Plazma D-Dimer yüksekliði pulmoner tromboemboli (PTE) ve pnömonide bildirilmiþtir. Bu çalýþmada prospektif olarak plazma D-Dimer düzeyi lateks aglutinasyon ile bakýlarak, PTE olgularý, akciðer tüberkülozu (tbc) olgularý ve saðlýklý eriþkinlerle karþýlaþtýrýldý.

Aralýk 2000-Kasým 2001 tarihleri arasýnda 23 PTE olgusu (Grup I) ile ayný yaþ grubundan 23 tbc olgusu (Grup II) ve 23 saðlýklý eriþkin (Grup III) çalýþmaya alýndý. Plazma D-Dimer düzeyi eþik deðeri 250 μg/L olarak kabul edildi.

Çalýþmamýzda sonuçlar Grup I’de 14’ünde (% 61) pozitif, Grup II’de 3’ünde (% 13) pozitif ve Grup III’de tüm hastalarda negatif bulundu. Klinik yüksek olasýlýklý PTE olgularýnýn deðerleri kontrol Grubu olarak saðlýklý eriþkinlere ve tbc olgularýna göre deðerlendirildiðinde; sýrasýyla duyarlýlýk (% 61 ve 61), özgüllük (% 100 ve 87), pozitif öngörü deðeri (% 100 ve 82) ve negatif öngörü deðeri (% 72 ve 69) bulundu. Ortalama plazma D-Dimer deðerleri gruplarda sýrasýyla 1091±1666 μg/L (0-5000), 183±349 μg/L (4-1325), 51±41 μg/L (5-135) tespit edildi. Grup I’in D-Dimer deðeri II ve III’e göre anlamlý yüksek iken (sýrasýyla p<0.0073, p<0.0019); Grup II’nin deðeri Grup III’e göre anlamlý yüksek bulundu (p<0.05).

Çalýþmamýzda lateks aglutinasyon yöntemi ile plazma D-Dimer düzeyi saðlýklý eriþkinlerin hepsinde PTE için tanýsal anlamý olan eþik deðerinden düþük saptandý.

The use of high plasma D-Dimer level in the suspicion of pulmonary tromboembolism (PTE) also can be used in pneumonia. Prospectively, in this study plasma D-Dimer levels with Latex Agglutination method in PTE cases were checked and compared with healthy and tuberculosis cases.

Between November 2000 and October 2001, 23 PTE cases (group 1), 23 pulmonary tuberculosis (group 2) and 23 healthy cases (group 3) were regarded in the same ages. D-Dimer cut-off level is accepted 250μg/L.

The results were found positive 14 cases in Group 1 (61%) and 3 cases in Group 2 (13%). All Group 3 were negative. Group 1 sensitivity (61%, 61%), spesifity (100%, 87%), pozitive predictive level (100%, 82%), negative predictive level (72%, 69%) were found respectively compared with Group 2 and 3. Mean plasma D-Dimer levels, in Group 1,2,3 are as follows respectively: 1091± 1666 μg/L (0-5000), 183±349 μg/L (4-1325), 51±41 μg/L (5-135). Group 1 was found istatistically significant compared with Group 2 and 3 (respectively p<0.0073, p<0.0019). The difference between values of Group 2 and group 3 was also significant (p<0.05).

In our study, plasma D-Dimer level with Latex Agglutination method was found below than cut-off level in healthy groups, the diagnosis of PTE can be subtracted.

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Çalýþmamýzda, elektif sezaryen olgularýnda epidural yolla uygulanan fentanil-bupivakain ve fentanil-ropivakain kombinasyonlarýnýn etkinliðinin araþtýrýlmasý amaçlandý.

Hastanemiz etik kurul onayý alýndýktan sonra epidural anesteziyi kabul eden 40 hasta rasgele iki eþit gruba ayrýldý. Hemodinami monitörize edildi. Epidural blok; çift kör olarak, Grup R’de % 0.5 ropivakain (15 ml) +100 μg fentanil ile, Grup B’de % 0.5 bupivakain (15 ml) +100 μg fentanil ile saðlandý. Epidural enjeksiyonu takiben 1, 5, 15 ve 30 dakikalarda duyusal blok (pin-prick) ve motor blok seviyeleri (Bromage) saptandý. Postoperatif 30 dk aralarla yapýlan takiplerle iki segment gerileme ve motor blok kalkýþ zamanlarý kaydedildi. Ýntraoperatif aðrý takibi vizüel analog skala ile deðerlendirildi. Bloðun istenen seviyeye gelmesi ile ilk analjezik yapýlma zamaný arasýndaki süre analjezi süresi olarak deðerlendirildi. Yan etkiler kaydedildi. Yenidoðanýn 1, 5 ve 10 dakika Apgar skorlarý ve umbilikal kord arter ve ven kan gazý deðerleri ölçüldü.

Duyusal blok seviyelerinin zamana göre deðiþimi ve maksimum blok seviyeleri açýsýndan iki grup benzerdi. Ýki segment gerileme zamaný Grup B’de istatistiksel olarak anlamlý uzundu (p<0.05). Analjezi süresi bakýmýndan gruplar arasýnda farklýlýk saptanmadý. Grup R’de % 15, Grup B’de % 65 olguda motor blok görüldü. Motor blok seviyesi 15 ve 30 dakikalarda Grup B’de anlamlý olarak yüksek bulundu (p<0.05). Motor blok kalkýþ süreleri arasýnda farklýlýk yoktu. Ortalama arter basýncý baþlangýç deðerine göre Grup R’de 5. dakikada, Grup B’de 15. dakikada anlamlý düþüþ gösterdi (p<0.01).

Sonuç olarak, sezaryen operasyonlarýnda epidural bupivakain-fentanil ve ropivakain-fentanil kombinasyonlarý ile yeterli analjezi saðlanabileceði kanýsýna varýldý.

The aim of our study was to evaluate the effectiveness of epidural administration of fentanyl-bupivacaine and fentanyl-ropivacaine combinations in elective cesarean operations.

After approval of hospital ethical committee, 40 patients, who had accepted epidural anesthesia were randomized into two groups. After standard hemodynamic monitorization, epidural blockade was achieved with ropivacaine 0.5 % (15 ml) + fentanyl
100 μg in Group R and bupivacaine 0.5 % (15 ml) + fentanyl 100 μg in Group B in a double blinded manner. Sensorial (pinprick test) and motor (Bromage Scale) blockade levels were assessed 1, 5, 15, 30 minutes after epidural blockade. Postoperative follow-up was performed in 30 minute’ intervals; two segment regression and motor blockade resolving times were recorded. Perioperative pain was evaluated with visual analogue scale (1-10), and postoperative pain was assessed with the time of the first analgesic requirement. Side effects were recorded. The Apgar scores of newborn infants at 1., 5., 10. minutes wre recorded, arterial and venous blood gases of umbilical cord were analyzed.

Sensorial blockade onset time and maximum level of motor blockade were similar in both groups. Two segments regression time was significantly longer in Group B (p<0.05). There was no significant difference between groups in terms of duration of analgesia. Motor blockade was seen 15 % in Group R and 65 % in Group B. Motor blockade levels at 15 and 30 min were significantly higher in Group B (p<0.05). Motor blockade resolving times were not different. Mean arterial pressures declined at the 5th min in Group R and at the 15th min in Group B when compared with the baseline values (p<0.01).

It is concluded that, epidural administration of bupivacainefentanyl and ropivacaine-fentanyl combinations in cesarean operations maintains adequate analgesia.

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Bu çalýþmada kliniðimizde katarakt ekstraksiyonu sonrasý birincil ve ikincil iþlem olarak ön kamaraya implante edilen göziçi lenslerinin klinik sonuçlarýný araþtýrdýk.

SSK Göztepe Eðitim Hastanesinde, Nisan 2000-Mart 2003 tarihleri arasýnda katarakt cerrahisi geçirmiþ ve ön kamaraya göziçi lensi (AC IOL) implante edilmiþ olan 34 hasta incelendi. Hastalarýn vizyon (Vo), oküler tansiyon (To), refraksiyon deðerleri ölçüldü, biyomikroskobik muayeneleri yapýldý. Her hastada bilateral kornea kalýnlýklarý pakimetri ile ölçülerek karþýlaþtýrýldý.

Vizyonlarýn preoperatif deðerlere göre 21 hastada (% 63.6) arttýðýný, 1 hastada (% 3.3) azaldýðýný ve 11 hastada (% 33.3) ayný kaldýðýný saptadýk. Oküler tansiyon ölçümlerinde, preoperatif deðerlere göre anlamlý bir fark saptanmadý. Opere gözün pakimetrik ölçümleri, diðer gözün ölçümlerinden anlamlý olarak yüksek bulundu. AC IOL implantasyonlu olgularýmýzda en sýk rastlanan komplikasyonlar astigmatizma, pupil irregularitesi, yara yeri komþuluðunda anterior sineþi, iriste sektöryel atrofi olarak tespit edildi.

AC IOL implantasyonu, kapsül desteðinin olmadýðý sorunlu olgularda baþvurulan bir yöntemdir. Dolayýsýyla bu iþlemde baðiçi ÝOL implantasyonu ile sonuçlanan bir katarakt cerrahisine göre daha yüksek sayýda komplikasyon ile karþýlaþýlmaktadýr. Bununla birlikte, AC IOL implantasyonu ile anlamlý derecede vizyon artýþý elde edilebilmesi bize bu yöntemin lens desteðinin olmadýðý sorunlu olgularda iyi bir seçenek olduðunu düþündürdü.

In this study we aimed to evaluate our clinical results of primary and secondary implantation of flexible open loop AC IOL after complicated cataract surgery.

We examined 33 patients who had cataract surgery and AC IOL implantation between the dates April 2000-Mart 2003 in Göztepe SSK Educational hospital. Visual acuity,‹ntraocular
pressure, refraction were evaluated and biomicroscopic examination was performed. The corneal thicness of both eyes of each patient were measured and compared.

There was an increase of the visual acuity of 21 patients (63.6 %), decrease in 1 patient (3.03 %), it remained the same in 11 patients (33.3 %). There wasn’t a statistically significant difference in the preoperative and postoperative IOP measurings. The pachimetric measurements of the operated eye were significantly higher than the other eye. Astigmatism, irregularities of the pupil, anterior sinechy on the wound side, sectorial atrophy of the iris were the most common complications.

AC IOL implantation is a method used in the complicated cases with lack of posterior capsular support. That’s why we have a higher rate of complications compared to cataract surgery which ends with in the bag IOL implantation. But according to our results there was an increase in the visual acuity in significant number of the cases,so we think that AC IOL implantatiom is a method which can be performed in complicated cases with absence of posterior capsule.

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Böbrekler hormonlarýn atýmý ve katabolizmasýnda önemli rol oynadýklarýndan, böbrek yetersizliði olgularýnda anormal hormon düzeyleri ve menstürel bozukluklarý sýk görülür. Bu çalýþmada, hemodiyaliz uygulanan kronik böbrek yetersizlikli olgularda menstürel siklus düzensizliklerini, normal menstürel siklusu olan saðlýklý kontrol grubu ile karþýlaþtýrýlarak deðerlendirme amaçlanmýþtýr.

Çalýþma, Nisan 2001-Eylül 2001 tarihleri arasýnda SSK Göztepe Eðitim Hastanesi hemodiyaliz merkezinde tedavi gören 30 kadýn ve 30 saðlýklý kontrol gurubu olmak üzere 60 olgu üzerinde yapýldý. Olgulardan hemodiyaliz öncesi kan alýnýp FSH, LH, E2, PRL, TSH deðerleri çalýþýldý. Kontrol grubundan alýnan kan deðerleri ile karþýlaþtýrýldý. Çalýþmamýzda hemodiyaliz uygulanan olgularda kontrol grubuna göre FSH, TSH, PRL, E2 düzeyleri istatistiksel olarak anlamlý þekilde farklý bulundu (p<0.01). Gruplara göre LH düzeyleri ortalamalarý da anlamlý derecede farklý idi (p<0.05).

Olgularýn menstürel düzensizliklerinin sadece hormonal dengelerin bozulmasýna baðlý deðil, ayný zamanda üremi ve hemodiyalizdeki birçok faktörden etkilendiðini düþünmekteyiz.

Kidney has a key role in the excretion and catabolism of hormones. Abnormal hormon levels is frequently seen in women with renal failure. In this article we evaluate menstruel cycle, hormone levels in women with healthy control group and haemodialysed
renal failure group. We studied 30 haemodialysed woman in haemodialysis center in SSK Göztepe Hospital between April 2001-September 2001 and 30 healthy control group. We took blood samples before haemodialysis for measuring FSH, LH, PRL, E2, TSH blood levels, and then compared hormone levels between haemodialysed woman and healthy
control group. We conclude that haemodialysed renal failure group have higher FSH, TSH, PRL, E2 serum level than control group. Result is statistically significiant
(p<0.01). Serum LH level is also significantly different between groups (p<0.05).
We think that menstruel cycle disorder is not only due to hormon level abnormalities but also due to uremia and factors related to haemodialysis.

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Endüstiyel toplumlarda insanlarýn % 75’i ömürlerinin herhangi bir döneminde en az bir kere bel aðrýsý çekerler ve bunlarýn % 10’unda kronik bel aðrýsý geliþir. Kronik bel aðrýsý toplum saðlýðýný tehtid eden önemli bir sorundur. Ayrýca yapýlan saðlýk harcamalarý ve iþ gücü kaybý göz önüne alýndýðýnda maliyetinin çok yüksek olduðu da açýktýr. Bu çalýþmada, hastaneye bel aðrýsý þikayeti ile baþvuran hastalarda kronik bel aðrýsýnýn etyolojik nedenleri incelendi. Kronik bel aðrýsýnda altta yatabilecek etiyolojik nedenlerin günümüz þartlarý ve imkanlarýyla deðerlendirilmesi ile elde edilen sonuçlar yayýmlanmýþ olup, konunun güncel tutulmasý açýsýndan faydalý olacaðý düþünüldü.

In industrial countries, % 75 of the adults suffer from low back pain at anytime in their life, and % 10 of them progress to chronic phase. Chronic low back pain is an important problem for public health. However, health expenses and lost work days cost very much to the countries. In this study, the etiologic causes of the chronic low back pain are examined
from the data obtained from outpatient records. The causes of chronic low back pain are evaluated with recent technologies and we thought that its worth to publish.

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Kronik böbrek yetersizliði (KBY) bütün vücudu etkilediði gibi daha da önemli olarak kardiyovasküler sistemi etkilemektedir. Bu çalýþmada amaç, düzenli hemodiyalize giren kronik böbrek yetersizlikli hastalarda kalpte meydana gelen morfolojik ve fonksiyonel deðiþiklikleri ekokardiyografik (EKO) olarak deðerlendirmek amacý ile planlandý.

Çalýþmaya, düzenli olarak diyalize giren toplam 50 KBY'li hasta, ve herhangi bir böbrek veya kardiyak þikayeti olmayan 40 saðlýklý olgu alýndý. M-Mode eko ile özellikle sol ventrikül boyutlarý, iki boyutlu eko ile duvar hareket bozukluðu ve perikard deðerlendirildi. Pulsed Doppler ile diyastolik mitral akým ölçüleri (DMAÖ) ve renkli Doppler eko ile kapak yetersizlikleri deðerlendirildi. Pulmoner arter basýncý ölçümü için triküspit yetersizlik akýmýndan yararlanýldý.

Olgularýn iki boyutlu eko deðerlendirmesinde KBY'li hastalarýn % 95'inde morfolojik deðiþiklikler izlendi. 45 olguda sol ventrikül hipertrofisi, 20 olguda miyokartta buzlu cam görünümü, 22 olguda kapak kalsifikasyonu, 20 olguda kapak yetersizliði, 15 olguda perikardiyal effüzyon, 11 olguda pulmoner hipertansiyon saptandý. Kontrol grubunda ise 2 olguda sol ventrikül hipertrofisi, 2 olguda kapak yetersizliði, 4 olguda mitral kapak prolapsusu saptandý. KBY grubu kontrol grubu ile karþýlaþtýrýldýðýnda, KBY'li hastalarda sol ventrikül erken doluþunda azalma (p<0.05) ve atrial doluþta artma görülürken (p<0.05), E/A oranlarýnda azalma ve deselerasyon zamanýnda uzama gözlendi (p<0.05, p<0.05). Ýzovolümetrik relaksasyon zamaný da KBY'li hastalarda kontrol grubundan yüksek bulundu (p<0.05).

KBY'li hastalarda ekokardiyografik takip tedavinin yönlendirilmesinde ucuz ve invaziv olmayan bir yöntem olarak deðerli bilgiler vermektedir. Bu nedenle, KBY'li hastalarýn düzenli aralýklarla ekokardiyografik incelemeye tabi tutulmasý gerektiði kansýndayýz.

Chronic renal failure affects significantly cardiovascular system as well as other systems of the body. In this study we aimed to investigate the morphologic and structural changes of the heart undergoing regular hemodialysis in patients with chronic renal failure, via echocardiography.

Fifty patients with chronic renal failure who were on regular hemodialysis and 40 healthy subjects without any renal or cardiac problems were included in this study. Left ventricular
dimensional were assessed via M-mode echo, wall motion disorder and pericard via two-dimensional echo, diastolic mitral flow rate via pulsed Doppler and valve insufficiencies via colored Doppler echo. Tricuspid regurgitation flow was the guide for the measurement of pulmonary artery pressure.

In 95 % of the patients with chronic renal failure had morphological changes via the assessment of two-dimension echo. There were 45 patients with left ventricular hypertrophy, 20 patients with icy glass appearance of the myocardium, 22 patients with valve calcification, 20 patients with valve regurgitation, 15 patients with pericardial effusion and 11 patients with pulmonary hypertension. In the control group, 2 subjects
had left ventricular hypertrophy, and there were 2 subjects with valve regurgitation and 4 subjects with mitral valve prolapse.
There was a decrease in early left ventricular filling (p<0.05), an increase in atrial filling (p>0.05), a decrease in the ratio of E/A, and lengthening in the deceleration time
(p<0.05, p<0.05) in patients with chronic renal failure when compared to the control group. Also, isovolumetric relaxation time was higher in patients with chronic renal failure
(p<0.05).

Conclusion: Echocardiographic follow up gives economic, non-invasive and valuable information about patients with chronic renal failure. We concluded that these patients should be assessed by echocardiography at regular intervals.

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Karaciðer hidatik kisti ülkemizde hala en sýk rastlanan selim karaciðer hastalýklarýndan biridir. Ýnvaziv radyolojik giriþimler ve ilaç tedavisindeki geliþmelere raðmen, hastalýðýn esas tedavisi cerrahidir. Ocak 1997-Aralýk 2003 tarihleri arasýnda kliniðimizde tedavi edilen 34 karaciðer hidatidozisli olguda karþýlaþýlan komplikasyonlar, bu makalede retrospektif olarak deðerlendirildi. Abdominal aðrý ve abdominal kitle en sýk rastlanan baþvuru semptomlarý idi. Tanýda en sýk abdominal ultrasonografi ve bilgisayarlý batýn tomografisi kullanýlmýþtýr. En sýk uygulanan ameliyatlar, 15 (% 45.6) olguda eksternal kapitonaj ve 19 (% 55.3) olguda parsiyel kistektomi+eksternal kapitonaj olmuþtur. ‹ntrabiliyer rüptüre baðlý süpürasyon 3 (% 7.2) olguda saptanmýþtýr. Postoperatif komplikasyon oraný % 16.6 olup, en sýk pnömotoraks ve subdiyafragmatik abse saptanmýþtýr. Solunum yetersizliði ve hemorajik diateze baðlý erken postoperatif dönemde 1 (% 3.8) olgu kaybedilmiþtir. Ortalama hastanede kalýþ süresi 6 gün olarak saptanmýþtýr. Serimizde kistektomi (hepatektomi) ve omentoplasti ameliyatlarýnýn, diðer cerrahi tekniklere nazaran daha düþük komplikasyon oranýna ve daha kýsa hastanede kalýþ süresine neden olduðu sonucuna ulaþýlmýþtýr.

Hydatid disease is still most common problem in the benign liver diseases in Turkey. Despite the improvements of invasive radiologic procedures and medical therapy, surgery is still the principal therapy of the disease. From January 1997 to December 2003, 34 consecutive cases with liver hydatidosis were treated by operations at Department of Surgery, Adana Research and Education Hospital. Abdominal pain and abdominal mass were the major symptoms of the cases at presentation. Diagnosis was based on abdominal ultrasound and abdominal CT. External capitonnage and partial cystectomy+ external capitonnage were mostly performed. The complication rate was 16.6 %. Pneumothorax and sub-diaphragmatic abscess were the most common complications. Median hospital stay was 6 days. We had one death due to respiratory insufficiency and haemorrhagic diathesis. As we compared the surgical techniques, cystectomy and omentoplasty, whenever possible, had lower complication rate, short hospital stay and better clinical results.

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Literatürde habis prostat bezlerinde de 34βE12 immünoreaktivite izlenebildiði bildirilmektedir. Bu çalýþmada, prostatik adenokarsinomlarda HMWCK 34βE12 immünoreaktivitesi ve nedenlerinin araþtýrýlmasý amaçlandý. 35 adet prostat karsinomu
olgusuna HMWCK 34βE12 ile immünohistokimyasal boyama yapýldý. Olgularýn hepsinde boyanma izlenen hücrelerin oraný tesbit edildi ve boyanma yoðunluklarý kuvvetli-orta-zayýf derece þeklinde gruplara ayrýlarak deðerlendirildi. 35 olgunun 10’unda (5 evre II ve 5 evre III) 34βE12 ile immünoreaktif hücre izlendi. Evre II olgularýn % 29.4’ünde ve evre III olgularýn ise % 27.8’inde boyanma görüldü. Evre I olgularýn hiçbirinde boyanma izlenmedi. Evre II tümörlerde boyanma yoðunluðu zayýf ve kuvvetli, evre III tümörlerde ise sadece zayýf þeklinde idi. Boyanma varlýðý ve yoðunluðu evrelere göre anlamlý farklýlýk göstermedi (p>0.05). Boyanma hemen her zaman daðýnýk tek hücre þeklinde idi. Ýmmünoreaktif hücre sayýsý bizce tümör genelinde tanýda problem yaratmayacak kadar çok azdý. Ancak, özellikle evre II tümörlerde izlediðimiz kuvvetli immünoreaktivitenin arada kalmýþ selim bezler, yüksek PÝN lezyonlarý veya karsinomun intraduktal yayýlýmýný içeren bir bezin teðet kesitinden kaynaklanabileceðini düþünmekteyiz.

Some reports describe 34bE12 immunoreactivity in prostatic carcinoma cells. Our objective is to search 34bE12 immunoreactivity in prostatic adenocarcinoma. 35 cases of prostatic adenocarcinoma were immunostained by HMWCK 34bE12. We determined the percentage of immunostained cells. The density of staining is grouped as strong-intermediate-weak. 10 cases showed positive staining (5 of Grade-II, % 29.4 and 5 of Grade-III, 27.8). Grade-I cases didn’t show any staining. The staining density was strong or weak in Grade-II cases and weak in Grade-III ones. The percentage and density of
staining didn’t show significant difference between grades (p>0.05). The staining was always scattered and in the form of single cell distribution. The immunoreactivity seen in Grade-II cases is probably related to benign glands surrounded by malign ones, high grade PIN lesions or tangential section of a gland containing intraductal tumor spread.

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Üçlü test fetal Down sendromu olgularýný saptamada önemli bir deðere sahiptir. Bu çalýþmada 35 yaþ altý kadýnlarda kromozom anomalileri ile üçlü test sonuçlarý araþtýrýldý.

Trizomi 21 için eþik deðeri 1/270 alýndýðýnda 201 pozitif testi olan gebe ve trizomi 18 için eþik deðerini 1/100 alýndýðýnda 12 pozitif testi olan gebe saptandý. Tüm olgulara amniosentez uygulandý. Trizomi 21 için pozitif teste sahip olgular içinde 2 fetal Down sendromu ve 4 normal kromozomal aberasyon saptandý. Trizomi 18 için pozitif teste sahip hastalardan ise sadece birinde fetal Turner sendromu mevcuttu.

Sonuç olarak, daha düþük eþik deðerleri kullanýlarak gereksiz amniosentezlerin azaltýlabileceði kanaatine varýldý.

Triple screening test has a significant predictive value for detection of fetal Down’s Syndrome cases. In this study we evaluated the results of triple screening test for chromosomal abnormalities in women less than 35 years of age.

We had 201 screen positive women for trisomy 21 at a cut off level 1/270 and 12 screen positive cases for trisomy 18 at a cut off level 1/100. Amniocentesis were performed for all. In cases with positive screen for trisomy 21 we detected two cases of fetal Down’s syndrome and 4 cases with normal chromosomal aberrations. In cases with with positive screen for trisomy 18 we detected a case with fetal Turner’s Syndrome.

We concluded that by using a lower cut off level for detecting fetal Down’s Syndrome cases unnecessary amniocentesis might be decreased.

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Rokuronyum, uyanýk hastada uygulandýðýnda yüksek oranda orta veya þiddetli aðrý yapan non-depolarizan bir nöromusküler blokerdir. Çalýþmamýzda elektif cerrahi planlanan hastalarda topikal lokal anestezik karýþýmý olan EMLA krem ile, vazodilatatör etkili transdermal nitrogliserinin (TNG) etkisini plasebo ile karþýlaþtýrmayý amaçladýk. 18-75 yaþ, ASA I-III 45 hasta rasgele 3 gruba ayrýldý. Genel anestezi indüksiyonundan 1 saat önce Grup I’de 50 mg TNG (24 saattte 10 mg nitrogliserin salýnýmlý), Grup II’de 1 gr EMLA krem, Grup III’de 1 gr dekspantenol krem (plasebo) uygulandý. Venöz kanülasyon ve priming doz rokuronyum sýrasýndaki aðrý ve yanma ile rokuronyumun entübasyon dozundan sonraki el hareketleri deðerlendirildi. Venöz kanülasyon ve priming doz rokuronyum sonrasý aðrý ve yanmanýn Grup II’de, Grup I ve Grup III’e göre anlamlý olarak az olduðu görüldü. Rokuronyumun entübasyon dozundan sonra gruplar arasýnda fark görülmedi. Venöz kanülasyon ve priming doz rokuronyumdan önce EMLA krem kullanýmýnýn uygun olduðu, TNG’nin ise iyi bir seçenek olmadýðý sonucuna varýldý.

Rocuronium is a non-depolarizan neuromuscular blocker which gives middle or strong pain in high rate when it is used before induction to awake patients. In our study, our aim was to compare the effects of EMLA cream which is a mixture of topical local anesthetic with transdermal nitroglycerin (TNG) that has vasodilatation effect and with placebo on the patients who are planned for elective surgery. 18-75 year-old, fortyfive ASA grade I-III patients were randomly selected in 3 groups. One hour before the general anesthesia induction, in Group I 50 mg TNG (10 mg TNG/24 hours release patchs), in Group II, 1 gr EMLA cream and in Group III, 1 gr dexpanthenol cream were used. We evaluated the pain and sensation during the intravenously canulation and priming dose of rocuronium and also we evaluated the hand movements after the intubation dose of rocuronium. There wasn’t much difference after intubation dose of rocuronium between groups. In Group II, we showed that the pain and sensation after intravenously canulation and priming dose of rocuronium were significantly lower than in Group I and III. Our results indicate that using EMLA cream before priming dose of rocuronium
is suitable but TNG isn’t a good choice.

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Çalýþmanýn amacý, 4 farklý göziçi lensinin (GÝL) katarakt operasyonu öncesinde hedeflenen refraksiyon ile elde edilen sonuç refraksiyon arasýndaki fark açýsýndan karþýlaþtýrýlmasý.

2000-2001 yýllarý arasýnda opere edilerek AcrySof® (Grup 1) implante edilen 37 hastanýn 50 gözü; Acryþex® (Grup 2) implante edilen 39 hastanýn 55 gözü; Corneal® (Grup 3) implante edilen 24 hastanýn 35 gözü ve Cee-On® (Grup 4) implante edilen 17 hastanýn 24 gözü çalýþmaya alýndý. Tüm hastalarýn biyometrik ölçüm ve hesaplamalarýnda ayný biyometri cihazý ve aksiyel uzunluða baðlý olarak SRK-2 veya SRK-T formülleri kullanýldý. Dört grup hedeflenen refraksiyon ile sonuç refraksiyon arasýndaki mutlak ve gerçek hata açýsýndan birbiri ile kýyaslandý.

AcrySof®, Acryþex®, Corneal® ve Cee-On® gruplarýnda sýrasý ile mutlak hata 0.52±0.39, 0.73±0.53, 0.87±0.94, 1.02±0.84; gerçek hata 0.28±0.59, 0.43±0.80, -0.53±1.17, - 0.90±0.97 olarak saptandý. Mutlak hata açýsýndan sadece AcrySof® ile diðer tüm mercekler arasýndaki fark istatistiksel olarak anlamlý bulundu. Gerçek hata açýsýndan ise AcrySof® ile Acryþex® ve Corneal® ile Cee-On® arasýnda anlamlý fark görülmezken, diðer gruplar arasýndaki fark anlamlý olarak deðerlendirildi.

AcrySof® GÝL hem mutlak hem de gerçek hata açýsýndan diðer merceklere göre daha üstün bulundu. Acryþex® 2. sýrada yer alýrken; Corneal® ile Cee-on® diðer iki merceðe göre daha az güvenilir sonuçlar verdi.

The aim of this study is to compare 4 different IOLs according to the difference between the predicted and postoperative refraction.
Fifty eyes of 37 patients implanted with AcrySof® (Group 1); 55 eyes of 39 patients with Acryflex® (Group 2); 35 eyes of 24 patients with Corneal® (Group 3) and 24 eyes of 17 patients with Cee-On® (Group 4) between 2000 and 2001 were enrolled into the study. For all the patients the biometric measurements and calculations were done by using the same biometry device and SRK-2 or SRK-T formulas depending on axiel length were used. The 4 different IOLs were compared according to the absolute and real error between the predicted and postoperative refractive state.
The mean absolute errors in AcrySof®, Acryflex®, Corneal® and Cee-On® groups were 0.52±0.39, 0.73±0.53, 0.87±0.94, 1.02±0.84 respectively and the mean real errors were
0.28±0.59, 0.43±0.80, - 0.53±1.17, - 0.90±0.97 in the same order. Only the mean absolute errors between AcrySof® and the other IOLs were statistically significant. There was no significant differerence between AcrySof®-Acryflex® and Corneal®-Cee-On® according to the real error, but other combinations of comparison turned out to be significantly different.
AcrySof® is found to be superior to the other IOLs according to the absolute and real error. While Acryflex® turned out to be the second most predictable IOL, Corneal® and Cee-on® had the least reliable results.

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Doðum deneyimi kadýnlarý hem fiziksel hem de psikolojik olarak etkilemektedir. Kadýnlar yaþamlarýnýn diðer dönemlerinde de bu deneyimi anýmsamaktadýrlar. Bu çalýþma, kadýnlarýn doðum deneyimlerini irdeleyerek, etkileyen faktörleri belirlemek amacýyla tanýmlayýcý olarak planlanmýþtýr.

Bulgularda, çalýþmaya katýlan grubun tamamýnýn doðum eylemini hatýrladýklarý görülmüþtür. Kadýnlarýn eðitim durumu arttýkça doðuma katýlan kiþileri hatýrlamanýn arttýðý, ancak doðum yapma yaþý ile doðum þeklinin doðuma katýlan kiþileri hatýrlamada etkili olmadýðý görülmüþtür.

Sonuçta; kadýnlarýn bireysel özellikleri doðum deneyimlerini anýmsamakta etkili olurken, diðer faktörlerin etkin olmadýðý belirlenmiþtir.

The experience of giving birth effects both physically and mentally on women.

The women remember this experience in the other stages of the life. This research is planned to determine the factors by searching the gained experience of the birth.

All of the group whom join the this study remembered to birth events. It is found that the increase on the level of education affects to remember the people who involved the birth but the age of women and the methods of birth do not have any effect.

As a result; the personel features of women affect on the rememberce of the birth experience but the other factors are not found effective.

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Muscular localization of echinococcosis is considered uncommon (1 %). To make a true diagnosis with computerized tomography, ultrasonography and immunologic tests are available. The authors reported here a case of such uncommon hydatid localization. Twenty-one year old male with cystic mass in obturatorius externus muscle extending to skin was admitted. Since the mass was resembled as a cystic lesion with pus with clinical and roentgenographic examination puncture was performed first. When it was realized the cyst be hyatid disease with unusual localization definitive surgical procedure, partial cystectomy+sterilizing the cavity was performed. Then medical treatment with albendazole (800 mg/day) was employed in cyclic use. Preoperative diagnosis imperative to avoid performing the wrong one. Unusual localization in hydatid cyst particularly muscular hydatid disease is rare in our country. But in the masses in atypic localisation determined by US and CT, hydatid disease should be eliminated. The treatment modality is the same as the lesion in liver. Surgical procedure, pericystectomy and medical treatment with Albendazole make the lesion clear.

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Perinatal neoplasia account 2.6 % of childhood tumours; 35 % of them are teratomas. 80 % of urogenital and anorectal tumours that cause anatomical and fuctional problems are
sacrococygeal teratomas. 21 years old, G1 woman referred to our hospital with a mass lesion in the fetus at 38 th gestational weeks of pregnancy. The ultrasonography result was
97*72 mm solid mass containing 53*45 mm cystic lesion in it. We perform second level ultrasonography at our clinics. Since the patient referred at very late gestational weeks; mass lesion could not be localized accurately. With these findings possible differential diagnosis are sacrococygeal teratoma or acardiac twin.

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Mikulicz disease is an entity that affects tissue of salivary gland. Normal salivary acinar and ductal tissue is replaced by lymphoid tissue. Mikulicz syndrome is unrelated to the disease
in that the syndrome is characterized by multiglandular involvement that is secondary to such d›ieases as leukemia, tuberculosis, syphilis, sarcoidosis, and lymphosarcoma. In this paper we present 38 year old male patient. We performed submandibular gland resection. No recurence was detected in regular clinical controls in 2 years.

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Malignant pleural mesothelioma is a fatal tumour of the pleura caused by asbestos exposure. Trombocytosis is a frequently seen paraneoplastic syndrome of this disease but vena cava superior syndrome (VCSS) is very rarely reported.

A 51 year old man living in Dicle presented with dyspnea, chest pain and weight loss. The history of the patient revealed 50 years environmental asbestos exposure. In the chest x-ray, pleural thickening of the right hemithorax and pleural effusion were detected. Pleural biopsy was done and malignant pleural mesothelioma was diagnosed. In the first thorax CT, vena cava superior (VCS) was detected normal. For the pleurodesis pleurocain was applied. In the 15 th day of the follow-up, the patient presented with edema of the head, neck, upper side of the chest and upper extremities so control thorax CT was taken for the suspicion of VCS syndrome (VCSS) caused by the invasion of the tumour but thrombus was found in the vena cava superior. Blood parameters showed no abnormalities for venous thrombosis. Treatment was started for the thrombus
but the patient died a month later.

During the follow-up of malignant pleural mesothelioma patients, if vena cava superior syndrome occurs, obstructive lesions like thrombus should be considered as well as the invasion of this vessel by the tumour.

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Amoebiasis is the second leading cause of death from parasitic disease worldwide. The causative protozoan parasite, Entamoeba histolityca, is a potent pathogen. Amebiasis may affect colon or extra-intestinal tissues such as liver, respiratory tract, brain and rarely genitourinary tract, perianal region. Amebic colitis is treated by metronidazole, followed by a luminal agent to eradicate colonisation. In this report we described a 48 years old man with amebic colitis who recieved long therapy.

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Dermatitis artefacta is an artefactual condition in which skin lesions with variable morphological features are solely produced or inflicted by the patient's own actions. This usually occurs as a result or manifestation of a psychological problem. It is more common in women than in men. Patients deny having done lesions because they aim sensory gains such as attention and affection. Early and accurate diagnosis by dermatologic and psychiatric approaches is important and thus unnecessary studies and treatment processes can be prevented.

Here we report a case presented with a pyoderma gangrenosum like necrotic ulcer but it was noticed that the lesion was formed by the patient and eventually diagnosed as dermatitis artefacta.

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Classical galactosemia, with otosomal recessive penetrance, occurs as a result of deficiency of galactos -1- P uridyl transferase and is the most common disorders of galactose metabolism. Clinical findings seen in newborn period are; poor sucking jaundice, failure to thrive, bleeding diathesis. If untreated, it results in life threatening complications in infants like feeding problems, failure to thrive, bleedind, hepatocellular
damage. Exact diagnosis is made by demonstrating the deficienct of galactose-1- P uridyl transferase activity.

Four cases followed up in SSK Göztepe Educational Hospital Pediatrics Department Gastroenterology and Metabolism Clinic between the years 2000-2002 are analyzed retrospectively. Three of them were males, one female and their ages ranged between 23 days and 2 months. There was 2 nd degree consanguinity in 3 of our cases. Their common complaint was jaundice and poor sucking. There was hepatomegaly in 4, splenomegaly in 2 and ascites in 2 of the cases. One of them had cataract an done had corneal opacity. In all of the cases, non glucose reluctant substance in urine was SGOT 49-270 IU/L between SGPT 3-120 IU/l. Liver biopsy was made in all of the case in three of them the diagnosis was made by demonstrating the deficiency of galactose-1- P uridyl transferase activitiy in blood. The lost case was diagnosed by clinical findings, reducing substance positively in were, liver biopsy findings and improvement in symptoms by lactose free diet.

We presented these cases to emphasize the importance of early diagnosis (intense of prognosis) in galactosemia cases in our country where consanguineous marriage is very common.

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Robinow syndrome, originally described in 1969, consists of mesomelic brachymelia, short stature, genital hypoplasia and characteristic facies. Associated organ system involvement
may include developmental delay, congenital heart disease, obstructive disorders of the urinary tract and renal cysts. As there is a potential for airway problems related to the facial
features, such as midface hypoplasia and micrognathia, perioperative management of these patients is important. We present the anesthetic management of 6-year-old boy, previously
diagnosed with Robinow syndrome, who was admitted for an orthopedic surgical procedure.

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In this report, by reviewing the literature, we present a case of 70 year old male patient with the neuroendocrine carcinoma of the larynx which has been diagnosed and treated in our hospital.

Neuroendocrine carcinomas of the larynx are very rare tumors. These tumors can be seen as gray whitish or light brown masses varying in size from small polyps to extensive
lesions. Microscopically pleomorphism, mitotic activity and necrosis can be seen. Immunohistochemistry shows characteristic positive staining with chromogranin-A and neuron spesific enolase (NSE). Most of the cases are male and intense smokers. Clinical course is agressive due to extensive local lymphatic and distant metastases and mortality rate is 50 %.

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