Amaç: Terapötik aralýkta olma zamaný (Time in therapeutic range-TTR), warfarin kullanan hastalarda antikoagülan tedavi etkinliðinin deðerlendirilmesinde kullanýlan bir yöntemdir. Bu çalýþmanýn amacý warfarin tedavisi altýndaki hastalarýn ne kadarýnýn TTR ile belirlenen terapötik aralýkta bulunduðunu belirlemek ve yaþ, cinsiyet ve warfarin endikasyonlarýna göre TTR deðerlerinin farklýlýk gösterip göstermediðini araþtýrmaktý.
Metod: Çalýþmaya Ýstanbul Medeniyet Üniversitesi Göztepe Eðitim ve Araþtýrma Hastanesi Ýç Hastalýklarý ve Kardiyoloji polikliniklerinde takip edilmekte olan, herhangi bir nedenle warfarin tedavisi alan ve en az 4 INR ölçümü bulunan 18 yaþ ve üzeri toplam 155 hasta (63 erkek, 92 kadýn, yaþ ortalamasý: 68±12) retrospektif olarak alýndý. Tüm olgularýn Rosendaal yöntemi ile TTR deðerleri hesaplandý. TTR deðerlerinin >% 60 bulunmasý hastalarýn hedeflenen warfarin terapötik aralýðýnda olmasý olarak kabul edildi. TTR deðerleri cinsiyete, yaþ gruplarýna göre (≥60 ve <60) ve warfarin endikasyonlarýna göre karþýlaþtýrýldý.
Bulgular: Olgularýn %77.4’ü atrial fibrillasyon, %13.5’i serebrovasküler hastalýk, %5.8’i kalp kapak replasmaný ve %3.3’ü derin ven trombozu nedeniyle warfarin kullanmaktaydý. Tüm hastalarda ortalama TTR deðeri %57.2±22.5 (kadýnlarda %58.86±22.10, erkeklerde %56.06±22.78, p=0.44) bulundu. TTR >%60 olan hasta sýklýðý %45.8, INR deðeri terapötik aralýkta bulunan hasta sýklýðý %51.7 idi. TTR deðerleri cinsiyete, yaþ gruplarýna ve warfarin endikasyonlarýna göre anlamlý farklýlýk göstermedi.
Sonuç: Warfarin tedavisi altýndaki hastalarýn yarýsýndan fazlasýnda koagülasyon testlerinin terapötik aralýkta bulunmadýðý görüldü. TTR deðerlerinin düþük bulunmasýnda warfarin ile etkileþen durum ve tedavilerin, sosyoekonomik ve sosyokültürel özelliklerin ve warfarin kullanýmý hakkýnda hastalarýn yetersiz bilgilendirilmelerinin rolü olabileceði düþünülmektedir.

Aim: Time in therapeutic range (TTR) is a method used to assess the efficacy of anticoagulant treatment in patients using warfarin. Aim of this study was to determine the rate of patients in TTR who are under warfarin treatment and to determine whether there is a difference in TTR according to age, gender and the indications of warfarin use.
Methods: A total of 155 patients (63 male, 92 female, mean age: 68±12) under warfarin treatment for any reason and with at least 4 INR measurements were recruited retrospectively from Istanbul Medeniyet University Goztepe Training and Research Hospital both Cardiology and Internal Medicine Clinics. TTR levels of each patient were calculated with Rosendaal method. A TTR level above 60% was considered as warfarin being in therapeutic range. TTR levels were compared to age groups (≥60 and <60), gender and indications of warfarin use.
Results: Indications of warfarin use were as follows: 77.4% atrial fibrillation, 13.5% cerebrovascular disease, 5.8% valve replacement, 3.3% deep vein thrombosis. In all patients mean TTR level was 57.2±22.5% (58.86±22.10% female and 56.06±22.78% male, p=0.44). The rate of patients with a TTR value higher than 60% was 45.8% and rate of patients with INR value within range was 51.7%. There was no significant difference in TTR values according to gender, age groups and warfarin indications.
Conclusion: More than half of the patients using warfarin were not in therapeutic range. Drug interactions, socioeconomial and sociocultural characteristics and inadequate informing of patients may have a role in these results.

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K-teli çoðunlukla kemik fiksasyonu için kullanýlmakta ancak serbest ucundan korunmak problemli olabilmektedir. Korunma amacýyla birçok metod kullanýlmaktadýr. Her ne kadar çoðunluðu pratik teknikler olarak görülmekteyse de tanýmsal açýklamalarý bulunmamaktadýr. Bu yazý, çeþitli teknikleri ortaya koymakta ve açýklama getirmektedir. Bu amaçla, bükme, teypleme, kan tüpü baþlýðý, kelebek iðneleri, soketler ve kauçuk contalar kullanýlmýþtýr. Hastalarýn konfor skorlarý deðerlendirilmiþtir. Teypleme en konforlu metod olarak görülmüþtür.

K-wire is mostly used for bone fixation, but the protection from the exposed end of the wire may be problematic. Numerous methods have been proposed for the protection of the free end of k-wire. Although most of them seem practical, they have not been completely described, ever. This note reveals simple and easy methods for the management of the free end of a k-wire by prescribing various ways. For this purpose, bending, taping, blood sampling tube caps, butterfly needles, needle hubs and rubber gaskets were used for the exposed end of the k-wires. The patients’ comfort scores were assessed. Taping was accepted as the most comfortable method to secure the wire end.

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Serebral palsi (SP) beraberinde sýklýkla uyku bozukluklarý görülen bir nörolojik tablodur. Buna raðmen, SP’li çocuklarda uyku bozukluklarýnýn nedenleri, motor kapasite ve hastalýk þiddeti ile iliþkisi tam olarak bilinmemektedir. Bu çalýþmada, serebral palsili çocuklarda uyku sorunlarýnýn hastalýk þiddeti, motor kapasite gibi faktörlerle iliþkisini ve yaþam kalitesi üzerine etkilerini araþtýrmayý amaçladýk. Çalýþmaya yaþlarý 4-14 yýl aralýðýnda olan 76 SP’li çocuk alýndý. Hastalarýn Kaba Motor Fonksiyon Ölçeði-88 (KMFÖ) ile motor fonksiyonel kapasiteleri, Çocuklar Ýçin Yaþam Kalitesi Ölçeði (ÇÝYKÖ) ile yaþam kaliteleri, Çocuklarda Uyku Ölçeði (ÇUÖ) ile uyku sorunlarý deðerlendirildi. Hastalarýn kaba motor sýnýflamalarý Kaba Motor Fonksiyon Sýnýflama Sistemi (KMFSS) ile yapýldý. KMFSS 1 ve 2 olanlar hafif, 3 olanlar orta, 4-5 olanlar ise aðýr SP olarak kabul edildi. ÇUÖ skorlarýnýn hafif SP grubunda orta ve aðýr SP gruplarýna göre düþük olduðu görüldü (sýrasýyla p=0,005, p=0,000). ÇUÖ skorlarýnýn ÇÝYKÖ ve KMFÖ skorlarý ile negatif iliþkili olduðu saptandý (tüm p’ler<0,001). Aðýr motor disabilitesi olanlar baþta olmak üzere, SP’li çocuklarda tedavi stratejileri belirlenirken, ciddi yaþam kalitesi kayýplarýna yol açan uyku bozukluklarý göz ardý edilmemelidir.

Cerebral palsy (CP) is a neurological disorder that is frequently associated with sleep disorders. Despite this, causes of sleep disorders among children with CP and the association of sleep disorders with motor capacity and severity of disease have not been fully elucidated. In the current study, we aimed to explore the association of sleep problems with factors including disease severity and motor capacity and the effects of sleep impairment on quality of life of children with CP. For this study, we enrolled 76 children with SP with an age range of 4-14 years. For all patients, the Gross Motor Function Scale (GMFS)-88 was used to evaluate functional motor capacity, the Pediatric Quality of Life Inventory (PedsQL) to assess the quality of life and the Pediatric Sleep Questionnaire (PSQ) to assess sleep problems. Classification of gross motor functions of the patients was performed using the Gross Motor Function Classification System (GMFSC). GMFSC Level 1 and 2 patients were considered as mild, Level 3 patients as moderate and Level 4 and 5 patients as having severe CP. PSQ scores were found to be lower in the mild CP group compared with those in moderate and severe CP groups (p=0.005 and p=0.000, respectively). PSQ scores were negatively correlated with PedsQL and GMFS scores (for all p<0.001). Given the substantial loss of quality of life caused by sleep disorders, sleep problems should be taken into account when establishing treatment strategies for children with CP, particularly for those with severe motor disabilities.

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Bu çalýþmadaki amacýmýz çeþitli nedenler ile yapýlan endometrial örnekleme iþleminin; endikasyonlarý ve histopatolojik tanýlarý arasýndaki iliþkiyi güncel literatür eþliðinde deðerlendirmektir. Bu çalýþmada Ocak 2012 ve Mayýs 2015 tarhleri arasýnda kliniðimizde çeþitli nedenler ile endometrial biyopsi yapýlan 799 olgunun dosyalarýndan retrospektif olarak elde edilen veriler deðerlendirildi. Endometrial biyopsi için en sýk endikasyon menometroraji olup %56,6 oranýnda tespit edildi. Tüm hasta popülasyonunda %1,9 endometrium kanseri tespit edildi. Endometrium kanseri için en riskli grup postmenopozal kanama yakýnmasý olan gruptu (%8,1). Myoma uteri ve benign nedenlerden dolayý histerektomi planlanan hastalarda operasyon öncesi yapýlan endometrial biyopsilerde premalign ya da malign histopatolojik tanýya rastlanmadý. Sonuç olarak, özellikle postmenopozal kanama þikayeti olan hastalar endometrium kanseri için yüksek bir risk içerdiklerinden dolayý endometriumun histopatolojik açýdan deðerlendirilmesi gerekir. Myoma uteri ya da diðer benign nedenlerden dolayý histerektomi yapýlan olgularda da premalign ve malign lezyonlar görülebileceðinden dolayý bu hastalara operasyon öncesi, risk faktörleri de göz önüne alýnarak endometrial deðerlendirme yapýlabilir.

In this study, we aimed to assess the relation between indications and histopathological diagnosis of the endometrial sampling interventions due to various reasons under the knowledge of current literature. The data obtained from the records of 799 cases performed endometrial biopsy due to various causes between January 2012 and May 2015 are evaluated in this retrospective study. The most frequent indication of endometrial biopsy was found as menometrorrhagia with a rate of %56,6. The endometrium cancer was found as %1.9 in all patient population. Patients with the complain of postmenopausal bleeding (%8,1) showed the highest risk for endometrium cancer. No histopathological diagnosis was found in endometrial biopsy materials performed before operation whose planned to undergo hysterectomy for myoma uteri and benign causes. In conclusion, patients particularly with the complain of postmenopausal bleeding caused by holding the highest risk for endometrium cancer require histopathological endometrial assessment. Preoperative endometrial assessment considering with the risk factors can be performed to the patients underwent hysterectomy within myoma uteri or benign reasons for the possible occurrence of premalign or malign lesions.

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Prizmalar optik özellikleri sayesinde görme eksenlerini düzelterek çift görmeyi ortadan kaldýrýrlar. Genelde tam bir þifa saðlayamazlarsa da, çift görme ve anormal baþ pozisyonu gibi, hastalarý çok rahatsýz eden semptomlarýn giderilmesini sýklýkla saðlarlar. Son zamanlarda oblik periferik prizmalarýn homonim hemianopili bireylerde, araba sürme gibi aktivitelerde kör alanlarýn bir miktar görünür hâle gelmesine yardýmcý olduklarý gösterilmiþtir. Prizmalar ayrýca retinitis pigmentoza gibi hastalýklar nedeniyle görme alaný daralmýþ olan bireylerde görme alanýný bir miktar geniþletmek için kullanýlabilir. Bu makalede prizma tedavisi, endikasyon ve kontrendikasyonlarý derlenmeye çalýþýlmýþtýr.

Thanks to their optical peculiarities, prisms could be used to correct diplopia by realigning the visual axis. Though they can not generally achieve a cure, the prisms often correct the symptoms such as diplopia and abnormal head posture which can be very disturbing for patients. Recently, it has been shown that oblique peripheral prisms improved responses of people with homonymous hemianopia to blind spot hazards when driving. Prisms may also be used to expand visual field in the patients with tubular vision due to retinitis pigmentosa etc. In this paper, we reviewed the prismotherapy, its indications and contraindications.

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Nekrotizan fasiit yýkýcý sonuçlanabilmektedir. Morbiditenin azaltýlmasý için taný konulduðu anda acil müdahale planlanmalýdýr.
Yirmi beþ yaþýnda erkek hasta, sol elinin üzerine nekrotizan fasiit ile baþvurdu. Hiç öncül travmasý veya enfeksiyon varlýðý olmayan hastanýn öyküsünde herhangi bir sebep de bulunmamaktaydý.
Seri debridmanlar sonrasý kapama kasýk flebi ile saðlandý. Rehabilitasyon programý dikiþler alýndýktan hemen sonra baþlatýldý. Minimum ekstansiyon kýsýtlýðý ile elde tam saðkalým elde edildi.
Nekrotizan fasit, çok atipik klinik ile karþýmýza çýkabilmektedir ancak tamamen saðlýklý hastalarda da olasýlýðý akýlda tutulmalýdýr.

Background: Necrotizing fasciitis can result with devastating consequences. Once diagnosed, an immediate action is needed to provide an outcome with minimum morbidities.
Methods: Here, a 25 years-old male patient is presented with the involvement of necrotizing fasciitis on his left hand. He had no antecedent trauma or infection, and his medical history did not show any reason.
Results: Serial debridements were carried out. The closure was established with groin flap successfully. Rehabilitation program was initiated immediately after the suture removal. Complete survival of the hand with minimum extension lag was achieved.
Conclusions: To us, the practitioners should be aware of the possibility of necrotizing fasciitis even in completely healthy patients with very atypical presentations.

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Hastanemiz Pediatri Servisinde pnömotoraks nedeniyle izlenen ve göðüs tüpü revizyonu sýrasýnda konvülziyon geçiren hasta, solunum yetmezliði nedeniyle entübe edilerek Çocuk Yoðun Bakým Ünitesine transfer edildi. Hasta mekanik ventilatörde SIMV-PS (basýnç destekli senkronize aralýklý zorunlu ventilasyon) modunda solutuldu. Bakýlan kontrol kan gazýnda pH: 7,01 ve pCO2: 115 mmHg olmasý nedeniyle hasta mekanik ventilatörden ayrýldý ve yüksek frekans ossilasyon ventilasyon uygulamasý baþlatýldý. Kan gazý takiplerinde respiratuvar asidozun düzeldiði ve oksijenasyon indeksinin azaldýðý görüldü. Yedinci günde konvansiyonel mekanik ventilasyona geçildi. Tanýsal amaçlý akciðer wedge rezeksiyon yapýldý, patolojik incelemede kistik adenomatoid malformasyon tanýsý kondu. Yatýþýnýn 26. gününde kademeli olarak ventilatörden ayrýldý, ekstübe edildi. Göðüs tüpü çekilen ve vital bulgularý stabil seyreden hasta pediatri servisine devredildi

Patient who had pneumothorax and suffered convulsion during chest tube revision was intubated due to respiratory failure and transferred from the service of the department of Children’s Health, and Diseases to its intensive care unit. The patient was ventilated in SIMV-PS (synchronized intermittent mandatory ventilation-pressure support) mode by mechanical ventilator. Control blood gas pH and pCO2 values were 7.01 and 115 mmHg, respectively. Then, the patient was weaned from mechanical ventilation and high-frequency oscilatory ventilation application was started. Respiratory acidosis improved and the oxygenation index decreased during blood gas monitoring. On the 7th day, patient was connected to conventional mechanical ventilation. Pulmonary wedge resection was performed for diagnostic purposes. Cystic adenomatoid malformation was diagnosed histopatologically. Patient was gradually separated from the ventilator on the 26th day of hospitalization. Chest tube was withdrawn and the patient was transferred to the ward of the department of pediatrics.

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Ender bir olgu olan “inflamatuvar rektal polipte osseöz metaplazi”
sunumu. Dokuz yaþýnda erkek hasta 6 aydýr ara ara olan yaklaþýk
15 kez yineleyen rektal kanama yakýnmasýyla baþvurdu. Rektal
duvardan 8 mm çapta polip eksize edildi. Histolojik olarak, akut
ve kronik inflamasyon ve granülasyon dokusunda oluþan stromada
daðýnýk uzamýþ, geniþlemiþ, müsinle dolu kolonik glandlar
görüldü. Stromada küçük bir odakta normal kolonik mukoza ile
çevrili yeni kemik oluþumu dikkati çekti. Oldukça ender görülen
rektal inflamatuvar polipte metaplastik kemik oluþumu olgusu
literatür bilgileri ile sunuldu.

To present a rare case of osseous metaplasia in an inflammatory
rectal polyp. A 9-year-old boy admitted to the clinic with
a 6 month history of intermittent rectal bleeding that occurred
approximately 15 times. An 8 mm polyp in diameter was totally
excised from rectal wall. Histologically, elongated, dilated, mucin
filled colonic glands were scattered within stroma which was
composed of both acute and chronic inflammatory and granulation
tissue. In the stroma there was a small focus of new bone
formation, which was covered with intact colonic mucosa. We
presented an extremely rare case report of a metaplastic bone
formation in a rectal inflammatory polyp.

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