Akciðere metastaz, akciðerin zengin vasküler ve lenfatik yapýsý nedeniyle oldukça sýktýr. Biz de merkezimizde iskelet sistemi tümörlerinin akciðer metastazý nedeniyle prospektif
olarak izlediðimiz, yaþlarý 14 ile 48 arasýnda deðiþen 14 olguyu, klinik, radyolojik ve histopatolojik özellikleri bakýmýndan deðerlendirdik.

Olgularýn radyolojik görünümü ve primer tümörün yerleþim yerlerine göre özelliklerini, literatür bilgisi ýþýðýnda sunmayý uygun bulduk.

Metastasis to the lungs in common because of the rich vascular and lymphatic structure of the lungs. We evaluated 14 cases followed prospectively in our centre with the ages ranging from 14 to 48, having metastasis of skeletal system tumours to the lungs. We evaluated
them with respect to their clinical, radiological and histopathological features. We considered it appropriate to present the and localizations of the primary tumour in the light of the literature.

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Son yýllarda istenmeyen gebelik olgularýnda cerrahi küretajýn yerini alabilecek noninvaziv ve komplikasyonsuz yöntemler araþtýrýlmaktadýr. Biz de metotreksat enjeksiyonunu izleyen 7. gün intravaginal uygulanan misoprostol’ün etkisini araþtýrdýk.

Çalýþmamýza Ocak-Mart 1996 ve Ocak-Nisan 1997 tarihleri arasýnda kliniðimize baþvuran 100 hasta katýldý. Bu hastalara 50 mg/m2 metotreksat enjeksiyonunu izleyen 7. günde 400 μg intravaginal misoprostol uygulandý. 24 saat içinde düþük yapmayanlara ikinci kez 300 μg intravaginal misoprostol uygulandý. Olgulara uygulama öncesi ve düþük sonrasý transvaginal ultrasonografi yapýldý.

Çalýþmaya katýlan 100 hastadan 6’sý metotreksat dozunun ikinci günü kendi isteði ile cerrahi küretaj oldu. 2 hasta misoprostol uygulanacaðý gün düþük yaptý. 88 hasta komplet düþük yaparken, inkomplet düþük yapan 4 hastaya cerrahi küretaj uygulandý. 88 hastadan 50’si ilk doz, 38’i ise ikinci doz misoprostol uygulamasýný takiben düþük yaptýlar. Misoprostolden sonra baþarýlý düþük yapan hastalarda aðrý veya kanama 3±1 saatte baþladý. Kanama nedeniyle hiçbir hastaya cerrahi küretaj gerekmedi. Metotreksat ve misoprostole ait yan etki oraný çok düþüktü.

Metotreksat enjeksiyonunu izleyen 7. günde uygulanan intravaginal Misoprostol’ün özellikle cerrahi küretaj istemeyen olgularda iyi bir alternatif olarak kullanýlabileceði
kanýsýndayýz.

In recent years there are many trials about new alternatives to surgical abortion. Our purpose was to determine the success rate of two known drugs; methotrexate&misoprostol.

A trial was performed to 100 women attending to our hospital whose pregnancy was < 63 days and who wanted medical abortion. 7 days after injecting methotrexate (50 mg/m2) we administered intravaginal misoprostol (400 μg). If no abortion occurred in the first 24 hours of misoprostol administiration we repeated the misoprostol on the second day. For all women we made vaginal ultrasonography before and after the study.

Six patients preferred surgical abortion in the second day of methotrexate injection without any reason, 2 woman aborted spontaneusly before the misoprostol. 88 women aborted completely, whereas 4 women had incomplete abortion and we made them vacuum curretage. 50 women aborted in the first 24 hours, 38 aborted following the second dose of misoprostol. In those women who aborted succesfully vaginal bleeding and abdominal pain started in 3±1 hours. There was no need for surgical procedures becouse of hemorrage. The side affects of methorexate or misoprostol were infrequent.

Misoprostol administiration 7th days after methotrexate injection may be a good alternative to surgical abortion procfedures.

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1994-1998 yýllarý arasýndaki 5 yýllýk dönemde Þiþli Etfal Hastanesi Kadýn Doðum Kliniði’nde doðan >500 g ve >22 haftalýk 26.072 bebeðin retrospektif taramasýnda ölü doðum hýzý % 0.29, erken neonatal mortalite hýzý % 0.11 ve geç neonatal mortalite hýzý % 0.1 idi. 1996 ve 1997 yýllarýnda gözlenen ölü doðum hýzýndaki artýþýn, o yýllara ait ne SGA, LGA prematürite ve ne de postnatal mortalite ve morbidite oranlarýna yansýmamasýnýn nedenleri tartýþýldý.

The retrospective survey of 26.072 babies with >500 gm birth weight and >22 wk intrauterine age yielded 0.29 % stillbirth rate and 0.11 % early neonatal and 0.1 % late neonatal mortality rates between the years of 1994-1998. The reason/s for the absence of any reflection/s of the increased stillbirth rates observed in the years of 1996 and 1997 to neither SGA, LGA, prematurity rates nor postnatal morbidity and mortality rates of those years were discussed.

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Son yýllarda tip 2 diabette hipertansiyon geliþmesindeki nedenlerden birinin sempatik sinir sistemi aktivasyonu olduðuna dair çalýþmalar mevcuttur.

Bu çalýþmada, SSK Kartal Hasta-nesi Diabet polikliniðine baþvuran hipertansiyonu olan tip 2 diabetli ve komplikasyonsuz diabeti olan hastalarda, kardiyovasküler refleks testleri kullanýlarak ve 24 saatlik idrarda norepinefrin düzeyine bakýlarak, sempatik sinir sistemi aktivasyonunun varlýðý araþtýrýldý. Hipertansiyonlu tip 2 diabetlilerde, hipertansiyonsuz tip 2 diabetlilere göre parasempatik nöropati anlamlý derecede daha sýk ve 24 saatlik idrarda nor-epinefrin düzeyleri anlamlý olarak yüksek bulundu.

There are some recent studies on sympathetic nervous system activation to be one of the reasons of hypertension in type 2 diabetes. In this study, the presence of sympathetic nervous system activation in patients with hypertension and type 2 diabetes, and also in patients with noncomplicated diabetes, enrolled into the outpatient diabetes clinic of SSK Kartal Hospital, has been researched by using cardiovascular reflex tests and 24-hours urinary norepinefrin levels. Comparing with type 2 diabetes without hypertension; parasympathetic neuropathy was found significantly more frequent and 24-hours urinary norepinefrin levels were significantly higher in type 2 diabetes with hypertension.

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Sefepim kullanýmý kolay, yüksek maliyeti olmayan ve etki spekturumu geniþ bir antibiyotiktir. Çalýþmamýzda 20 pürülan menenjit vakasýnda sefepim tedavisi 2x1 g/gün olarak 14 gün uygulandý ve hastalarýn tümünde tam þifa saðlandý. Eriþkin pürülan menenjit hastalarýnda etkenler gözönüne alýnarak sefepim monoterapi olarak kullanýlabilir.

Cefepim is a wide spectrum antibiotic with low cost and easy use. In this study, cefepim was used 1 g 2 times/day (14 day) on 20 purulan menengitis and all pat›ents recovered. Considering the agents of adult purulent meningitis, cefepim can be used as a monoterapy.

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Abdominal aort cerrahisinden sonra görülen komplikasyonlarýn en sýkýntýlýlarýndan birisi kolon iskemisidir. Hastanemizde abdominal aort operasyonlarýndan sonra 11 adet kolon iskemisi tesbit edildi. Bunlardan 7’si rüptüre aort anevrizmasý sonrasý geliþmiþti. Yedi olgu opere edildi, nekrotik kolon rezeksiyonu ve kolostomi yapýldý. Ancak toplam 8 olgu (opere
olan 7 hasta ve opere edilmeyen bir olgu) kaybedildi.

Olgularýn preoperatif özelllikleri incelendiðinde, özellikle rüptüre abdominal aort anevrizmalarýnda kolon iskemisi sýk olarak görüldü. Tüm olgularda hipotansiyon, düþük hematokrit, renal yetersizlik ve solunum yetersizliði ön planda idi. Ayrýca 2 hasta hariç tüm olgularda inferior mezenterik arter baðlandý.

Kolon iskemisinin yüksek mortaliteyle seyrettiði göz önüne alýndýðýnda, preoperatuar deðerlendirmenin ve inferior mezenterik arter ligasyon kriterlerinin ve tekniklerinin daha iyi bilinmesi kanaatindeyiz.

One of the most dreaded complications of abdominal aortic surgery is colon ischemia. In our hospital in 11 cases colon ischemia is detected following abdominal aortic surgery.
Seven of them were due to ruptered abdominal aortic aneurysm. Seven of the 11 cases were reoperated and unfortunately 8 cases (7 operated and 1 nonoperated) were lost.

When preoperative characters of the cases were evaluated colon ischemia as detected especially in ruptured abdominal aortic aneurysms. In all these ruptured cases hypotension, low hematocrit, renal insufficiency and respiratuar insufficiency were in common. On the other hand in all cases except 2, inferior mezenteric artery has been ligated.

Due to the high mortality of serious colon ischemia preoperative evaluation of the patient’s condition and criteria and tecniques of inferior mezenteric artery ligation should be precisely known.

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Guyon kanalý, ya da distal ulnar tünel, el bileðinin anteromedialinde bulunan ve n.ulnaris ve a.ulnaris’i içeren fibroosseöz bir tüneldir. Bu bölgedeki anatomik varyasyonlar el cerrahisinde
önem taþýmaktadýr.

Bu çalýþma, 36 kadavra el bileði üzerinde gerçekleþtirildi. Ramus palmaris profundus a. ulnaris’in, ramus superficialis n.ulnaris ve ramus profundus n.ulnaris ile iliþkisinde varyasyon
gözlenmiþtir. Ancak, Guyon kanalýnda aksesuar kaslar görülmemiþ ve n.ulnaris’in aberran dallarýna nadiren rastlanmýþtýr.

Guyon’s canal or distal ulnar tunnel is a fibroosseus tunnel along the anteromedial portion of the wrist that contains the ulnar nerve and artery. The frequency of anatomic variants in
this area is important for hand surgeon. This study was done by using thirty-six cadaver wrists. The relationship of the deep branch of the ulnar artery to the superficial and deep
branches of the ulnar nerve was found to vary. Surprisingly accessory muscles which are passing through guyon’s canal was not determined in this study. In the same way, aberrant branching of the ulnar nerve in this area was rare.

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Bu çalýþmada Kasým 1996-Kasým 2000 tarihleri arasýnda kliniðimize baþvuran ve mesh plug herniorafi tekniði ile tedavi ettiðimiz 250 inguinal hernili hasta tartýþýlmýþtýr. Bu hastalarýn 47’si kadýn, 203’ü erkek, yaþ ortalamasý 45 (16-93) idi. 223 hastada primer, 27 hastada sekonder inguinal herni mevcuttu. Ameliyat süresi ortalama 28 (20-32) dk. ‹di. Postoperatif mobilizasyon süresi ortalama 8.2 saatti. Hastanede kalýþ süresi ortalama 0,8 gündü. Morbidite oraný% 7.6 idi. Mortalite geliþmedi.

Ýnguinal herni tedavisinde mesh plug herniorafi kolay uygulanabilen, özel bir eðitim gerektirmeyen, postoperatif dönemi oldukça konforlu, kýsa hastanede kalýþ süresi ve erken iþe dönüþ süresi nedeni ile de ekonomik bir yöntem olup, morbiditesi düþük etkin bir yöntemdir.

In this study, we discussed 250 inguinal hernia case, threated by mesh plug hernioraphy technique between November 1996 and November 2000. 47 cases were female and 203 were male. Mean age was 45 (16 to 93). 223 cases were primery and 27 were secondary inguinal hernia. Operation time was nearly 28 minutes (20 to 32) and postoperative mobilization time was nearly 8.2 hours. Hospital stay was nearly 0.8 day. Morbidity rate was 7.6 % and no mortality was found.

In inguinal hernia repair, mesh plug hernioraphy is an echonomic and simple technique without special surgical expertise, low morbidity, more postoperative comfort, minimum
hospital stay and minimum time off work.

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Infectious lymphocytosis is characterized by mild complaints, vomiting, diarrhea, upper respiratory tract infection, abdominal pain, slight or absent fever, symptom of short duration. There is no enlargement of liver, spleen or lymph nodes white blood cell counts varying from 40.000 to 100.000/mm3, lymphocyte rate is % 70. There is no anemia or thrombocytopenia. This disease to be differentiated from acut leukemia, infectious mononucleosis and lymphocytosis accompanying certain infections, particularly pertusis. Prognosis is excellent and no treatment required. We aimed to emphisize with these cases that when lymphocytosis is found the differential diagnosis must include acut infectious lymphocytosis

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The antiphospholipid antibody syndrome (APS) is characterized by antibodies directed against either phospholipids or plasma proteins bound to anionic phospholipids. Patients with
the APS may display a constellation of clinical features including venous and arterial thrombosis, recurrent fetal losses and thrombocytopenia. This disorder is referred to as the primary APS when it occurs alone; however, it can also be found in association with systemic lupus erythematosus (SLE), other rheumatic diseases and with certain infections
and drugs.

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Radiation myelopathy is a rarely seen complication of radiation therapy, has a bad prognosis that follows, after a various period of time, the irradiation of malignant tissues which also exposes to the normal neighbouring nerve tissues to irradiation.

A case of 42 years old women, showing the history, neurological examination and results of the MR and CSF cytology of this myelopathy is presented.

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45 years old female patient admited to clinic with complaints of noisea, fever, headache for three days and because of symptoms of meningeal irritation. Lomber puncture performed.
In CNS fluid, protein level was high, glucose level was normal and % 90 of cells were lymphocyte, blood and CNS fluid were founded HSV 1 IgM negative. So the patient was evaluated as viral menengitis and antiviral chemotherapy was begun with acyclovir. Cranial CT has been thought herpes encephalitis because has been seen temporal involvement

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In this report, a case with pyeloureteritis cystica caused by urinary calculus disease is presented. The patient had right flank pain and microscopic haematuria was examined by abdominal ultrasound and excretory urography. Multiple nodular radiolucent filling defects as air bubbles were seen in collecting systems especially in renal pelvis and 1/3 proximal ureter. After excretory urography, ureteroscopy and cold cup biopsy were performed and histological examination revealed cystic epithelial appearances and metaplastic changes in uretelium.

Pyeloureteritis cystica is a specific urinary system pathology which is rarely seen but easily diagnosed by excretory urography. Approximately 100 cases have been reported in the literature since the disease was first reported by Morgagni in 1761. The etiology of disease has been usually accepted to recurrent inflammation especially chronic pyeloureteritis by most authors.

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A case of recurrent anterior chest wall tumor who had previous operation for same lesion 12 years ago with pathologic diagnosis of chondroma, has been reported. Wide en-bloc excision of tumor together with lower sternum, ksifoid and costal kartilages with a safety margin of 4 cm was performed. Chest wall defect which is about 14x20 cm was repaired with polytetraflouroethylene (PTFE) greft. No complication was seen postoperatively. Pathological result was benign chondroma.

Radical wide excision is necessary for all primary chest wall tumors in order to reach absolute microscopic diagnosis, prevent recurrences and to provide best chance for cure. Chest wall stabilization with various kind of greft is possible.

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Colonic lipomas arise from deposits of adipose tissue in the bowel wall and have no malignant potential. Most are located in the submucosal layer, but some also lie subserosally. Most lipomas are asymptomatic. They rarely cause obstruction, but
when they do it is usually caused by intussusception, with the lipoma forming the lead point. Often these lesions are found as an incidental mass at laparotomy, and a partial colectomy is
needed to confirm the diagnosis.

In this study, we present a case, with rectal heamoragie and chronic constipation; confirmed as left colonic leiomyoma in colonoscopy and CT; and after the operation it is confirmed as
colonic lipoma.

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An anaphylaxis case in a 39 years old female who was under general anaesthesia for hidatid cyst operation is presented. In patients with echinococcus infestation, the hydatid fluid causes both immediate and delayed type hypersensitivity reaction. Systemic anaphylaxis symtoms have unpredictable nature and may be mortal. For this reason, probability of anaphylaxis always must be remembered and ready for it.

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Biotinidase deficiency is an autosomal recessive disorder of biotin recycling. Children with profound biotinidase deficiency usually have neurological and cutaneous symptoms in early childhood, but they may not develop symptoms until adolescence. Here we report a 5 months old baby who became symptomathic with myochlonic convulsions that began in the
second month of life and diagnosed when she was 5 month sold.

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Paget’s disease of bone (osteitis deformans) is a focal and chronic skeletal disorder characterized by an accelerated rate of bone turnover with excessive resorption and formation of bone. Most of the patients are asymptomatic. Main clinical manifestations of Paget’s disease in symptomatic patients are pain, deformities and fractures in affected areas. Paget’s disease should be strongly suspected in a healthy older patient who has a high serum alkaline phosphatase concentration, a normal serum calcium concentration, and no evidence of hepatobiliary disease. A radionuclide bone scan is more sensitive
than plain radiographies in identifying pagetic bone lesions. Serum calcium and phosphorus concentrations are normal in most patients with Paget’s disease. However, hypercalcemia, hypocalsemia, primary or secondary hyperparathyroidism
can occur. Primary indications for treatment are to relieve symptoms and to treat or prevent complications associated with the disease. Calcitonin and bisphosphonates are specific antipagetic drugs.

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Imerslund-Grasbeck syndrome is an uncommon, hereditary disease, characterized by megaloblastic anemia and proteinuria. A two-year-old boy with the characteristic findings is
described in our Clinic. Replacement therapy with parenteral vitamin B12 resulted in remarkable clinical and haematological improvement.

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Malign melanoma of the choroid is the most common primary intraocular tumor in adults. Presentation is most commonly during the sixth decade of life. The typical choroidal malign melanoma is a brown elevated, dome shaped subretinal mass the degree of pigmentation ranges from dark brown to totally amelanotic. Clinical evaluation of all posterior uveal melanomas should include an extensive history and complete ophtalmologic evaluation to definitively establish the diagnosis. The correct management of malign melanomas of the choroid is contraversial. The choice of appropriate therapy depends on three major factor; firstly visual acuity of involved eye size, secondly location, extent and apparent activity of the tumor and thirdly general health and age of the patient. We present the clinical findings and treatment in a 40 years old male patient.

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Behçet disease is a vasculitis in which multiple organ involvement occurs. Remisions and exacerbations are seen in its course and it is a chronic relapsing disease. Diagnosis is very difficult. There are no patognomonic symptoms or laboratory signs. Recurent oral and genital ulserations, ocular and dermatological signs are diagnostic. The disease is rarely seen in childhood and sometimes presantation may be papilledema.

A ten year old were taken to our clinic because of headache, fatigue, cranial sinus thrombosis. No cause was found while searching all cranial occlusive causes of venous thrombosis emesis, myalgia sixteen months ago. When the etiology of headache searched papilledema was found as a result of. Diazoxide, low dose asetylsalisylate, warfarin were administered to the patient for cranial sagittal sinus right transverse sinus
thrombosis. MRI-MRI venograpy were used fo controlling sinus thrombosis.

Long term observation of the patient in the policlinic and in the hospital it is found that except the complaints of severe headache, relapsing fever, there are recurent oral ulcerations, non-erovise artritis of knee and lower extremities, erithema nodosume like dermal lesions in lower extremities, thrombophylebitis and iridocyclitis as the other signes. In addition to this, acute phase reactants were high during these periods. HLA B51 was found in his tissue group analyse. After labarotory data and clinical findings the patients diagnosis is juvenil Behçet’s disease. In our clinic his theraphy and visits are regularly controlled.

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