyaçlarının optimal şekilde ...
Özet: Son yıllarda önemi giderek artan su ürünleri yetiştiriciliğinde, üretimin temel amacı olan ... more Özet: Son yıllarda önemi giderek artan su ürünleri yetiştiriciliğinde, üretimin temel amacı olan büyümenin, optimum değerlere taşınması düşüncesi de önem kazanmaktadır. Şüphesiz canlının en iyi şekilde büyümesini sağlamak yetiştiricilikte ana amaçtır. Bu ...
Microscopic analyses in fish feeds. Microscopic identifications of feed are based on comparisons ... more Microscopic analyses in fish feeds. Microscopic identifications of feed are based on comparisons of unknown materials to known standards. For investigated feed and ingredients, stereomicroscope at 8x to 50x was used. Ingredients samples were identified by their shape, color, particle size and texture.
Iatrogenic thrombosis within the heart is rare following intracardiac operations. We undertook su... more Iatrogenic thrombosis within the heart is rare following intracardiac operations. We undertook surgery to correct a 30-month-old girl with Fallot's tetralogy. After a period of 6 months following the operation, echocardiography revealed a thrombus measuring 16 by 12 millimetres attached to the tendinous cords supporting the antero-superior leaflet of the tricuspid valve. Medical treatment having failed, we proceeded to surgical excision so as to avoid pulmonary embolisation. Histological examination confirmed the thrombotic nature of the mass.
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