GÝRÝÞ ve AMAÇ: Kliniðimize baþvuran 20-25 haftalýk semptomatik veya asemptomatik gebelerde serviks uzunluk ölçümünün preterm doðumu (erken doðumu) öngörmedeki yerini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Baðcýlar Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum Kliniði Gebe ve Acil polikliniklerine 6 Mart 2012-3 Haziran 2012 tarihleri arasýnda rutin antenatal takip veya yakýnmalarýyla baþvuran gebelerden çalýþma kriterlerine uyan ve çalýþmamýza katýlmayý kabul eden 261 gebe ile çalýþma grubumuz oluþturuldu. Çoðul gebelikler, bilinen uterin anomalisi olanlar, bu gebeliðinde erken doðum eylemi tanýsý alanlar ve fetal anomalili gebelikler çalýþma dýþý býrakýldý. Otuz yedinci gebelik haftasýndan önceki doðumlar preterm doðum grubunu, 37. gebelik haftasý ve sonrasýndaki doðumlar term doðum grubunu oluþturdu. Sonuçlarda anlamlýlýk p<0.05 düzeyinde deðerlendirilmiþtir.
BULGULAR: Çalýþmaya 261 gebe ile baþlandý. Daha sonraki süreçte 6 gebeye ulaþýlamadý. Ýki yüz elli beþ gebe ile çalýþma sonlandýrýldý. Gebelerin 24’ü (% 9.4) preterm, 231’i (% 90.6) term dönemde doðum yaptý. Term grubunun serviks uzunluk ortalamasý (36.346 mm), preterm grubunun serviks uzunluk ortalamasýndan (28.792 mm) anlamlý derecede yüksek bulunmuþtur (p=0.000). Preterm grupla term grup arasýnda yaþ ortalamasý açýsýndan anlamlý bir fark bulunamadý (p>0.05). Ancak ED (Erken Doðum) öyküsü, abortus öyküsü ve multiparite preterm grubunda anlamlý derecede yüksek bulundu (p<0.05).
TARTIÞMA ve SONUÇ: Günümüzde yenidoðan yoðun bakým koþullarýnýn geliþmesi nedeniyle morbidite ve mortalitede azalma söz konusu olsa da preterm eylemin erken taný almasý, tedavinin planlanmasý açýsýndan son derece önemlidir. Bu nedenle preterm eylem tanýsýnda çok sayýda parametre araþtýrýlmaktadýr. Çalýþmamýzda 20.-25. haftalar arasýnda ölçülen serviks uzunluðunda term ve preterm gruplar arasýnda anlamlý farklýlýk saptanmýþtýr. Bu durum serviks uzunluk ölçümünün preterm doðumu öngörmedeki güvenilirliðini arttýrmýþtýr.

INTRODUCTION: The aim of this study is to invazivestigate the place of the measurement of cervical length in of the prediction of preterm delivery in asymptomatic and symptomatic pregnant women consulted to our clinic at their 20-25 gestational weeks.
METHODS: The study group consisted of 261 eligible pregnant women who consented to participate in our study and consulted to Baðcýlar Hospital Obstetrics and Gynecolgy clinic between March 6, 2012, and June 3, 2012 because of their complaints or routine pregnancy controls. Pregnant women with multiple pregnancies, known fetal and/or uterine anomalies, and preterm labor diagnosed at admission were excluded from the study. Preterm birth group consisted of pregnant women who gave birth before 37. weeks of gestation, and term birth group consisted of pregnancies who gave birth at 37 weeks and after 37 weeks. Significance was defined as a P value of <0.05.
RESULTS: The study began with 261 pregnant women. and 6 pregnant women were lost to follow-up. Study was terminated with 255 pregnant women. Twenty-four pregnant women (% 9.4) gave birth to premature and 231 pregnant women (% 90.6) to term babies. The average length of the cervix in the term group (36.346 mm) was significantly higher than the average length of the cervix in the preterm group (28.792 mm) (p=0.000). There were no differences between mean age of two groups (p>0.05). However, incidence of premature birth, abortion and multiparity were significantly higher in preterm group (p<0.05).
DISCUSSION AND CONCLUSION: Today, neonatal mortality and morbidity have been reduced due to improvement6 in the conditions of neonatal intensive care unit nevertheless early diagnosis of preterm labor is extremely important in order to plan treatment. For this reason, many diagnostic parameters influential on preterm labor have been still investigated. In our study significant differences were detected between term and preterm groups as for cervical length measurements at 20-25. weeks. Our findings have supported increased reliabilty of cervical length measurements in the prediction of preterm delivery.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada radius alt uç kýrýðý olan 60 yaþ ve üzeri hastalarda cerrahi dýþý yöntemlerle yapýlan tedavi sonuçlarýmýz deðerlendirildi.
YÖNTEM ve GEREÇLER: Çalýþmada 60 yaþ ve üstü 52 hasta (34 kadýn, 18 erkek; ort. yaþ 68.2) deplase radius alt uç kýrýðý nedeniyle kapalý yerleþtirme ve dirsek altý sirküler alçý ile tedavi edildi. AO (Arbeitsgemeinschaft für Osteosynthesefragen) sýnýflamasýna göre hastalarýn kýrýk tipleri 28 hastada tip B, 24 hastada ise tip C idi. Klinik sonuçlar Q-DASH (Quick-Disability of Arm, Shoulder and Hand) ile, radyolojik deðerlendirme ise Stewart deðerlendirme ölçütleri ile yapýldý. Ortalama takip süresi 11 ay (5-18 ay) idi.
BULGULAR: Elli iki hastanýn DEXA (dual energy x-ray absorbsiyometri) ile yapýlan kemik yoðunluðu ölçümlerinde 37 hastada (% 71.1) T skorunun -2,5’in altýnda olduðu tespit edilerek osteoporoz olarak deðerlendirildi. Kýrýklarýn tümü ortalama 4.3 (3.7-6.1) haftada kaynadý. Stewart deðerlendirme ölçütlerine göre 35 hastada (% 67.3) iyi, 12 hastada (% 23) orta, 5 hastada (% 9.7) ise kötü sonuç alýndý. Q-DASH puaný 2. ayda 40±10.2, 4. ayda 30±7.4 son kontrolde ise 21±3.2 bulundu. Ýki hastada kötü kaynama geliþti ve bu hastalara düzeltici osteotomi ameliyatý önerildi.
TARTIÞMA ve SONUÇ: Yaþlýlarda görülen radius alt uç kýrýklarý normal populasyona göre daha düþük enerjili travma ile oluþmaktadýr. Genç hastalar ile karþýlaþtýrýldýðýnda tedavisinde konservatif kalma eðilimi daha fazla kabul görmektedir. Çalýþmamýzýn sonucu da bu görüþü destekler niteliktedir. Yaþlý hastalarýn cerrahiye engel diðer sistemik riskleri ve fonksiyonel beklentileri de göz önüne alýndýðýnda distal radius kýrýklarýnýn kapalý yerleþtirme ve kýsa kol alçý ile tedavi edilebileceði sonucuna varýldý.

INTRODUCTION: The aim of this study is to investigate the clinical results of conservative treatment of distal radius fractures in patients aged sixty years or older.
METHODS: The clinical results of distal radius fractures in sixty age and elder people who was treated with conservative treatment were investigated in this study. Fifty-two patients (34 female, 18 male; median age, 68.2 yrs) aged ≥ 60 years with displaced distal radius fractures were treated by closed reduction and short -arm circular cast stabilization. According to AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification, the fractures were of types B (n=28), and C (n=24). Clinical results were evaluated with Q-DASH (Quick-Disability of Arm, Shoulder and Hand) scale and radiological results with Stewart scale. The average length of follow-up period was 11 (5-18) months.
RESULTS: In 37 (71,1 %) of 52 patients, DEXA (dual energy x-ray absorptiometry) measurements indicated that T scores were beneath -2.5 and they were regarded as osteoporosis. All of the fractures healed in an average of 4.3 (3.7-6.1) weeks. According to Stewart scale; good results were detected in 35 (67.3 %) patients, intermediate results in 12 (23 %) and bad results in 5 (9.7 %) patients. The average Q-DASH scores were noted as 40±10.2 in the second, and, 30±7,4 in the fourth months, and 21±3,2 at the last control. Two patients were recommended to undergo corrective osteotomies due to malunion.
DISCUSSION AND CONCLUSION: Distal radius fractures in elderly people are tend to occur with lower velocity trauma. Comparing with young patients conservative treatment of distal radius fractures in elder people is a more acceptable approach. In this study our findings also support this suggestion. Considering the comorbities coming with older age and lower functional expectations, close reduction and short arm cast stabilization is a reasonable approach for this group of patients.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý kimyasal þift yöntemi ile daha önce karaciðer biyopsisi ile taný konmuþ nonalkolik yaðlý karaciðer hastalýðý olan hastalarda hepatik steatozun kantitatif MR ile korelasyonunu belirlemektir.
YÖNTEM ve GEREÇLER: 01.01.2011-15.02.2011 tarihleri arasýnda, Göztepe Eðitim ve Araþtýrma Hastanesi Radyoloji Kliniðinde, histopatolojik nonalkolik karaciðer hastalýðý tanýsý almýþ olan 31 hastada (15 kadýn, 16 erkek) dual-eko GRE kimyasal þift görüntüleme yöntemi yapýldý. Kullanýlan sinyal intensite oraný SI (ayný faz)-SI (dýþ faz)/2SI (ayný faz) formülle intensite ölçümü belirlendi. Ölçüme göre %9-18 arasý oranlar orta yaðlanmayý, % 18 ve üzeri oranlar aþýrý yaðlanmayý göstermektedir. Bu oranlar histopatolojik bulgularla korelasyon gösterdi.
BULGULAR: Olgularýn MR ile yapýlan steatoz deðerlendirmesinde % 22.6’sýnda (n=7) grade 1, % 61.3’ünde (n=19) grade 2 ve % 16.1’inde (n=5) grade 3 steatoz saptandý. Olgularýmýzýn histopatolojik olarak yapýlan steatoz deðerlendirmesinde % 19.4’ünde (n=6) grade 1, % 64,5’inde (n=20) grade 2 ve % 16.1’inde (n=5) grade 3 steatoz saptandý. Histopatolojik steatoz dercesi ile MR’da saptanan steatoz derecelerinin oldukça korele olduðu saptandý. Bu iki yöntemin karþýlaþtýrýlmasýnda, her iki grupta da hastalarýn % 19.4’ünde (n=6) grade 1 steatoz saptandý. Histopatolojik olarak grade 2 steatoz saptanan 20 hastanýn (% 64,5) 19’unda MR ile de grade 2 steatoz saptanýrken, 1 olguda grade 1 steatoz saptandý. Son olarak her iki yöntemde de olgularýn % 16.1’inde (n=5) grade 3 steatoz saptandý. Mevcut sonuçlarla histopatolojik steatoz derecesi ile MR’da saptanan steatoz dereceleri arasýnda Cohen Kappa uyum düzeyi % 94 olarak saptanmýþ olup, yüksek düzeyde bir uyum görülmektedir.
TARTIÞMA ve SONUÇ: Çalýþmamýzda hepatosteatozu ve steatoz derecesini saptamada MR’ýn oldukça duyarlý bir yöntem olduðu görülmektedir.

INTRODUCTION: The aim of this study is to determine the correlation between hepatic steatosis with quantitative MR findings in patients diagnosed by chemical shift magnetic resonance imaging method, and previous liver biopsy as nonalcoholic fatty liver disease.
METHODS: Thirty-one patients (15 females, 16 males) who had histopathologically diagnosed as nonalcoholic liver disease in Goztepe Training and Research Hospital Department of Radiology between 01.01.2011-15.02.2011underwent dual-echo GRE chemical shift imaging method. Using SI signal intensity ratio (same phase)-SI (external phase) / 2 SI (same phase) ratio, intensity formula was constructed. Rates between 9 to 18 % were accepted as internediate steatosis, and higher rates than 18 % indicated severe steatosis.
RESULTS: In MRI evaluation of steatotic conditions, the patients had grade 1 (n=7; 22.6 %), 2 (n=19; 61.3 %), and 3 (n=5; 16.1 %) steatosis. Based on histopathological evaluation, 19,4 % of patients (n=6), grade 1, 64,5 % ‘patients (n=20) grade 2 and 16,1 % of patients (n=5) had grade 3 steatosis. The degree of steatosis demonstrated the presence of a strong correlation between histopathological and MRI evaluations. Six (19.4 %) patients in both groups had grade 1 steatosis. Histopathologically, 20 (64.5 %) patients had grade 2 steatosis, while grade 2 steatosis was detected in 19 patients using MR criteria.. One patient had grade 1 steatosis. Finally, in both groups, 16.1 % (n=5) of the patients had grade 3 steatosis. The degree of steatosis grading with histopathology and MRI correlated with a high level of compliance (94 %) as assessed by Cohen Kappa method.
DISCUSSION AND CONCLUSION: MRI study was found as a sensitive method to determine the steatosis and degree of steatosis.

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GÝRÝÞ ve AMAÇ: Malnütrisyon hastanede yatmakta olan hastalarda önemli olup, sýklýkla karþýlaþýlmaktadýr. Parenteral nütrisyon (PN) almakta olan hastanede yatan hastalarda biyokimyasal parametreler, hastanede kalýþ süresi ve mortalite deðerlendirilerek malnütrisyonun düzeltilmesinde zeytinyaðý bazlý ve soya yaðý bazlý yað emülsiyonlarýnýn etkileri karþýlaþtýrýldý.
YÖNTEM ve GEREÇLER: Retrospektif olan bu çalýþmada 24 saatten fazla yatýþý olan ve malnütrisyon olduðu belirlenen, parenteral nutrisyon alan eriþkin hastalar çalýþmaya dâhil edildi. Nutrisyon desteði hastanýn hekimi tarafýndan uygulanmýþ olup, nutrsiyon takibi nutrisyon desteðine müdahale etmeden hastane beslenme ekibi tarafýndan yapýldý.
BULGULAR: Toplam 605 hastaya soya yaðý bazlý (n=408) ve zeytinyaðý bazlý (n=197) lipid emülsiyonu uygulandý. Hastanede kalýþ süresi zeytinyaðý bazlý PN grubuna göre soya bazlý yaðý PN grubunda anlamlý olarak daha uzundu (sýrasýyla 14.2±10.7 ve 11.5±8.2 gün, p<0.01). Mortalite oranlarý soya yaðý bazlý PN ve zeytinyaðý bazlý PN grubunda sýrasýyla % 21.8 ve % 22.8 idi. NRS-2002 skoru ve vücut kitle indeksi yüzde deðiþimi anlamlý olarak farklý deðildi. Albümin düzeyi yüzde deðiþiminde gruplar arasýnda anlamlý bir fark olmamakla birlikte, sýrasýyla % 7.0 ve % 6.7 idi. Prealbümin düzeyindeki yüzde deðiþim anlamlý fark olmaksýzýn soya yaðý bazlý PN grubunda % 3.4 ve zeytinyaðý bazlý PN grubunda % 15.2 idi.
TARTIÞMA ve SONUÇ: Ýki grup arasýnda serum albümin ve prealbümin düzeyleri ve mortalite açýsýndan benzer sonuçlar bulundu. Hastanede kalýþ süresi zeytinyaðý bazlý PN grubunda soya yaðý bazlý PN’dekinden daha kýsa idi.

INTRODUCTION: Malnutrition has a great importance and frequently encountered in hospitalized patients. Herein, the effects of olive oil-based and soybean oil-based fat emulsions on improvement of malnutrition status were compared together with evaluaten of biochemical parameters and hospital stay and mortality in hospitalized patients receiving parenteral nutrition (PN).
METHODS: This retrospective study enrolled adult patients who were hospitalized longer than 24 hours, and considered as malnourished and supplied with parenteral nutrition were included in the study. Nutritional supplementation was applied by his/her clinician and they were followed up by hospital nutrition team without interfering the nutrition supplementation.
RESULTS: A total of 605 patients received soybean oil-based (n=408) and olive oil-based (n=197) lipid emulsions. The length of hospital stay was significantly longer in the soybean based oil-PN group than that of olive oil-based PN group (14.2±10.7 and 11.5±8.2 days, respectively; p<0.01). The mortality rates for soybean based oil-PN and olive oil-based PN group were 21.8 % and 22.8 %, respectively. The percent change in NRS-2002 score and body mass index were not different significantly. The percent change in albumin level was 7.0 % and 6.7 %, respectively without significant difference between groups. The percent change in prealbumin level in the soybean oil PN group were 3.4 % and was 15.2 % in olive oil PN group without significant difference.
DISCUSSION AND CONCLUSION: We found similar results between two groups in terms of serum albumin and prealbumin levels and mortality rates. Olive oil-based PN was associated with shorter duration of hospital stay than soybean oil-based PN.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada Afyon ilinde farklý yaþ gruplarýnda hepatit A seroprevalansýnýn belirlenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Mayýs 2012-Temmuz 2013 tarihleri arasýnda, hastanemize farklý yakýnmalar nedeni ile baþvuran ve elektrokemiluminesans yöntemi ile (Cobas 6000 Analizer, Roche marka kitlerle) Anti HAV IgG testi çalýþýlan 0-57 yaþlarý arasýndaki hastalar, hepatit A seroprevalansýnýn belirlenmesi amacýyla çalýþmaya dâhil edilmiþtir.
BULGULAR: On beþ aylýk sürede, Anti-HAV IgG testi çalýþýlan toplam 1458 hastanýn 1016’sýnda (% 69.68) pozitiflik saptanmýþtýr. Olgular; 0-2, 3-4, 5-6, 7-8, 9-10, 11-12, 13-18, 19-29, 30-39 ve 40 yaþ üzeri olarak yaþlarýna göre gruplandýrýlmýþtýr. Bu gruplara ait HAV IgG pozitiflik oranlarý sýrasýyla; % 57.42, % 44.23, % 56.13, % 66,84, % 59.35, % 64.03, % 66.42, % 86.36, % 94.35 ve % 97.79 olarak bulunmuþtur.
TARTIÞMA ve SONUÇ: Bu çalýþmada, Afyon ilindeki Anti-HAV seropozitifliði, ne yazýk ki özellikle genç yaþ gruplarýnda ülkemiz ortalamasýndan düþük saptanmamýþtýr. Fekal oral yolla bulaþan bu hastalýðýn önlenmesinde aþýlama, eðitim, saðlýk önlemleri ve çevresel hijyen koþullarýnýn önemi kabul edilmelidir.

INTRODUCTION: The aim of this study was to determine the seroprevalence rates of Hepatitis A virus infection in different age groups in the province of Afyonkarahisar.
METHODS: The patients aged 0-57 years who consulted to our hospital, between May 2012, and July 2013 were included in the study. Anti-HAV Ig G assays performed by using electrochemiluminescence method (Cobas 6000 Analyzer, Roche Diagnostics) in order to determine seroprevalence of hepatitis A virus infection.
RESULTS: In 1016 (69.68 %) out of 1458 patients who were tested for Anti-HAV IgG during a period of 15 months. Anti-HAV IgG seropositivity was found. Rates of seropositivity were detected to be 57.42 %, 44.23 %, 56.13 %, 66.84 %, 59.35 %, 64.03 %, 66.42 %, 86.36 %, 94.35 % and 97.79 %, in age groups of 0-2, 3-4, 5-6, 7-8, 9-10, 11-12, 13-18, 19-29, 30-39 and > 40 years, respectively.
DISCUSSION AND CONCLUSION: Unfortunately, Anti-HAV IgG seropositivity rate in the province of Afyonkarahisar was not lower than the average rate of Turkey, especially in the young age groups. The importance of HAV vaccination, training programs, sanitation and environmental hygiene precautions should be acknowledged in order to reduce seropositivity rate of HAV infection which transmites via fecal-oral route.

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GÝRÝÞ ve AMAÇ: Sezaryen doðumlarda yenidoðan açýsýndan anestezi yöntemlerinin birbirlerine üstünlüðünü araþtýrmak.
YÖNTEM ve GEREÇLER: Kahramanmaraþ Necip Fazýl Þehir Hastanesi Kadýn Hastalýklarý ve Doðum Kliniðinde, Eylül 2013 tarihlerinde ≥ 37 haftalýk tek gebeliði olan, elektif sezaryen uygulanan 156 anne ve yenidoðan kayýtlarý retrospektif incelendi. Demografik veriler, kan sayýmý, cilt insizyonu- bebek çýkýþ zamaný, yenidoðan Apgar skorlarý, umblikal kord kan gazý verileri, yenidoðanýn yoðun bakým gereksinimi kaydedildi.
BULGULAR: Yüz elli altý olgunun % 25’ine (n: 39) genel anestezi; % 75’ine (n: 117) spinal anestezi uygulandýðý görüldü. Demografik veriler, gebelik haftalarý, preoperatif hemoglobin deðerleri, 1. ve 5. dk. Apgar skoru açýsýndan gruplar arasýnda fark saptanmadý. Ýnsizyon-bebek çýkýþ zamaný genel anestezi grubunda daha kýsa bulundu. Genel anestezi grubunda umblikal kord kan gazý pH anlamlý olarak düþük ve pCO2 anlamlý olarak yüksek bulundu. Ancak, pH ve pCO2 deðerleri normal sýnýrlarda olduðu için klinik önemi yoktu. Yirmi dört saat içinde yenidoðan yoðun bakým gereksinimi açýsýndan fark bulunmadý.
TARTIÞMA ve SONUÇ: Elektif sezaryenlerde spinal anestezi ve genel anestezinin yenidoðan üzerine etkileri bakýmýndan birbirlerine üstünlüðü saptanmamýþtýr.

INTRODUCTION: Investigating the short term effects of spinal and general anaesthesia on newborn in cesarean birth.
METHODS: Medical records of 156 term parturients at their ≥ 37. gestational weeks scheduled for elective C/S under spinal and general anesthesia in the Clinics of Obstetrics, and Gynecology of Kahramanmaraþ Necip Fazýl City Hospital. and their newborns were retrospectively examined. Their emographic data, whole baþlamabaþlamaood counts,time interval between skin incision and delivery, Apgar scores, umbilical cord gas analyses, needs for intensive care unit were recorded.
RESULTS: Spinal (n=39; 25 %), and general anesthesia (n=117; 75 %) had been performed for a total of 156 cases. There were no differences between the groups according to the demographic data, preoperative hemoglobin concentrations, gestational weeks, 1 and 5 minute-Apgar scores. Time interval between skin incision and delivery was lower in general anesthesia group. Umbilical cord pH were significiantly lower and umbilical cord PCO2 were significiantly higher in general anesthesia group, but there was no clinical importance because all participants values were in normal range. There was no significant difference between the groups according to the number of newborns necessitating neonatal intensive care unit. No newborns need balloon-valve mask and intubation in each group.
DISCUSSION AND CONCLUSION: For elective cesarean section, spinal and general anesthesia techniques had no superiority of each other in terms of the newborn.

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Metotreksat dermatolojide yaklaþýk 40 yýldýr birçok inflamatuvar hastalýkta baþarýyla kullanýlan bir immunsupresif ilaçtýr. Folik asid analoðu olarak anti proliferatif etkisi yanýnda adenosin üzerine etkileriyle anti-inflamatuvar özelliktedir. Bu makalede, metotreksatýn farmokinetiði, etki mekanizmasý, dozaj ve tedavi þemalarý eþliðinde deðerlendirilerek yan etki profili ile birlikte, izlemde dikkat edeceðimiz hususlar gözden geçirilmiþtir. Bu bilgiler ýþýðýnda metoreksatýn dermatolojik hastalýklardaki klinik kullanýmý gelecekte tedavi edilmemiþ hastalýklarda umut olmasý dileðiyle son literatür tabanlý verilerle geniþ olarak sunulmuþtur.

Methotrexate is an immunsuppressive drug for use in inflammatory diseases by dermatologists, and used successfully for over 40 years for a wide variety of cutaneous diseases. In addition to its antiproliferative properties due to being a folic acid analog, methotrexate has other more recently recognized anti-inflammatory properties related to its effects on adenosine. In this review pharmacokinetics, mode of administration, dosing guidelines, side effect profile, and medication interactions of methotrexate were evaluated, and important points to be considered during monitorization were reviewed. In the light of relevant information clinical usages of methotrexate in dermatological diseases were presented with recent literature data hoping to use this drug as a promising remedy of many untreated diseases in the future.

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Yirmi dört yaþýnda erkek hasta, sol gözüne çivi batmasý nedeniyle kliniðimize baþvurdu. Muayenesinde, düzeltilmiþ görme keskinliði sað gözde 10/10, sol gözde 50 santimetreden parmak sayma düzeyindeydi. Biomikroskobik muayenesinde sað göz korneasýnda radial keratotomi skarlarý dýþýndaki bulgularý doðaldý, sol gözde konjonktiva ve korneada ödem vardý. Korneada radial keratotomi skarlarý mevcuttu. Saat 3’teki radial keratotomi skarýndan baþlayan ve skar boyunca temporal korneaskleral limbusa ilerleyen, limbusu geçerek 2 mm skleraya uzanan kornea-skleral perforasyon hattý vardý. Saat 3’te ön kamarada hemoraji mevcuttu. Lens saydam ve arka segment doðaldý. Hastanýn direkt kafa grafisi, orbita tomografisi ve rutin tetkikleri yapýldýktan sonra opere edildi. Kornea-skleral perforasyon yeri 10-0 monoflaman nylon ile sütüre edildi. Postoperatif 2. ayda düzeltilmiþ görme keskinliði 10/10 idi.
Kornea perforasyonu daha çok radial keratotomi sýrasýnda olmasýna raðmen, radial keratotominin üzerinden kaç yýl geçmiþ olursa olsun bu olgular travma ile perforasyon riski taþýrlar.

A 24 year-old man admitted to our clinic because of penetration of nail into his left eye. On our examination best corrected visual acuity 10/10 for the right eye and finger count from 50 cm for the left eye were detected. Microscopic examination showed normal findings except scars of radial keratotomy in his right eye. There were conjunctival and corneal edema, scars of corneal radial keratotomy in his left eye. The cornea-scleral perforation at the 3 o’clock meridian extended through the temporal corneoscleral limbus into the sclera. for about 2 mm. There was hemorrhage in anterior chamber at 3 o’clock position. Crystalline lens was intact and posterior segment was normal. Operation was performed on the patient after evaluation of his cranial X-ray, orbital computed tomography and routine laboratory analysis. Corneoscleral perforation was sutured with 10-0 monoflament nylon. Two months later, his best corrected visual acuity was 10/10.
Although corneal perforation generally occur during radial keratotomy, the patients who have radial keratotomy have always risk of perforation due to trauma even after years of operation.

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Apert sendromu, akrosefalosindaktili grubu bozukluklardan olup, genellikle sporadik oluþan FGFR2 genindeki deðiþime baðlý doðumsal bir bozukluktur. Tipik özellikleri akrobrakisefali, kraniosinotosiz, ellerde ve ayaklarda kemik ve/veya kutenöz sindaktiliyle karakterizedir. Akrobrakisefali, bilateral komplet sindaktili ve FGFR2 geninde P253R mutasyonunun olmasý nedeniyle tipik Apert Sendromu olan olgunun tipik bulgularýyla literatüre katký amacýyla sunuldu.

Apert syndrome is a disorder of acrocephalosyndactyly group, usually consisting of sporadic congenital disorder due to changes in FGFR2 gene. Typical features of syndrome are characterized with acrobrachycephaly, craniosynostosis, bony and/or cutaneous syndactyly of hands and toes. We presented a case with typical features of Apert Syndrome that has acrobrachycephaly, bilateral complete syndactyly and the P253R mutation in the FGFR2 gene as contribution to the literature.

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Kartagener sendromu; sinüzit, bronþektazi ve situs inversus triadý ile seyreden, otozomal resesif kalýtým gösteren, ender görülen bir klinik tablodur. Ýmmotil silia sendromu olarak da adlandýrýlýr. Primer siliyer diskinezi sendromlarýnýn % 50’sini oluþturur.
Bu makalede 23 yaþýnda, kronik sinuzit ve nazal polipozis kliniði ile bize baþvuran situs inversus ve bronþektazisi de bulunan bir kartagener sendromlu olgu sunduk. Klinik ve radyolojik bulgular literatür eþliðinde sunulmuþtur. Bu ender görülen hastalýkta tanýnýn doðru konulmasý komplikasyonlarýn önlenmesinde ve tedavinin zamanýnda uygulanmasýnda önemlidir

Kartagener syndrome is a rare clinical entity inherited as an autosomal recessive trait and characterized by the triad of the sinusitis, bronchiectasis and situs inversus. It is also called immotile cilia syndrome. Fifty percent of individuals with primary ciliary dyskinesia have Kartagener syndrome.
We present a case of 23 year old boy with chronic sinusitis, nasal polyposis, situs inversus and bronchiectasis. Clinical and radiological findings of Kartagener’s syndrome were presented with a literature review. The correct diagnosis of this rare disorder is important, as many of the complications can be prevented if timely management is instituted.

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Giriþ: Langerhans hücreli histiositoz, langerhans tipi histiositlerin iyi huylu proliferatif bir hastalýðýdýr. Histiositoz X grubu hastalýklarýn lokalize þeklidir. Hastalarýn % 90’ý 5 ile 15 yaþ arasýndadýr.
Olgu Sunumu: Yirmi dokuz yaþýnda erkek hasta, baþýnýn sað tarafýnda aðrý ve ayný bölgede küçük cilt altý þiþlik yakýnmalarý ile beyin cerrahi polikliniðine baþvurmuþ. Sað temporoparietal kemikte saptanan kitle, total çýkarýlmýþ. Patolojisi histiositoz “X” olarak rapor edilen hasta, onkolojiye yönlendirilmiþ.
Sonuç: Direkt grafide osteolitik kemik lezyonu görülen genç hastalarda, langerhans hücreli histiositoz ayýrýcý tanýda düþünülmeli ve ileri inceleme yapýlmalýdýr. Genellikle cerrahi eksizyon yeterlidir. Uygun tedavi hastanýn prognozu açýsýndan önemli bir faktördür. Bu nedenle, lezyonun yerleþimi ve klinik olarak alt tipinin doðru belirlenmesi, tedavi yaklaþýmýnýn doðru planlanmasýnda çok önemlidir.

Objective: Langerhans cell histiocytosis is a benign proliferative disease of langerhans type histiocytes. This type is the localized form of histiocytosis X group diseases. Ninety percent of patients are between 5 and 15 years of age.
Case Presentation: A 29-year-old male patient consulted to neurosurgery clinic with symptoms of headache and swelling under skin of the right side of his head. The mass, which was detected in the right temporoparietal bone was excised totaly The patient, whose histopathology was reported as histiocytosis X was referred to medical oncology clinic.
Conclussion: Langerhans-cell histiocytosis should be considered in the differential diagnosis of young patients, whose rontgenograms demonstrated osteolytic bone lessions, and advanced examinations should be performed.. Usually, surgical excision suffices. Appropriate therapy is important factor for the patient’s prognosis. Therefore localisation of the lesion, and identification of its subtype is very important for accurate planning of therapy approach.

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Eagle sendromu stiloid ligamanýn kalsifikasyonu veya stiloid proçes elongasyonuna baðlý oluþur. Yineleyen boðaz aðrýsý, boðazda yabancý cisim hissi, disfaji ve ayný tarafa yansýyan kulak aðrýsý gibi yakýnmalar oluþturur. Ýlk olarak 1937 yýlýnda WW Eagle tarafýndan tanýmlanmýþtýr. Eagle sendromunun toplumdaki insidan % 4 olarak belirtilmiþ ve bunlarýnda % 4’ünün semptomatik olduðu rapor edilmiþtir. Eagle sendromunun primer tedavisi cerrahidir. Stiloid proses intraoral veya eksternal yaklaþýmla kýsaltýlýr. Kliniðimizde intraoral yaklaþým ile opere ettiðimiz 42 yaþýndaki kadýn hasta literatür bilgisi ýþýðýnda sunulmuþtur.

Eagle’s syndrome occurs related to an elongated styloid process or calcified stylohyoid ligament. Major symptoms are recurrent throat pain, foreign body sensation in the throat, dysphagia, otalgia, and facial pain. Watt Eagle described it for the first time in 1937. The incidence of elongated styloid process in the population has been reported to be 4 %, and 4 % of them present with clinical symptoms. The treatment of Eagle’s syndrome is primarily surgical. The styloid process can be shortened through an intraoral or external approach. We present a 42 year- old woman with elongated styloid process operated in pour clinic in the light of the current literature.

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Edinsel vajinal darlýk ender görülen bir klinik durumdur. Bu çalýþmada gebe bir kadýnda, geçirilmiþ sezaryen operasyonunda vajinal sütürasyon yapýlmasýna baðlý geliþmiþ vajinal darlýk olgusunun yönetiminin sunulmasýný amaçladýk.
Yirmi beþ yaþýnda, gravida 2, parite 1, 33 hafta gebeliði olan hasta hafif preeklampsi ve intrauterin geliþme geriliði nedeniyle kliniðimize sevk edildi. Vajinal muayenede vajinanýn üst 1/3’lik kýsmýnýn yalnýzca 1 mm bir açýklýk olacak þekilde kapalý olduðu ve serviksin izlenemediði tespit edildi. Hastanýn týbbi kayýtlarýnda bir önceki sezaryen operasyonu sýrasýnda geliþen vajinal yýrtýðýn primer sütürasyonla tamir edildiði görüldü. Otuz dört gebelik haftasýnda fetal distres geliþen hasta sezaryene alýndý. Fetusun doðurtulmasýnýn ardýndan antegrad manuel eksplorasyonla serviks ve vajen üst kýsmý izlendi. Ayný anda 6 numara dilatator retrograd olarak vagenden geçirildi ve vajinal darlýk geniþletildi. Doðumdan sonra vajinal akýntýda bir sorun izlenmedi. Postoperatif üçüncü ayda hastaya ofis histereskopi yapýldý ve vajinal darlýk bölgesi düzeltildi.
Sezaryen operasyonu sýrasýnda geliþen vajinal yýrtýklarýn primer sütürasyonu vajinal darlýk geliþmesine neden olabilir. Eðer vajinal darlýðýn tanýsý gebelik sýrasýnda konursa darlýðýn geniþletilmesi sezaryen sýrasýnda yapýlmalý ve künt yöntemler tercih edilmelidir. Daha agresif tedavi metodlarýn seçimi hastanýn semptomlarý ve beklentileri göz önüne alýnarak yapýlmalýdýr.

Acquired vaginal stricture is a rare clinical entity. In this study, we aimed to present the management of acquired vaginal stenosis in a pregnant woman which had developed due to vaginal suturing performed during previous cesarean section.
A 25-year-old, 33 weeks pregnant woman gravida 2, para 1, referred to our clinic because of intrauterine growth retardation and mild preeclampsia. On vaginal examination, it was detected that the upper thýrd of the vagina was closed with only a 1 mm hole at the vaginal dome. The cervix could not be seen. Her previous medical records revealed that vaginal tear developed during the previous cesarean section had been closed with primary suturing. When fetal distress developed in the 34th week, a cesarean section was carried out. At the same session, following delivery, antegrade manual exploration of the cervical canal was performed and upper portion of the vaginal canal was observed. At the same time, a 6 F stylet dilator was advanced retrogradely through the vaginal route, and the vaginal stricture was dilated. No interference with vaginal post-delivery flow was noted. In the third postoperative month an office hysteroscopy was performed and the vaginal stenosis was corrected.
Primary suturing of vaginal laceration at the time of cesarean section may cause vaginal stenosis. If the diagnosis of the vaginal stenosis is made during pregnancy, dilatation of vaginal stenosis should be done at the time of cesarean section and blunt techniques should be chosen. The symptoms and the expectations of the patients should be considered before selecting more aggressive treatment options.

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Çocuklarda travmatik kalça çýkýðý oldukça ender, yetiþkin yaþ grubuyla kýyaslandýðýnda daha düþük enerjili travmalarla oluþmaktadýr. Kartilaj esnekliði ve ligaman gevþekliði bu çýkýklarýn ortaya çýkmasýna zemin saðlamaktadýr. Çýkýktan sonraki ilk 24 saat içerisinde redüksiyonun saðlanmasý bu yaralanmalarda çok önemlidir. Bu süreyi aþan olgularda ilerleyici ve geri dönüþü olmayan femur baþý avasküler nekrozu, prematür epizyal füzyon gibi komplikasyonlarýn oraný artmaktadýr.

Relatively rare traumatic hip dislocations could occur with low- energy trauma in children when compared with adults. Pliable cartilages and extensively flexible ligaments predispose to the emergence of this condition. After traumatic hip dislocations, reduction of hip joint immediately especially within 24 hours is extremely important. Progressive and irreversible complications including avascular necrosis of the femoral head, premature epiphyseal fusion are more frequently seen if reduction of hip joint is delayed for more than 24 hours.

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Over kisti kadýnlarda sýklýkla görülmesine karþýn dev over kistleri çok ender görülmektedir. Bu olgu sunumunda 84 yaþýnda akut batýn bulgularýyla kliniðimize baþvuran kadýn hastayý sunduk. Hastadaki kistin mezenter kisti olduðu düþünülerek kliniðimizde ameliyat edilmiþtir. Olgumuz eþliðinde dev over kistlerinin özelliklerini, taný ve tedavi yöntemlerini ortaya koymaya çalýþtýk.

Though ovarian cysts are frequently seen in women, giant ovarian cysts are extremely referans aralýðýe. We have reported a 84 year-old female patient who had presented to our clinic with symptoms of acute abdomen. We though that the patient has got mesenteric cysts and operated in our clinic. We have tried to present characteristics of giant over cysts, their diagnosis and treatment.

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Mc Ardle’s hastalýðý ender görülen, çocukluk çaðýnda baþlayan, egzersiz intoleransý ile karakterize otozomal resesif, metabolik bir hastalýktýr. Tipik olarak; egzersizi izleyen miyalji, kramplar, yüksek kreatin kinaz düzeyleri ve ‘ikinci dalga fenomeni’ ile ortaya çýkar. Ýskemik önkol egzersiz testi glikojenolizis eksikliðini ortaya çýkarýr. Hastalýk fenotipik olarak klinik farklýlýklar gösterir. Klasik bulgularla seyreden tipler dýþýnda atipik formlar da tanýmlanmýþtýr. Biz de burada kronik yorgunluk gibi subjektif yakýnmalarla seyreden atipik bir Mc Ardle olgusý sunduk.

As an uncommon autosomal recessive metabolic disorder, Mc Ardle’s disease is characterized by exercise intolerance with its onset in childhood. Disease typically presents with myalgia, cramps, elevated creatine kinase levels following exercise and ‘Second Wind Phenomenon’. Ischemic forearm exercise test reveals a state of deficient glycogenolysis. The disease phenotypically exhibits clinical heterogeneity. There are atypical forms of Mc Ardle’s disease as well as classical forms. We report an atypical case of Mc Ardle’s disease in which fatigability was the only subjective complaint.

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Bifid mandibuler kondil (BMK) oldukça alýþýlmamýþ bir durumdur ve sýklýkla panoramik radyografilerde insidental teþhis edilir. Etiyolojisi ve patogenezi bilinmemekle beraber, en sýk kabul edilen teori travmaya sekoneder olduðudur. Sunulan olgu trafik kazasý sonrasý bilgisayarlý tomografi incelemeleri boyunca insidental teþhis konulan bilateral bifid mandibuler kondilli 40 yaþýnda erkek hastaya aittir.

The bifid mandibular condyle is a rather uncommon case and it is often diagnosed incidentally with panoramic radiographs. Its etiology and pathogenesis is unknown, but the most commonly accepted theory is that it occurs secondary to trauma. The present case is a 40-year- old male patient with bilateral bifid mandibular condyle, which was diagnosed incidentally during a computed tomographic examination after a traffic accident.

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Osteopoikilozis ender bir osteosklerotik kemik displazisidir. Genellikle asemptomatik bir hastalýktýr ve teþhis rastlantýen iskelet sistemi radyografilerinde görülen çok sayýda, küçük, sýnýrlarý belirgin, ovoid ya da yuvarlak þekilli sklerotik alanlarýn görülmesi ile konulur. Radyolojik görünüm metastatik kemik lezyonlarýný andýrabilir. Bu makalede bel aðrýsý yakýnmaiyle baþvuran ve radyolojik incelemelerinde tipik osteopoikilozis tutulumu saptanan bir olgu sunulmuþ ve literatür eþliðinde tartýþýlmýþtýr.

Osteopoikilosis is an uncommon osteosclerotic bone dysplasia. Usually, it is an asymptomatic disease and the diagnosis is made incidentally by imaging techniques which show multiple, small, well defined, ovoid or circular sclerotic lesions. Herein we report a case presenting with low back pain whose radiologic investigation revealed typical osteopoikilotic lesions and discuss the case in the light of the literature findings.

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