Gebeliðin ilk yarýsýnda gözlenen her türlü kanama abortus imminens olarak tanýmlanmaktadýr. Abortus imminens, tüm gebeliklerin % 20-50 kadarýnda izlenen önemli bir gebelik komplikasyonudur. Bu gebeliklerde gebeliðin prognozunu belirlemek oldukça önem taþýr.

Çalýþmamýzda abortus imminenste β-hCG, estradiol, progesteron, CA 125 gibi hormonal ve biyokimyasal parametrelerle, obstetrik ultrasonografinin prognostik deðerini karþýlaþtýrmayý amaçladýk.

Çalýþma Ekim 1997-Eylül 1998 tarihleri arasýnda SSK Göztepe Eðitim Hastanesi, Kadýn hastalýklarý ve Doðum Kliniðine vajinal kanama þikayeti ile baþvuran ve abortus imminens tanýsý ile yatýrýlarak izlenen hastalarla (olgu grubu), poliklinikte ayaktan izlenen normal gebeler (kontrol grubu) arasýnda yapýldý. Olgu grubu 38, kontrol grubu 34 hastadan oluþturuldu. Ayrýca olgu grubunu oluþturan gebeler de; gebeliði devam edenler ve abortusla sonuçlananlar olmak üzere 2 alt gruba ayrýldý. Araþtýrmaya katýlan tüm gebelerin önkol veninden 5 cc venöz kan alýnarak, serumlarýnda β-hCG, E2, progesteron, CA 125 düzeyleri çalýþýldý. Gestasyonel haftalarý, son adet tarihi ve ultrasonografi ile belirlendi. Yapýlan obstetrik US ile fetal nodun varlýðý, gestasyonel kesenin büyüklüðü, þekli, baþ-popo mesafesi, fetal kardiak aktivitenin varlýðý ve korpus luteum özellikleri kaydedildi.

β-hCG, estradiol, CA 125, progesteron deðerleri olgu ve kontrol gruplarý arasýnda karþýlaþtýrýldýðýnda, sonuçlar istatistiksel olarak anlamlý derecede farklý idi (p<0.05). Ultrasonografi ile deðerlendirilen gestasyonel kese ve korpus luteum karþýlaþtýrýldýðýnda sonuçlar istatistiksel olarak anlamlý bulundu.

Abortus imminens olgularýnda, sözkonusu hormonal, biyokimyasal ve ultrasonografik yöntemlerin gebeliðin prognozunu belirlemede önem taþýdýðý sonucuna varýldý.

Any type of bleeding that is shown in the first half of pregnancy is known that to be abortion imminens. Abortion imminens is one of the pregnancy complication that is occured in 20-50 % of all pregnancies. In this pregnancies to determine the prognosis of pregnancy is quite a bit important.

In our study we aimed to compare hormonal and biochemical parameters such as b-hCG, Estradiol, progesteron and CA 125 with the prognostic value of obstetrics ultrasonography.

The study was performed between the patient who have applied to Gynaecology and Obstetrics clinic of SSK Goztepe Educational Hospital from October 1997 to September 1998 with complaining of vaginal bleeding (case) and normal pregnant women (control) who were outpatients. Case group was taken form 38 patients and the control one was 34. The case group was divided in two groups to be continuing pregnancy and result in abortion. 5 cc blood were taken from all pregnant women forearm weins and b-hCG, E2, progesteron and CA 125 levels were studied in their blood serums. Gestational age was determined by last menstruel period and ultrasonography. The presence of fetal node, the size and the form of gestational sac, crown-rump length, fetal cardiac activity and
the chracteristics of corpus luteum were recorded.

Statistically comparison the result of b-hCG, E2, CA 125 and progesteron values between case and control group were significantly different (p<0.05).

The result were significantly meaningful when the evaluated gestational sac by ultrasonography was compared with corpus luteum.In conclusion, hormonal profile, biochemistry and ultrasonographic analysis are important to investigate the
prognosis of pregnancy in abortion imminens cases.

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Çalýþmamýzda sisatrakuryum besilatýn 3xED95 ve 4xED95 dozlarýnýn entübasyon koþullarýný, hemodinamik etkilerini ve yan etki sýklýklarýný karþýlaþtýrmayý amaçladýk.

Çalýþmaya ortopedi ve genel cerrahi kliniklerinde opere olan ASA I-II grubunda 40 hasta dahil edildi. Dolaþým ve solunum sistemi hastalýðý olanlar, alerji anamnezi verenler, gebeler ve zor entübasyon olabileceði düþünülen hastalar çalýþma dýþý býrakýldý. Hiçbir hastaya premedikasyon uygulanmadý. Hastalar EKG, SpO2, noninvaziv arter basýncý ölçer ve TOF-Guard (Organon Teknika) ile monitörize edildiler. Anestezi indüksiyonunda I. Gruba 0.15 mg/kg, II. Gruba 0.2 mg/kg sisatrakuryum besilat verilerek tekli uyarana yanýtta % 95 depresyon elde edilmesi sonrasýnda entübasyon gerçekleþtirildi. Entübasyon koþullarý Goldberg skalasý ile deðerlendirildi. Entübasyon öncesi, entübasyondan 5 dakika sonraki ve entübasyondan 10 dakika sonraki kalp atým hýzý (KAH), sistolik arter basýncý (SAB), diastolik arter basýncý (DAB) ve ortalama arter basýncý (OAB) deðerleri kaydedildi. Anestezi indüksiyonu sonrasý 10 dakika içinde görülen bradikardi (KAH ²50/dk), hipotansiyon (OAB ²% 20), havayolu spazmý, deri kýzarýklýðý ve deri döküntüsü gibi yan etkiler saptandý. Hemodinamik sonuçlar student’s t testi ile, entübasyon koþullarý ve yan etkiler nonparametrik Wilcoxon testi ile deðerlendirildi.

Demografik veriler (yaþ ve kilo), KAH, SAB, DAB ve OAB deðerlerinde gruplar arasýnda anlamlý fark yoktu (p>0.05). Entübasyon koþullarý her iki grupta da mükemmel-iyi düzeyindeydi ve gruplar arasýnda anlamlý fark yoktu (p>0.05). Hipotansiyon ve bradikardi II. Grupta daha sýktý ve bu iki yan etki bakýmýndan gruplar arasýnda anlamlý fark mevcuttu (p<0.05).

Sonuç olarak, sisatrakuryum besilatýn 3xED95 (0.15 mg/kg) ve 4xED95 (0.2 mg/kg)’lýk iki dozu arasýnda, entübasyon koþullarý ve hemodinamik özellikler yönünden fark bulunmadý. Hipotansiyon ve bradikardi dýþýnda yan etki gözlenmedi. Bu iki yan etki daha yüksek doz kullanýlan grupta anlamlý olarak arttý.

In this study, we compared two different dose (0.15 mg/kg versus 0.2 mg/kg) of cisatracurium besilate which is a new nondepolarizing neuromuscular blocker. Forty patients, in ASA I-II status were studied, except has respiratory or cardiovascular disorder, allergy, pregnancy and intubation difficulty. None of them were premedicated. All patients were monitored with EKG, SpO2 noninvaziv arterial pressure and neuromusculart moniteur (TOF-Guard, Organon Tecnica). At the induction of anesthesia intubation was performed after 0.15 mg/kg (Group I) and 0.2 mg/kg (Group II) cisatracurium besilate was injected and waited for 2 minutes because of the single twitch depression reach 95 %. Intubation conditions were scored with Goldberg’s scale. Heart rate, systolic, diastolic and mean arterial pressure were enrolled; before, 5 minutes
and 10 minutes after intubation. Adverse effects (bradycardia, hypotension, airway spasm, rush and flush) which was occured after 10 minutes from the induction of anesthesia, also were enrolled. Haemodynamic values were evaluated with student’s t test, and for intubation conditions and adverse effects, Wilcoxon test was applied.

Intubation conditions were perfect or good in both groups without ana significant differences (p>0.05). There was no significant difference in demographic data (age and weight), heart rate, systolic, diastolic and mean arterial pressure between two goups either (p>0.05). But Group II had more advers effects (bradycardia and hypotension) than Group I and this was a significant difference between higher dose group and lower dose one (p<0.05).

In summary higher dose (0.2 mg/kg) cisatracurium besilate has more advers effects against lower (0.15 mg/kg) dose, without any significant changes about haemodynamic values or intubation conditions.

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Memenin invaziv duktal karsinomlarýnda c-erbB-2 onkogeninin overekspresyonunun prognostik rolünü belirlemek amacý ile 40 adet invaziv duktal karsinomlu radikal mastektomi
materyaline ait H&E kesitlerde bilinen prognostik faktörlerden yaþ, tümör boyutu, histolojik grade (Bloom Richardson), damar tutulumu, tümör sýnýrýnýn tipi, aksiller lenf nodu metastazý,
inþamatuar reaksiyon, in situ- komedo alanlarýn varlýðý deðerlendirildi, c-erbB-2’nin overekspresyonunu deðerlendirmek için tümörlü bloklara anti c-erbB-2 uygulandý. Olgular
boyanma olmayan grup negatif (C0), % 25’den az tümör hücre boyanmasý (C1) ve % 25’den fazla tümör hücre boyanmasý (C2) olarak gruplara ayrýldý. Sonuç olarak c-erbB-2 immunoreaktivitesinin tüm prognostik faktörlerle iliþkisiz olduðunu saptadýk.

In order to determine the prognostic role of c-erbB-2 oncogene overexpression in invasive ductal carcinomas of mammary gland, 40 H&E stained radical mastectomy materials with invasive ductal carcinoma are evaluated in regard of known prognostic factors such as age of patient, size of the tumour, histological grade of the tumour (Bloom Richardson), vascular involvement of the tumour, type of tumour margins, metastasis to axillary lymph nodes, inflammatory reaction and accompanying in situ comedo carcinomas. Immunohistologically the parrafin blocks of tumoural tissues are stained
with anti c-erbB-2 in order to evaluate the overexpression of c-erbB-2 oncogene. Cases with negative immunoreactivity are classified as C0, cases with staining in less than 25 % of tumoural tissues are grouped as C1 and cases with staining in more than 25 % of the tumour are interpreted as C3. As a result in our study we found no relation between c-erbB-2 immunoreactivity and the prognostic factors.

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SSK Göztepe Eðitim Hastanesi Çocuk Kliniði Yenidoðan Servisinde takip edilen, 4 yarýk dudak, 7 yarýk damak ve 9 yarýk damak-dudak anomalisi olan toplam 20 olgu deðerlendirildi. Yarýk dudaklý 4 olgunun hiçbirinde ilave patoloji saptanmazken, yarýk damaðý olan 16 olgunun 7 (% 44)’sinde çeþitli anomaliler saptandý. Bunlardan; % 19’unda serebral anomali, % 25’inde fasiyal anomali, % 19’unda kalp malformasyonlarý, % 12’sinde ekstremite anomalileri tespit edildi.

Konjenital malformasyonlar yarýk damaklý bebeklerde daha fazla görüldüðünden, bu hastalarýn ayrýntýlý incelenerek eþlik edebilecek ilave patolojilerin tespiti ve multidisipliner bir
þekilde takip edilmeleri gereklidir.

Cleft of the lip and palate are distinct entities closely related embryologically, functionally and genetically. The incidence of associated congenital malformations and of impairment in development is increased in children with cleft defects, especially in those with cleft palate alone. In our study, 4 isolated cleft lip, 7 isolated cleft palate and 9 cleft lip with cleft palate cases who were internalized to SSK Göztepe Educational Hospital Pediatric Neonatology Unit were evaluated. No other anomalies were detected in the patients with cleft lip; whereas 7 (% 44) of the 16 cleft palate cases had associated congenital defects. % 19 of these patients had cerebral malformations, % 25 facial anomalies, % 19 heart defects and % 12 extremity problems.

Consequently, we point out that this group of children require attention for the other associated congenital problems and should be evaluated and followed with a multidiscipliner approach.

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Sentinel nod tümörden ilk drenajý alan lenf nodudur. Lymphazurin mavi boya injeksiyonu, radyoaktif kolloid kullanýmý veya lenfosintigrafi ile saptanabilir. Mavi boya kullanýmýnda, sentinel nod, maviye boyanmýþ bir lenf yolunun eþlik ettiði mavi bir nod þeklinde görülür. Çalýþmalar, deneyimli ellerde % 90’ýn üzerinde olguda sentinel nod saptanabildiðini ve bunun
da % 95’in üzerinde oranlarda aksillanýn durumunu açýklayabildiðini göstermektedir. Bu tekniðin uygulanmasýyla, aksiller nod diseksiyonu sentinel nodda tümör yayýlýmý olan hastalarla sýnýrlý kalabilir ve bu sayede diðer hastalar bu iþlemden uzak tutulabilir. Bu çalýþmada, yalnýzca mavi boya yöntemi kullanýmýyla, sentinel nod disseksiyonundaki duyarlýlýk ve özgüllüðü sunmaktayýz.

The sentinel node is defined as the first lymph node to receive drainage from a tumor. It can be identified by injecting lymphazurin blue dye, a radiaoctive colloid or lymphoschintigraphy. When blue dye is used, the sentinel node is found by visual identification of a blue-stained lymphatic channel leading to a blue node. Studies have shown that with experience a sentinel node can be identified in more than 90 % of patients and that the status of the remaining axillary nodes in over 95 % of cases. Using this technique, axillary node dissection can be limited to those patients who have tumor in the sentinel node who will benefit from the procedure.In this study, we present our sensitivity and spesitivity for sentinel node dissection using blue dye technique alone.

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Ýntrauterin geliþme geriliði (IUGG), neonatal mortalite ve morbitenin önemli bir nedenidir. IUGG olan gebeliklerin belirlenmesinde seri ultrasonografi ve doppler tekniklerin dýþýnda fetus kanýnda saptanan leptin düzeyi de önemli bir biyokimyasal belirteçtir. Leptin adipoz dokudan kaynaklanan bir obezite geni tarafýndan kodlanan bir hormondur. Düþük serum leptin düzeyleri gebeliðin erken döneminde IUGG’ni gösterebilir.

Çalýþmamýzda term gebelerde IUGG tanýsýnda fetal kord kanýnda ve maternal kanda leptin düzeyleri ile vücut kitle indeksinin (BMI) deðerini incelemeyi amaçladýk.

Çalýþmaya Aralýk 1998-fiubat 1999 tarihleri arasýnda SSK Göztepe Eðitim Hastanesi 2. Kadýn Hastalýklarý ve Doðum Kliniðine baþvuran fetal geliþme geriliðine sahip olan ve olmayan 51 gebe alýndý. IUGG olan fetusa sahip 30 gebe 1. grupta, normal geliþimi olan fetusa sahip 21 gebe 2. Grupta incelendi. Tüm gebelerde fetal ve maternal serum leptin düzeyleri belirlendi. Leptin düzeyi ile BMI arasýnda pozitif korelasyon olduðundan gebelerin BMI’leri de hesaplanarak kaydedildi.

Fetal leptin düzeyi 1. grupta ort. 7.06±6.2 ng/ml, 2. Grupta ort. 13.14±9.97 bulunmuþtur. Sonuçlar IUGG’ni belirlemede istatistiksel olarak anlamlýdýr (p<0.05). Maternal leptin düzeyi ve maternal BMI’nin iki grup arasýnda karþýlaþtýrýldýðý istatiksel yöntemlerin hiçbiri anlamlý sonuç vermemiþtir.

Sonuç olarak, fetal leptin düzeyinin düþük saptanmasý IUGG olan fetuslarý saptamada önemli bir parametre iken maternal leptin düzeyinin ve BMI’nin deðeri yoktur.

IUGR is one of the principal reason of the neonatal mortality and morbidity. Within the IUGR diagnosis, a recent parameter is the level of the fetal leptin. Leptin is a hormon coding by gene of the obesity, which is caused of the adipose tissue. Low level leptin can show IUGR of the pregnants earlier.

Within our work we have researched that if the leptin level of the fetal cord serum, maternal serum and Body Mass Index (BMI) can form objective parameters in the IUGR diagnosis with the term pregnants.

51 pregnant women who had been applied to SSK Göztepe Educational Hospital, 2. clinic of gynecology and obstetric between December 1198 - February 1999; and who possess
fetal development gene or not; have been participated to our study. 30 pregnants who have a fetus with IUGR have been observed in the first group, next 21 pregnants have a normal development, have been observed in the second group. In all pregnants, the level of the fetal cord serum, maternal serum leptin have been recorded. Because of the positive corelation between the leptin level and the BMI, maternal BMI have been also recorded.

The level of the fetal leptin is 7.06±6.2 in the first group and this level is 13.14±9.97 in the second group. Then, the results have been considered statistically meaningful as regards the identification of the IUGR (p<0.05). The level of the maternal leptin and the maternal BMI have been compared between the first and the second group and a significant difference has not been found.

The identification of the fetal leptin level is a significant parameter while fixing the regression of the fetal development. But the maternal leptin level and BMI are not effective in identifying the regression of the fetal development.

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West sendromu (WS), yaþamýn ilk yýlýnda ortaya çýkan, kötü huylu bir epilepsi hastalýðýdýr. Bu çalýþmada, hastanemizde semptomatik WS tanýsý ile izlenen hastalarda yapýlan görüntüleme tetkiklerinde saptanan nöroradyolojik bulgular incelendi.

Çalýþmaya semptomatik WS tanýlý 53 hasta alýndý. Nöroradyolojik inceleme yöntemi olarak uygulanan bilgisayarlý beyin tomografisi (BBT) ve manyetik rezonans görüntüleme (MRG)’nin bir veya her ikisi ile elde edilen bulgular deðerlendirildi. Çalýþmadaki 53 hastanýn 29’una BBT, 35 olguya da MRG incelemesi yapýldý, 11 olguda ise her iki tetkik çalýþýldý. Serebral kortikal atrofi her iki incelemeyle en sýk tespit edilen bulgu idi. Görüntüleme yöntemleri, klinik ve serolojik olarak tanýlanan tuberoz skleroz ve intrauterin infeksiyonlara ait bulgularý detaylý þekilde ortaya koydu. Üç hastada görüntüleme ile patoloji tespit edilemedi. BBT sonucu normal bulunan iki hastada MRG ile ek lezyonlar gösterilebildi.

BBT ve MRG, semptomatik WS’lu olgularýmýzýn % 94.3-’ünde etyolojiyi açýklayan bir lezyonu gösterdi. Her iki yöntemin uygulandýðý hastalarda MRG, BBT’ye göre daha fazla detayý ortaya koyabildi. Çalýþmada bazý olgularda farklý sonuçlar elde edildiðinden, inceleme için BBT ve MRG’den herhangi birinin seçiminde, beklenen patolojiye göre tercih yapýlmasýnýn uygun olacaðý düþünüldü.

West syndrome (WS) is a malignant type of epilepsy presented in the first year of life. The neuroradiological results detected with imaging measures were reviewed.

53 patients with symptomatic WS have been included in this study. Either computed tomography (CT) or magnetic resonance imaging (MRI) of the brain, or both were performed and the results were compared. 29 patients were underwent CT, whereas 35 had MRI and both modalities were studied in 11 patients. Cerebral cortical atrophy was the most striking pathologic pattern observed in both imaging methods. Neuroimaging
modalities revealed in detail the findings of the tuberous sclerosis and intrauterine infections diagnosed with clinical and serological evaluation. MRI demonstrated further
information than CT scan in two patients.

CT and MRI were successful in proving the lesion responsible from the etiology in 94.3 % of the patients. MRI was much informative than CT in revealing the pathology when both
examinations were studied. As varying results were obtained in some scans, it was concluded that the decision to have CT or MRI should be made according to the expected pathology.

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Menenjit, hayatý tehdit eden önemli infeksiyon hastalýklarýndan birisidir. Tanýnýn erken konulmasý ve erken tedavi, mortalite ve morbiditeyi azaltýr. Sepsis veya menenjit gibi ciddi infeksiyonlarda taný amaçlý kullanýlacak ideal bir gösterge; yüksek özgüllük ve duyarlýlýða sahip olmalý, ucuz olmalý, kolay ölçülebilmeli, tedavinin etkinliðini deðerlendirmede yardýmcý olabilmelidir. Günümüzde kullanýlan göstergelerin hiç birisi tam olarak bu koflullarý saðlayamamaktadýr.

Menenjit olgularýnda, BOS bulgularýna göre viral-bakteriyel ayýrýmý yapmak her zaman olanaklý deðildir. Bu da gereksiz antibiyotik kullanýmýna neden olmaktadýr. PCT’nin son yýllarda sistemik enfeksiyonlarýn tanýsýnda, hastalýðýn seyri ve tedavi yanýtýnýn izlenmesinde, inflamatuar hastalýklarýn ve nedeni bilinmeyen ateþin ayýrýcý tanýsýnda, büyük cerrahi giriþim ya da çoklu travma geçiren, organ transplantasyonu yapýlan veya uzun süre yoðun bakýmda kalan hastalarýn bakteriyel infeksiyon açýsýndan izlenmesinde kullanýlmaya baþlanmýþ yeni bir göstergedir.

Bu çalýþmada, çocukluk çaðýndaki bakteriyel ve viral menenjitin baþlangýç dönemlerinde plazma prokalsitonin (PCT) düzeyleri araþtýrýlarak, çocukluk çaðý menenjitlerinin erken ayrýcý tanýsýnda faydalý olup olamayacaðý sorgulanmak istendi.

Menengitis is one of the major lethal infectious diseases, early diagnosis and treatment decrease the mortality and morbidity. An ideal parameter that will be used in the diagnosis of serious infectious disease like sepsis or menegitis should have high specialty and sensitivity. It should be cheap, easy to measure and let us the clinician follow up the efficacy of the treatment.

Differential diagnosis of bacterial meningitis over viral ones by CSF findings is not always possible; and this may lead to unnecessary antibiotic usage. Recently PCT is used in the
diagnosis of systemic infections and differential diagnosis of inflammatory bowel disease and FUO. It is valuable during monitoring of the disease and fallow up the efficacy of treatment. It is new usage is the fallow up of patients who had major surgery multiple travma, transplantation of organ or long intensive care unit stay for bacterial infections.

In this study, ýt is aimed to determine whether PCT is useful in the early differential diagnosis of meningitis in pediatric patients by comparing the serum plazma PCT levels drawn grow patients with meningitis in the early period of the disease.

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Bu çalýþmada, maternal serum inhibin Aα[?]subunit düzeyinin preeklampsinin prediksiyonunda bir belirteç olup olamayacaðýný araþtýrdýk.

Normal gebelerle karþýlaþtýrdýðýmýzda, preeklamptik gebelerde serum inhibin Aα[?]subunit düzeyini anlamlý olarak yüksek bulduk (p<0.001). Preeklamptik gebelerde doðum aðýrlýðý
anlamlý derecede düþüktü. Fakat, doðum aðýrlýðý ile inhibin α[?]düzeyleri arasýnda bir korelasyon bulamadýk. Ayný þekilde[?]cinsiyet ile inhibin Aα[?]subüniti arasýnda da bir korelasyon[?]bulunamadý.

Sonuç olarak, preeklamptik gebelerdeki inhibin Aα[?]subünitinin artýþýnýn, sinsitiyal proliferasyondaki düzenleyici mekanizmalarý ve plasental fonksiyonu gösteren bir indeks olabileceðini söyleyebiliriz.

In this study we have searched that serum inhibin Aa subunit level is a marker in the prediction of preeclampsia or not. Serum inhibin Aa level was expressive high in preeclamptic pregnant when we compared with normal pregnant women’s (p<0.001). Birth weight was expressive low in preeclamptic pregnant women. But we could not find any correlation between birth weight and inhibin Aa levels. There was no any correlation between sex and inhibin Aa subunit either.

In conclusion, we may say that the increasing of inhibin Aa subunit in preeclamptic pregnant women is an index, which shows the regulation mechanisms in sinsitial proliferation and placental function.

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Kas gevþeticiler genel anestezi uygulamalarýnýn vazgeçilmez bir parçasýdýr. Çalýþmamýzda, her ikisi de non-depolarizan, orta etki süreli nöromüsküler bloker olan atrakuryum ve cisatrakuryumun hemodinamik etkilerini karþýlaþtýrmayý amaçladýk. Elektif cerrahi planlanan ASA I-II risk grubundan, 18-65 yaþ arasý 15’i kadýn 30 hasta randomize olarak iki gruba ayrýldý. Tüm hastalara preoperatif 30 dakika önce IM 0.5 mg atropin, 50 mg meperidinle premedikasyon uygulandý. Operasyon masasýnda 1 μg/kg IV fentanili takiben 2.5 mg/kg propofol ile indüksiyon saðlandý. Grup I’de 0.5 mg/kg atrakuryum, Grup II’de 0.2 mg/kg cisatrakuryum uygulanýp, 2 dakika beklendikten sonra entübasyon yapýldý. Gruplarýn bazal, fentanil sonrasý, nöromüsküler bloker sonrasý, entübasyon sonrasý, entübasyondan sonraki 1., 3., 5. dakikalardaki, kalp atým hýzý, kan basýnçlarý ve SpO2 deðerleri kaydedildi. Yan etkiler deðerlendirildi. Hemodinamik açýdan gruplar arasýnda anlamlý fark bulunmadý. Grup içi karþýlaþtýrmada kalp atým hýzýnda Grup I’in, kan basýnçlarýnda Grup II’nin daha stabil olduðu görüldü. Grup I’de 5 hastada ciltte eritem, Grup II’de 3 hastada entübasyona reaksiyon görüldü. Entübasyon için cisatrakuryumu daha yüksek dozda uygulamak ya da etkisini göstermesi için entübasyondan önce bir süre daha beklemek gerektiði sonucuna varýldý.

Myelorelaxants are essantial for general anesthesia. In this study our objective was to compare haemodynamic effects of atracurium and cis-atracurium which are non-depolarizing neuromuscular blocker agents. 30 patients (15 female) aged 18-65 who planed elective surgery at ASA I-II risk population were randomized two groups all patients were applied premedication with 0.5 mg atropin IM and 50 mg meperidin IM
30 minutes before operation, induction was obtained with 2.5 mg/kg propofol following 1 μg/kg fentanyl 0.5 mg/kg atracurium was applied in grup I, 0.2 mg/kg cis-atracurium was
applied in group II then entubation was done after 2 minutes waiting time. Heart rate, blood pressure and SpO2 were recorded at baseline and after fentanyl aplication and neuromusculer blocker and at minutes 1.,2., 3. after entübation. Side effect were evaluated. There were no significant difference between the groubs in haemodynamic paramaters. Heart rate for group I and blood pressure for group II were found more stable in group comparison. Result; cis-atracurium should be used higher dose for entubation or same more time is needed to show efficacy before entubation.

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The hemolitic-uremic syndrome (HUS) is the most common cause of acute renal failure in young children and the incidence is increasing. The syndrome is most common in children
under the age of 4 year. The onset is usually preceded by gastroenteritis (fever, vomiting, abdominal pain and diarrhea, which is often bloody) or less commonly, by an upper respiratory tract infection. This is followed in 5-10 days by the sudden onset of pallor, irritability, weakness, lethargy and oliguria. Physical examination may reveal dehydration, edema, petechiae, hepatosplenomegaly and marked irritability. The primer event in pathogenesis of the syndrome appears to be endothelial cell injury. Treatment is symptomatic. Plasmapheresis or the administration of fresh frozen plasma or both
are recomended. Long term observation is necessary to watch off late development of hypertension or chronic kidney disease. ‹n this report a case who was diagnosed HUS are presented. HÜS should be considered in differential diagnosis of acut begining anemia with renal failure signs.

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A rare case of Krukenberg’s tumor is discussed according to the knowledge obtained from literature.Krukenberg tumor is defined a metastatic carcinoma of the ovary usually from the
stomach until proven otherwise. Typically the ovarian tumors were bilateal, asymmetrical large and solid. Historically krukenberg tumor mucinous signet ring cells was more common
(80 %) than the tubular variant. We report a 54 years old female patient who operated for gastric cancer. That patient admitted to our clinic for pelvic pain, MRI findings shown that
bilateral solid ovarian mass, hepatomegaly, ascites. Krukenberg tumor was confirmed by pathologically.

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Osteoarticular tuberculosis is one of the chronic inflammatuary diseases of the joints. Joint inflammation is usually monoarticular and most cases occur in the vertebrae, the hip
and the knee. Early recognition and treatment of this slow progressive disease is important in preventing the complications. In cases with persistent, unexplained joint compliants,
osteoarticular tuberculosis must be thought. In this paper a tuberculous arthritis case in a child is reported who was attempted with resistant knee complaints.

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Small intestine tumors, which take place in about % 75 in the length and more than % 90 of the mucosal surface of the gastrointestinal system are very rare. % 3-6 of all benign intestine tumors and % 1 of all malign intestine tumors are colonized in the small intestine. Leiomyomas are the most seen and symptomatic benign tumors. They are asymptomatic in general but might become symptomatic by growing in mass. Symptoms then are intestinal obtstruction, bleeding, intusseption and volvulus. They rarely present themselves ind the pelvis as a tumoral mass.

We present a patient with an intestinal leiomyom in the pelvis which has been pre-diagnosed as an ovarial tumor. Our aim is reminding surgeons that postmenoposal prediagnosed ovarian masses might be intestine leiomyomas.

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Hemophilia B (Christmas Disease) is a congenital coagulopathy characterized by factor IX deficiency. In the neonatal period, it may be presented with intracranial, umblical and gastrointestinal tract hemorrage. Our case was a neonate presented with hematoma formation in his thigh after an intramuscular injection. Hemophilia B was considered as the
cause after detecting the blood factor IX levels % 0.

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Oncocytoma, or adenoma with oncocytic features, is a benign neoplasm that is characterized by large cells with small, uniform, round nuclei and an abundant eosinophilic cytoplasm (1,2). Oncocytomas may grow to a size large enough to cause a
palpable mass, pain, and hematuria, and these findings lead to an investigation for malignancy of the urinary tract or they may be asymptomatic. Small oncocytomas are often detected as an incidental mass. Althouh most often solitary, multiple and bilateral oncocytomas do occur (3). In this case report, the patient who fell from a height of 3 meters without any previous complaint was evaluated. A renal hemorragic solid mass was found. Postoperative pathologic specimens was found to be a renal oncocytoma.

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Joubert Syndrome is a rare syndrome characterised by hypoplasia of the cerebellar vermis, hypotonia, abnormal eye movements, abnormal breathing pattern, ataxia, developmental delay and mental retardation. A 4-day old boy was referred to our clinics with the complaints of difficulty in breathing and convulsions. Cranial MRI taken in the axial
plane demonstrated disorganised, disgenetik and split cerebellar vermis, thick superior cerebellar pedincles and small inferior cerebellar pedincles. With these clinical and radiological findings the patient had the diagnosis of Joubert Syndrome. Because it is a rare syndrome we present this neonatal case of Joubert Syndrome.

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An inflammatory disorder of unknown cause, characterized by the occurence of relapsing uveitis and recurrent genital and oral ulcers, was described by Behçet in 1937. The disease
may involve the nervous system, skin, joints, and peripheral blood vessels. Pathologically, small arterioles or venulesare infiltrated with inflammatory cells. We discussed a case of
Behcet’s Disease with venous sinus thrombosis.

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Clear cell sarcoma of the kidney is an extremely rare malignant renal tumor of children especially in the neonatal period. Although it has similarities with Wilms tumor in localization
and demographic features, it is a more aggressive tumor with a propensity to metastasize to bone. We report this case becouse it is presented with a paraneoplastic syndrome and
this tumor occurs only rarely in the neonatal period.

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Hidatid disease has been known since the period when Hippocrate survived. It is fairly common disease in the mediterrenian and middle east countries. Peritoneal echinococcosis is rare even in areas where hydotidosis is endemic. Peritoneal echinococcosis representing uncommon manifestation of disease may be either primary or secondary. It could be pretty serious in cases of cystic processes of unusual origin that may be difficult to diagnose. That means a long lasting multiple cystic process contains certain risk. We report young male having hydatid cyst with unusual location. His presenting symptoms were atypical and discovered accidentaly. It was necessary that CT and abdominal USG in order to diagnose cystic disease in abdominal cavity is employed. The main treatment is surgery with antihelmintic (as albendazole) drug used cyclic or continious regimen in follow up period. The reason for this case presenting symptoms below why it has been made our knowledge on peritoneal hydatidosis updated.

The patient was 26 years old male living in a little town and working for argicultural events. When the patient was examined first time in the clinic we got several symptoms such as stomach ache, weakness, vomiting, which he had experienced for almost one month. In addition the solid mass like 12x7 cm locating from umblicus to his pelvic space in his abdominal cavity was noticed. His blood samples gave us to know that all screening test were normal except SGOT (70 IU/ml) and LDH (246 U/ml) and total IgE more than 10 IU/ml that were increased and eosinophilia in his blood as well. His diagnosis
was created after abdominal USG and computed tomography as hidatid cyst.

After diagnosing the mass in his abdominal space as hidatid cyst the assent about the study being held in our clinic on the hydatidosis and the consent form was taken. Cystectomy and partial omentectomy was then employed as his procedure.

There was no problem in his early postoperative period. He has taken Albendozol 800 mg/day/dose since 1st day postoperatively. Syclic drug regimen was employed for him about 4 mounths postoperatively. He was charged in 7th day after surgery with no complication. He came back to be examined in 7th-8th week. Abdominal USG done gave us normal abdominal imaging. In his examination in 1 year after surgery, June 2000, no problem with him was experienced. He has no disease in this particular time process.

As a result EKH disease is rare esthablished in peritoneal space as the cyst with unusual localisation (5-14 %). Firstchoise of treatment should be the surgery resecting them
all. Surgery with antihelmintic drugs in cyclic or another regimen has more beneficial than surgery alone.

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We evaluated combined rheumatic and congenital heart disease in 4 patients. Congenital defects were ventricular septal defect, patent ductus arteriosus, operated valvular pulmonary stenosis, bicuspid aortic valve plus aortic valve stenosis. Rheumatic manifestations were mitral and aortic valve regurgitation in 3 patients and mitral regurgitation in one patient. Sydenham’ chorea was seen together with rehumatic valve
disease in one patient. The incidence of combined rheumatic and congenital heart disease was % 3 in our 124 rheumatic fever patients. Conclusion: because of high incidence of rheumatic fever in Turkey, when clinical and labarotory findings of rheumatic fever are established in patients with congenital heart disease, diagnosis of combined rheumatic and congenital heart disese could be made.

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