GÝRÝÞ ve AMAÇ: Ýkinci basamak devlet hastanesinde bronkoskopik iþlemlerin uygulanýþ koþullarýný ve sonuçlarýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Haziran 2010-Haziran 2012 tarihleri arasýnda poliklinik ve konsültasyonlar sýrasýnda bronkoskopi endikasyonu konularak yapýlan 30 bronkoskopik iþlem retrospektif olarak deðerlendirildi. Çalýþmaya alýnan olgularýn demografik özellikleri, radyolojik bulgularý, bronkoskopi yapýlan yer, iþlem nedeni, bronkoskopik bulgularý, taný ve iþlem komplikasyonlarý deðerlendirildi.
BULGULAR: 25’i erkek, 5’i kadýn 30 olguya yapýlan bronkoskopik iþlem çalýþmaya alýndý. Ortalama yaþ 50.1 idi (20-81). Yapýlan bronkoskopik iþlemlerin % 66.7’si tanýsal, % 33.3’ü tanýsal ve tedavi amaçlýydý. Olgularýn % 63.3’üne (n: 19) iþlem ameliyat odasýnda, % 33.3’üne (n: 9) yoðun bakýmda, % 3.4’üne (n: 1) yatak baþýnda yapýlmýþtýr. Ýþlem öncesi bronkoskopi kararý verirken % 50’sinde (n: 15) malignite kuþkusu, % 33.3’ünde (n: 9) hipoksemi, % 6.6’sýnda (n: 2) hemoptizi, % 6.65’sýnda (n: 2) tüberküloz þüphesi, % 3.4’ünde (n: 1) kronik öksürük vardý. Ýþlem öncesi olgularýn radyolojik bulgularýnda % 46.7’sinde atelektazi (n: 14), % 16.7’sinde konsolidasyon (n: 5), % 13.3’ünde peribronþial kalýnlaþma (n: 4), % 6.65’inde kitle (n: 2), % 3.4’ünde kavite (n: 1), % 3.4’ünde plörezi (n: 1) vardý, % 10’unda ise radyolojik patolojik bulguya rastlanmadý (n: 3). Olgularýn bronkoskopik tanýlarý; Pnömoni (n: 12, % 40), Akciðer malignitesi (n: 5, % 16.6), sekel fibrozis ve antrakoz (n: 5, % 16.6), tüberküloz (n: 4, % 13.4), endobronþial mantar (n: 1, % 3.4), endobronþial endometriozis (n: 1, % 3.4), dinamik hava yolu kollapsý (n: 1, % 3.4), vokal kord paralizisi (n: 1, % 3.4) olarak saptanmýþtýr.
TARTIÞMA ve SONUÇ: Çalýþmamýzda, deneyim ve daha fazla çaba ile bronkoskopinin ikinci basamak devlet hastanesinde kýsýtlý olanaklarla uygulanabildiði ve yarar saðladýðý sonucuna varýldý.

INTRODUCTION: The objective of this study was to evaluate the circumstances and results of bronchoscopy practice in a secondary care public hospital.
METHODS: We retrospectively reviewed 30 bronchoscopic procedures that found indication during outpatient practice as well as inhospital consultations and performed within the two year period between June 2010, and June 2012. The demographic properties and radiologic findings of the subjects enrolled, circumstances where the procedure was performed, indications for the procedures, bronchoscopic findings, the final diagnosis and complications attributed to the bronchoscopic procedure were evaluated.
RESULTS: The median age of the study patients (25 males, 5 females) was 50.13 [20-81] years; 66.7 % of bronchoscopic procedures were diagnostic and 33.3 % (n: 19) of them were both diagnostic and therapeutic. The procedure was performed in the operating room in 66.3 % (n: 9), in intensive care unit in 33.3 %, and in bedside in 3.4 % (n: 1) of the cases. The indications for bronchoscopy were established as follows; suspicion of malignancy (50 %, n: 15), hypoxia (33.3 %, n: 9), hemoptysis (6.6 %, n: 2), suspicion of tuberculosis (6.6 %, n: 2), and chronic cough (3.4 %, n: 1). During preprocedural evaluation of the patients as radiologic findings atelectasis (n: 14; 46.7 %), consolidation (n: 5; 16.7 %), peribronchial thickening (n: 4; 13.3 %), a mass (n: 2; 6.6 %), a cavity (n: 1; 3.4 %) and pleurisy (3.4 %) were detected; whereas 10 % of the patients did not have any typical radiologic manifestations. The bronchoscopic diagnosis of cases were; pneumonia (40 %, n: 12), malignancy (16.6 %, n: 5), sequelar fibrosis and anthracosis (16.6 %, n: 5), tuberculosis (13.4 %, n: 4), endobronchial mycosis (3.4 %, n: 1), endobronchial endometriosis (3.4 %, n: 1), dynamic airway collapse (3.4 %, n: 1) and vocal cord paralysis (3.4 %, n: 1).
DISCUSSION AND CONCLUSION: In our study we concluded that bronchoscopy could be implemented in a secondary care public hospital dispite limiting circumstences with some extra effort and additionally this practice is useful if performed by experienced clinicians.

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Uyluðun proksimal bölgesinde yerleþen kompleks yumuþak doku defektlerinin onarýmý plastik cerrahlar için halen çeþitli sorunlar göstermektedir. Ýnguinal bölgedeki yaralarýn iyileþmesi cilt kalýnlýðýnýn az ve vaskülarizasyonunun nispeten yetersiz olmasý nedeniyle kimi zaman sorun oluþturmaktadýr (1). Bu bölgedeki primer onarýmlar sonrasýnda yara infeksiyonu ve dehisansý sýklýkla ortaya çýkmaktadýr (2). Tüm bu durumlar göz önüne alýndýðýnda inguinal bölgedeki doku defektlerinin rekonstrüksiyonunda kan dolaþýmýnýn daha iyi olduðu pediküllü veya serbest fleplerin kullaným gereksinimi ortaya çýkmaktadýr (3). Bu makalede inguinal bölge doku defektlerinde uygulanabilecek farklý rekonstrüksiyon seçenekleri tartýþýlmýþtýr.

Repair of complex inguinal region defects still creates problems for plastic surgeons. Healing of groin wounds sometimes poses difficulties because of insufficient thickness and poor vascularity of the skin (1). After primary recontruction, wound infection and dehisence frequently occur (2). For the reconstruction of inguinal region it appears to be necessary to use pediculated or free flaps that are better vascularized, when all these situations have been considered (3). In these reports we discussed different reconstructive alternatives of the inguinal region tissue defects.

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GÝRÝÞ ve AMAÇ: Varus gonartrozu bulunan ve yüksek tibial osteotomi (YTO) ameliyatý yapýlan hastalarda dize ayný anda artroskopik debridman uygulamasýnýn, daha sonra diz fonksiyonlarýna etkisi olup olmadýðýný araþtýrdýk.
YÖNTEM ve GEREÇLER: Varus gonartrozu bulunan yaþlarý 48-64 arasýnda olan 23 hastanýn 29 dizine YTO ameliyatý uygulandý. Yirmi dokuz dizin 18’ine YTO ile ayný seansta artroskopik debridman uygulandý, 11’ine yalnýzca YTO uygulandý. Ameliyat sonrasý hastalarýn diz fonksiyonlarý The Hospital for Special Surgery (HSS) diz skoru, Knee outcome survey activities of daily livind scale (ADLS) ve Oxford diz skoruna (ODS) göre 3 ayrý fonksiyonel ölçüm kriterleri kullanýldý. Ameliyat öncesi ve sonrasý skorlar deðerlendirildi ve istatiksel analizleri yapýldý.
BULGULAR: YTO ile birlikte artroskopi yapýlan dizlerde HSS skorlarý ameliyat sonrasýnda, artroskopi yapýlmayanlara göre anlamlý derecede düzelirken, ADLS ve ODS’larý ameliyat sonrasý, öncesine göre artroskopi yapýlanlarda ve yapýlmayanlarda anlamlý derecede düzelmiþti.
TARTIÞMA ve SONUÇ: YTO ile birlikte artroskopik debridman yapýlmasý genç hastalarda yararlý bir iþlemdir.

INTRODUCTION: We investigated whether the effect of knee function with varus gonarthrosis of simultaneous arthroscopic debridment that high tibial osteotomy was applied in patients.
METHODS: HTO surgery was applied on 29 knees of 23 patients (aged 48-64 years) with varus gonarthrosis. On 18 of 29 knees simultaneous arthroscopic debridement was applied, on other 11 knees only HTO was applied. Knee functions of patients were examined postoperatively according to three different scale scores defined by The Hospital for Special Surgery (HSS) knee sacle, Knee outcome survey activities of daily living scale (ADLS), and Oxford Knee Scale (OKS). Scores obtained during the preoperative and postoperative periods were evaluated, and statistical analysis was performed.
RESULTS: As a result, HSS scores of knees which were exposed to HTO combined with arthroscopy were significantly improved during the postoperative period relative to the preoperative period when compared with those managed by only arthroscopy. ADLS and OKS scores were improved in patients treated with or without arthroscopy
DISCUSSION AND CONCLUSION: Arthroscopic debridment with YTO is useful in young patients.

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GÝRÝÞ ve AMAÇ: Vajinal ekosistem dengesi bozulduðu zaman, bakteriyel vajinozda olduðu gibi, postoperatif infeksiyon riskinde belirgin derecede artýþ görülmektedir. Bu çalýþmada histerektomi ve radikal operasyon sonrasý antibiyotik profilaksisinin vajinal flora üzerine etkisini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþmada 2011 Mart-2011 Eylül arasý Ýstanbul Medeniyet Üniversitesi Göztepe Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum Kliniði'nde çeþitli endikasyonlarla histerektomi olan 64 hastayý retrospektif araþtýrma kapsamýnda inceledik. Bütün hastalara cerrahi öncesi antibiyotik profilaksisi ve % 10’luk povidon iyot ile vajinal duþ uygulanmýþtý. Bütün hastalardan eksterne edilmeden önce vajinal kültür alýnmýþtý.
BULGULAR: En çok kolonize olan bakteri 31 hastadan izole edilen E.coli idi ve sekiz tanesi b-laktamaz yapan E.coli suþuydu.Yalnýzca iki hastada yara infeksiyonu vardý. Yara yeri ve vajinal kültürden b-laktamaz üreten E.coli izole edildi.
TARTIÞMA ve SONUÇ: Bu çalýþmada antibiyotik profilaksisine raðmen, infeksiyon kontrolünün fizik muayene ve laboratuvar testleri ile kontrol edilmesi gerektiði sonucuna vardýk.

INTRODUCTION: When the vaginal ecosystem becomes unbalanced, as in the case of bacterial vaginosis, the risk of postoperative infection increases noticeably. In this study, we aimed to investigate the change of vaginal flora under antibiotic prophylaxis after hysterectomy and radical operations.
METHODS: In this study, sixty-four patients who had undergone hysterectomy for a variety of indications between 2011 March and 2011 September in gynecology clinics of Istanbul Medeniyet University Goztepe Research and Training Hospital Department of Obstetrics and Gynecology were evaluated retrospectively. All patients had been treated with vaginal douche with % 10 povidone iodine and antibiotic prophylaxis before surgery. We obtained samples for culture from vaginal stump with cotton swab before all patients were discharged. Samples were sent to bacteriology laboratory of our hospital.
RESULTS: The most common colonized bacteria in 31 cultures was E.coli and eight strains were extended spectrum beta lactamase producing E.coli. Only two patients had wound infections and from vaginal and wound cultures of these patients, beta lactamase producing E.coli was colonized.
DISCUSSION AND CONCLUSION: In this study, we emphasize the fact that in all cases, infection control should be done in consideration of postoperative physical examination and bacteriological laboratory tests, despite preoperative antibiotic prophylaxis.

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GÝRÝÞ ve AMAÇ: Genç eriþkinlerdeki femur boyun kýrýklarý ortopedi ve travmatolojinin gerçek acillerinden biridir. Femur baþýnýn avasküler nekrozu nedeniyle yaralanmadan sonra erken kýrýk redüksiyonu ve stabil fiksasyon yapýlmasýnýn gerekli olduðu düþünülmektedir. 1997-2010 yýllarý arasýnda tedavi edilen genç eriþkin femur boyun kýrýklarýnýn sonuçlarýný retrospektif olarak analiz ettik.
YÖNTEM ve GEREÇLER: 1997-2010 yýllarý arasýnda 88 genç eriþkin hasta femur boyun kýrýðý nedeniyle açýk redüksiyon ve internal fiksasyonla tedavi edildi. Takipleri yapýlan 77 hasta çalýþma kapsamýna alýndý. Hastalarýn 52 (% 67.5)’si erkek ve 25 (% 32.5)’i kadýndý. Hastalarýn fonksiyonel sonuçlarý Harris Kalça Skorlama sistemi ve SF 36 skorlama sistemi ile deðerlendirildi.
BULGULAR: Ortalama takip süresi 77.1 (24-175) aydý. Kýrýklarýn Garden Sýnýflamasýna göre daðýlýmý 2 (% 2.5) tip 1, 14 (% 18.2) tip 2, 37 (% 48.1) tip 3 ve 24 (% 31.2) tip 4 þeklindeydi. Altý (% 7.8) hastada kaynamama görüldü. Avasküler nekroz 13 (% 16.9) hastada geliþti. Ortalama ameliyata kadar geçen süre 41.2±74.79 (4-480) saatti. Harris kalça skorlarýna göre 52 (% 67.6) hastada mükemmel, 12 (% 15.6) iyi, 8 (% 10.3) orta ve 5 (% 6.5) kötü sonuç elde edildi. Kaynama oranlarýyla ameliyata kadar geçen süre korelasyonu istatistiksel olarak anlamlý bulundu (p<0.05)
TARTIÞMA ve SONUÇ: Genç eriþkinlerdeki femur boyun kýrýklarýnda açýk redüksiyon ve kanüllü vida ile internal tespiti günümüzde hâlâ en iyi seçenektir. Erken cerrahi, komplikasyonlarý özellikle kaynamama oranlarýný azaltmada önemlidir.

INTRODUCTION: Femoral neck fractures in young adults are real emergencies in orthopaedics. It is thought that the reduction and stable fixation have to be done immediately after the injury because of the development of avascular necrosis of the femoral neck. We retrospectively evaluated the results of the young adult patients who had been operated because of femoral neck fractures in our clinic between 1997-2010.
METHODS: Eighty-eight young adult patients had been treated with open reduction and internal fixation in our clinics. because of femur neck fracture between 1997-2010. Seventy- seven patients who were followed up included in our study. There were 52 (67.5 %) male, and 25 (32.5 %) female patients in our group. Functional outcomes were measured using Harris Hip Score and SF36 scoring system. Avascular necrosis was determined using Ficat and Arlet criteria.
RESULTS: Mean follow-up period was 77. 1 months (24-175). Distribution of fractures according to Garden Classification was as follows: Types 1 (n=2; 2.5 %), 2 (n=14; 18.2 %), 3 (n=37; 48.1 %), and 4 (n=24; 31,2 %) Nonunion was observed in 6 (7.8 %), and avascular necrosis in 13 (16.9 %) patients. The mean time from injury to surgery was 41.2±74.79 (4-480) hours. The outcome according to Harris Hip Score was excellent in 52 (67.6 %), good in 12 (15.6 %), fair in 8 (10.3 %) and poor in 5 (6.5 %) patients The correlation between the union rate and time from injury to surgery was statistically significant (p<0.05).
DISCUSSION AND CONCLUSION: Open reduction and internal fixation with cannulated screws in the treatment of femoral neck fractures is still the best choice in young adults. Early surgery is important to decrease complications especially nonunion rates.

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GÝRÝÞ ve AMAÇ: Son 3 yýl içinde serebrovasküler olay (SVO) geçiren hemipleji sekelli hastalarda fonksiyonel durumu ile, uyku kalitesi ve depresyon arasýndaki iliþkinin incelenmesidir.
YÖNTEM ve GEREÇLER: Çalýþmaya yaþlarý 38-85 arasýnda olan 42 hemiplejik hasta alýndý. Hastalar muayene edilerek her bir ekstremitenin Modifiye Ashworth Skalasýna göre spastisitesi ve üst ve alt ekstremite ve el Brunstromme deðerleri kaydedildi. Hastalarýn fonksiyonel durumlarý Fonksiyonel Baðýmsýzlýk Ölçütü (FBÖ) ile, uyku kaliteleri Pittsburgh Uyku Kalitesi indeksi (PUKÝ) ile, duygu durumlarý ise Beck Depresyon Ölçeði ile deðerlendirildi.
BULGULAR: Hastalarýn yaþ ortalamasý 64,9±11,6 olarak hesaplandý. Çalýþmaya alýnan hastalarýn 20’si (% 47,6) erkek 22’si (% 52,4) kadýndý. Ortalama hemipleji süreleri 6,9±8,5 ay olarak hesaplandý. Hastalarýn 40'ý (% 95,2) iskemik, 2'si (% 4,8) hemorajik SVO geçirmiþ. Hastalarýn üst ekstremite Brunstromme ortalamalarý 2,43±1,55, alt ekstremite Brunstromme ortalamalarý 3,45±1,78, el Brunstromme ortalamalarý 2,09±1,57 idi. Spastisiteleri Modifiye Ashworth Skalasýna göre üst ve alt ekstremitede global olarak deðerlendirildiðinde, üst ekstremite spastisite ortalamalarý 1,21±1,16, alt ekstremite spastisite ortalamalarý 0,79±1,12 olarak bulundu. Hastalarýn FBÖ puan ortalamalarý 72,90±29,40, Pittsburgh Uyku Kalitesi Ýndeksi puan ortalamalarý 8,48±4,80, Beck Depresyon Ölçeði puan ortalamalarý 15,19±9,12 olarak hesaplandý. FBÖ puanlarý ile PUKÝ puanlarý ve Beck Depresyon Skalasý puanlarý arasýnda istatistiksel anlamlý iliþki saptandý (sýrasýyla, p=0.03, p<0.005). Beck Depresyon Skalasý puanlarý ile PUKÝ puanlarý arasýnda da istatistiksel anlamlý iliþki saptandý (p<0.005).
TARTIÞMA ve SONUÇ: Hemiplejili hastalarda uyku kalitesinin bozulmasý ve depresyonun fonksiyonel durumu negatif yönde etkilediðini düþünmekteyiz.

INTRODUCTION: The aim of this study is to analyse the relation between functional status, sleep quality and depression in hemiplegic patients who had experienced serebrovascular disease (SVD) in last three years.
METHODS: 38-85 year-old 42 patients were included in the study. All of the patients were examined and scores of each extremity’s spasticity according to Modified Ashworth Scale (MAS) and upper and lower limb and hand Brunstromme scores were noted. Patient’s functional status was assessed with Functional Independence Measure (FIM), sleep qualities with Pittsburgh Sleep Quality Index (PSQI) and moods with Beck Depression Scale, respectively.
RESULTS: The average age was 64.9±11.6 years. Twenty patients (% 47,6) were male, and 22 of them (% 52,4) were female. Mean duration of hemiplegia in patients was 6,9±8,5 months. 40 patients (% 95,2) had ischemic SVD, 2 of them hemorrhagic SVD. The patient’s mean upper, lower limb, and hand Brunstromme scores were 2.43±1.55, and 3.45±1.78, and 2.09±1.57, respectively. MAS mean upper, and lower limb global spasticity scores of the patients were 1.21±1.16, and 0.79±1.12, respectively. Mean FIM, PSQI, and Beck Depression Scale scores were 72.90±29.40, 8.48±4.80 and 15.19±9.12, respectively. There was statistically significant relation between FIM and PSQI scores (p=0.03), FIM and Beck depression scale scores (p<0.005). Also there was statistically significant relation between Beck depression scale scores and PSQI scores (p<0,005).
DISCUSSION AND CONCLUSION: We suppose that poor sleep quality and depression effect functional status negatively in hemiplegic patients.

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GÝRÝÞ ve AMAÇ: Jinekolojik kanser ameliyatlarýnda ameliyat sýrasý ve sonrasýnda analjezi saðlanmasýnda adjuvan ajan olarak kullanýlan magnezyum sülfatýn kan reolojisi üzerine etkilerinin araþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Prospektif, rasgele, tek kör olarak planlanan çalýþmaya jinekolojik kanser ameliyatý olacak 31 hasta dâhil edildi. Magnezyum sülfat (Mg) grubuna anestezi indüksiyonundan 30 dk. önce 30 mg/kg % 15’lik magnezyum sülfat 5 dk. içinde IV infüzyon olarak uygulandý. Kontrol grubuna benzer volümde ve hýzda % 0.9 sodyum klorür verildi. Magnezyum uygulamasýndan önce, 90. dk. ve 24. saatte alýnan kan örneklerinde kan vizkozitesi, plazma vizkozitesi, eritrosit deformabilitesi, Mg, Na, K, Ca, total protein, albümin, fibrinojen ve hematokrit ölçümleri yapýldý.
BULGULAR: Gruplar arasý karþýlaþtýrmada benzer ölçüm zamanlarýnda düþük, orta ve yüksek kayma hýzýndaki kan vizkozitesi deðerleri ve % 45 hematokrit düzeyine standardize edilmiþ kan vizkozitesi deðerleri, eritrosit deformabilitesi deðerleri, 90. dk. ve 24. saatteki plazma vizkozitesi deðerleri arasýnda istatistiki olarak anlamlý fark saptanmadý (p<0.05). Gruplar arasý karþýlaþtýrmada baþlangýç plazma vizkozitesi deðeri Mg grubunda anlamlý derecede yüksek saptandý (p<0.05). Gruplar arasý karþýlaþtýrmada 90. dk. ve 24. saatteki Mg deðerleri arasýnda istatistiki olarak anlamlý fark saptandý (p<0.0001). Gruplar arasý karþýlaþtýrmada benzer ölçüm zamanlarýnda total protein,albümin, fibrinojen, hematokrit deðerleri arasýnda istatistiki olarak anlamlý fark saptanmadý (p<0.05).
TARTIÞMA ve SONUÇ: Bulgularýmýz jinekolojik kanser ameliyatlarýnda ameliyat sýrasý ve sonrasýnda aðrý tedavisinde ameliyat sýrasý ve sonrasýnda adjuvan ajan olarak kullanýlan magnezyum sülfatýn uygulanan dozda kan vizkozitesi, plazma vizkozitesi, eritrosit deformabilitesi deðerleri üzerine etkisi olmadýðýný yönündedir.

INTRODUCTION: This study tested magnesium sulphate infusion to improve blood rheology during and after gynecologic oncology surgery.
METHODS: In a randomized, single blinded study, patients were assigned to two groups. The magnesium group received an inital dose of 30 mg/kg followed by 10 mg/kg/h over 20h. The control group received placebo. Blood samples were obtained before magnesium administration, 90 minutes and 24 hours following initial magnesium administration. Blood viscosity, plasma viscosity, red blood cell deformability, Mg, total protein, albumin, fibrinogen and Htc were investigated.
RESULTS: There were no significant differences between two groups in blood viscosity, plasma viscosity, and red blood cell deformability. Blood viscosity levels decreased in both groups. Plasma viscosity levels unchanged in both groups. Red blood cell deformability decreased in both groups.
DISCUSSION AND CONCLUSION: IV administration of Mg sulphate in conventional dosage had no effect on blood viscosity, plasma viscosity, red blood cell deformability.

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Adneksiyel torsiyon gebelik boyunca yaygýn olmayan bir durumdur. Torsiyon, genellikle daha önce taný almýþ kisti veya tümörü olan overlerde görülür. Ýlerleyen gebelikle beraber, daha önceden normal olan bir overin torsiyone olmasý çok enderdir. Burada, biz herhangi bir predispozan faktörü olmayan 9 haftalýk bir gebelikte adneksiyel torsiyon olgusunu sunduk. Hasta acil bölümüne hafif karýn aðrýsý ve kusma ile baþvurdu. Kötüleþen klinik ve ultrasonografik belirtiler ile beraber hastaya sað salpingo-ooferektomi uygulandý. Gebe hasta, operasyonun ardýndan sývý ve uygun ilaç destekleri ile tedavi edildi ve gebeliðin devam etmesi saðlandý. Bilindiði üzere ender olan adneksiyel torsiyon, alt karýn aðrýsý olan gebeliklerde ayýrýcý tanýda akýlda tutulmalýdýr.

Adnexal torsion is an uncommon case during pregnancy. Torsion usually occurs in ovaries with previously diagnosed cysts or tumors. It is rare for a previously normal ovary to undergo torsion in advanced gestation. Here, we report a case of adnexal torsion during the 9th week of pregnancy without any predisposing factors. The patient was admitted to emergency department with mild lower abdominal pain and nausea. With the worsening of clinical and ultrasonographic signs, a right salpingo-ovariectomy was performed. After surgery, the pregnant patient was treated with fluid and appropriate drug supplementations and continuation of the pregnancy was achieved. Adnexal torsion, though rare, should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation.

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Nöroleptik malign sendrom (NMS) hayati tehlike oluþturan idiyosinkratik, istenmeyen bir etki olup, dopamin blokajý yapan antipsikotik ilaç kullanýmý sonrasý ortaya çýkmaktadýr. Yüksek doz, ilk kez ve özellikle kas içi nöroleptik kullanan mental retardasyonlu hastalar NMS geliþimi için daha yüksek risk altýndadýr. Bu olgu sunumunda mental retardasyonu olan bir erkek hastada, flufenazin dekanoat uygulanmasý sonrasý geliþen NMS, klinik seyri ve elektrokonvulsif tedavi (EKT) olumlu yanýtý incelenmiþtir.

Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic adverse reaction which occurs after use of antipsychotic drugs that block dopamine. Patients with mental retardation are at high risk for the development of NMS especially at high dose, first time, and intramuscular usage of neuroleptic medication. In this case report, the clinical course and positive response to ECT of a male patient with mental retardation who developed NMS, after implementation of the fluphenazine decanoate was examined.

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Ani iþitme kaybý, yýlda yaklaþýk olarak 100000 hastanýn 5-20’sinde görülen ve olgularýn çoðunda unilateral olarak ortaya çýkan ender bir klinik tablodur. Non-Hodgkin lenfoma ani iþitme kaybýnýn etiyolojik faktörlerinden biri olmasýna raðmen, bu hastalýk non-Hodgkin lenfomada ender olarak ilk semptomlardan biri olarak karþýmýza çýkmaktadýr.
Bu makalede; ilk bulgu olarak bilateral ani iþitme kaybý ile prezante olan bir non-Hodgkin lenfoma olgusu sunulmuþtur ve özellikle bu durumla iliþkili etyopatogenetik faktörler vurgulanmýþtýr. Ayrýca bu hastalýðýn klinik, radyolojik ve histopatolojik özellikleriyle birlikte günümüzde uygulanan güncel tedavi modaliteleri tartýþýlmýþtýr.

Sudden hearing loss is a rare clinical entity which has an approximate incidence of 5-20: 100000 per year, and manifests as unilaterally in most of the cases. Although non-Hodgkin lymphoma is considered as one of the etiologic factors for sudden hearing loss, it is rare to encounter sudden hearing loss as the first presenting symptom of non-Hodgkin lymphoma.
In this article, we present a case of non-Hodgkin lymphoma which presented with bilateral sudden hearing loss as the first sign, and especially highlight the factors of etiopathogenetic factors related to this condition. Additionally, clinic, radiological, and histopathological characteristics of the disease with current treatment modalities are discussed.

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Melkersson Rosenthal sendromu yineleyen periferik fasiyal paralizi, orofasiyal ödem ve fissürlü dil triadý ile karakterize granülomatöz bir hastalýktýr. Klasik triadýn görülmesi çok enderdir ve genellikle mono-oligosemptomatik tutulum izlenir. Altý ay ara ile önce sað sonra sol periferik fasiyal paralizi geliþen ve Melkersson Rosenthal sendromu tanýsý alan 10 yaþýndaki kýz olgu, yineleyen fasiyal paralizilerin ayýrýcý tanýsýnda MRS’ nin düþünülmesi gerektiðini vurgulanmak amacýyla sunuldu.

Melkersson-Rosenthal Syndrome is a granulomatous disease characterized by recurrent facial nerve paralysis, orofacial edema and fissured tongue. Observation of the classical triad is very rare and usually mono-oligosymptomatic involvement is observed. A ten year-old female patient admitted first with left peripheral facial paralysis and six months later with right peripheral facial paralysis and diagnosed with Melkersson Rosenthal syndrome was presented in order to emphasize that Melkersson-Rosenthal Syndrome must be considered in the differential diagnosis of recurrent facial paralysis.

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Baþparmak hipoplazisi ve radial displazi sýklýkla el terapisine yönlendirilen konjenital sorunlardandýr. Ancak, literatüre bakýldýðýnda baþparmak ekstansör kaslarýnýn bilateral konjenital yokluðuna ve bu durumun rehabilitasyonuna dair çalýþmalarýn eksik olduðu göze çarpmaktadýr. Bu olgu sunumunun amacý; bilateral konjenital ekstansör pollicis longus ve brevis yokluðu olan bir çocukta baþparmak ekstansiyonunun restorasyonu ile ilgili literatüre katkýda bulunmaktadýr. Beþ yaþýnda bir kýz çocuðu olan olgumuzun baþparmak ekstansiyonu olmadýðý ailesi tarafýndan fark edilmiþtir. Bir ortopedist tarafýndan bilateral konjenital baþparmak ekstansörlerinin yokluðu tespit edilmiþ ve diðer sistemik sorunlar ekarte etmek üzere gerekli tetkikler yapýlmýþtýr. Hastamýz cerrahiden sonra 6 hafta boyunca 20° bilek ekstansiyonu ve tam baþparmak ekstansiyon ve abduksiyonu saðlayan önkol splinti içerisinde immobilize edilmiþtir. Erken dinamik hareket protokolüne göre 8. haftaya kadar pasif ve aktif-asistif egzersizler yapýlmýþ, bu haftadan itibaren dirençli egzersizlere geçilmiþtir. Yine 8. haftadan itibaren giderek artan dirençle iþ-uðraþý tedavisine geçilirken, 4. aydan itibaren hasta günlük yaþamda elini kullanmada tamamen serbest býrakýlmýþtýr. Cerrahi sonrasý 6., 8. ve 12. haftalarda yapýlan deðerlendirmelerde baþparmaklarýn eklem hareket açýklýðý, kavrama ve çimdikleyici kuvvetlerinde belirgin iyileþme olduðu görülmüþ; bu sonuçlar elin fonksiyonel seviyesine de olumlu yönde yansýmýþtýr. Hastamýzda okul çaðýndan önce baþparmak ekstansiyonunun cerrahi ve el rehabilitasyonu ile restore edilmesi el fonksiyonu ve yaþam kalitesini optimal seviyeye çýkarmýþtýr.

Thumb hypoplasia and radial dysplasia are two of the most common hand therapy requiring conditions among the congenital problems. However, any cases with congenital agenesis of bilateral thumb extensors, and their related rehabilitatitive therapy were not reported in the literature. The aim of this case report is to make the first contribution to the restoration of thumb extension function in a child with congenital absence of bilateral extensor pollicis longus (EPL) and extensor pollicis brevis (EPB) The case was a 5-year old girl and her family noticed that she had no thumb extension. Results of the tests performed to eliminate the other systemic problems were all in normal ranges. The patient underwent immobilization in a forearm cast with 20° wrist extension and full thumb extension and abduction for 6 weeks. During this period, early dynamic motion protocol was applied by a wire-rubber system splint. After removal of the splint, therapeutic ultrasound was applied and passive and active- assisted exercises gradually proceeded to resistive exercises through the 8th week. By the 8th week, occupational therapy with gradually increasing resistance was initiated while the patient was permitted to use both hands in daily activities after 4th month. Assessments on the post-operative 6th, 8th and 12th weeks revealed significant improvements in range of motion in the thumbs, grip and pinching strengths and hand functional level. Restoration of thumb extension with surgery and hand rehabilitation before school age provided optimal hand function and quality of life of this child.

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