Son yýllardaki çalýþmalar geçici nörolojik semptomlarýn (GNS) sýklýkla lidokain spinal anestezisinden sonra oluþtuðunu göstermiþtir. Ancak, GNS oluþumunu etkileyen faktörlere iliþkin bilgiler halen sýnýrlýdýr. Bu prospektif çalýþmadaki amacýmýz, GNS ile iliþkili potansiyel risk faktörlerini deðerlendirmekti.
18 aylýk sürede 648 hasta üzerinde çalýþýldý ve bu olgularýn % 40’ýna lidokain ve % 60’ýna bupivakain ile spinal anestezi uygulandý. Çalýþmaya alýnan 60 yaþ üzerindeki olgular için 22 G Quincke, daha genç olgularda ise 25 G Quincke veya Sprotte spinal iðne ile giriþim gerçekleþtirildi. Kýsa süreli operasyonlar için izobarik % 2 lidokain 20-80 mg arasý, uzun süreli operasyonlar için hiperbarik % 0.5 bupivakain 5-15 mg arasýndaki dozlar tercih edildi. Lidokain ile spinal anestezi uygulanan olgularýn % 24’ünde, bupivakain uygulanan olgularýn ise % 0.5’inde GNS geliþti. Ayný zamanda elde edilen veriler, lidokain spinal anestezisi ile iliþkili GNS için obezitenin, litotomi pozisyonunun, günübirlik cerrahinin ve yüksek lidokain dozlarýnýn en önemli risk faktörleri olduðunu gösterdi.
Bulgularýmýz GNS’nin lidokain spinal anestezisinden sonra sýklýkla meydana geldiðini, ancak bupivakain kullanýldýðýnda ise daha nadiren geliþtiðini göstermiþtir. Bununla birlikte, obezite, litotomi pozisyonu ve erken mobilizasyon gibi faktörler spinal lidokaine baðlý GNS geliþimini potansiyalize etmektedir.

Recent studies suggest that transient neurologic symptoms (TNS) commonly follow lidocaine spinal anesthesia. However, information about factors that affect their occurrence is still limited. Our aim for this prospective study was to evaluate potential risk factors related with TNS.
During an 18-month period, 648 patients were studied, of whom 40 % received lidocaine and 60 % bupivacaine. Spinal anesthesia was performed with 22 G Quincke spinal needles
for patients older than 60 years old and 25 G Quincke or Sprotte spinal needles for younger patients. For short term operations 20-80 mg 2 % isobaric lidocaine or for long term operations 5-15 mg 0.5 % hyperbaric bupivacaine was preferred respectively. TNS developed in 24 % of patients in lidocaine spinal anesthesia and 0.5 % of patients in bupivacaine spinal anesthesia. Our data also identified obesity, lithotomy position, out-patient status, and higher lidocaine doses as important risk factors in patients received lidocaine.
Our results implied that transient neurologic symptoms commonly follow lidocaine spinal anesthesia but are relatively uncommon with bupivacaine. Obesity, lithotomy position and
early mobilization may also augment TNS induced by spinal lidocaine.

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GÝRÝÞ ve AMAÇ: Diyabetik traksiyonel makula dekolmaný nedeni ile pars plana vitrektomi uygulanan gözlerdeki anatomik ve fonksiyonel baþarý oranlarýný incelemek ve baþarýyý etkileyen faktörleri araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Materyal ve metod: 2001 ve 2002 yýllarýnda diyabetik traksiyonel makula dekolmaný nedeni ile vitrektomi uyguladýðýmýz 15 hastanýn 15 gözü çalýþmaya alýndý. Hastalarýn yaþ ortalamasý 53.3±13.6 yýldý. Vitrektomi tekni¤i olarak, 13 göze (% 86.7) delaminasyon, 2 göze (% 13.3) delaminasyon ve segmentasyon uygulandý. Anatomik ve fonksiyonel baþarý oranlarý hesaplandý ve fonksiyonel baþarýya etki eden faktörler korelasyon analizi ile incelendi.
BULGULAR: Ortalama 6.6±4.4 ay takip sonunda; 12 gözde (% 80) anatomik baþarý, 9 gözde (% 60) fonksiyonel baþarý elde edildi. 15 gözün 9’unda görme keskinli¤i artarken 1’inde ayný kaldý, 5’inde azaldý. Ameliyat öncesi görme keskinliði ne kadar iyi (k=0.78, p= 0.001), diabet süresi ne kadar kýsa (k=-0.67, p=0.007) ise fonksiyonel baþarý o oranda yüksek olarak gerçekleþti.

TARTIÞMA ve SONUÇ: Diyabetik hastalarda geliþen traksiyonel maküla dekolmaný tedavisinde, pars plana vitrektomi sonrasý anatomik baþarý yüksek olmakla birlikte her zaman yeterli görme artýþý elde edilememektedir. Serimizde özellikle ameliyat öncesi görme keskinliði ýþýk hissi seviyesindeki gözlerde, vitreoretinal cerrahi giriþimleriyle anlamlý görme artýþý saðlanamamýþtýr.

INTRODUCTION: To investigate visual and anatomical results in patients undergone pars plana vitrectomy for diabetic tractional macular detachment and factors on final success rate.
METHODS: 15 eyes of 15 patients who undergone pars plana vitrectomy for diabetic tractional macular detachment in 2001 and 2002 were enrolled into the study. Mean age was
53.3±13.6 years. Delamination was performed to 13 eyes (86.7 %) and segmentation and delamination in 2 eyes (13.3 %). Anatomical and functional success rates were calculated and factors influencing the functional success rate were investigated with correlation analysis.
RESULTS: Anatomical success was achieved in 12 eyes (80 %) and functional success in 9 eyes (60 %) after mean follow-up of 6.6 ± 4.4 months. Visual acuity improved in 9, remained the same in 1 and worsened in 5 eyes. Functional success was correlated positively with preoperative visual acuity (k=0.78, p=0.001) and negatively with diabetes duration (k=-0.67, p=0.007).
DISCUSSION AND CONCLUSION: Although anatomical success rate is reported to be high after pars plana vitrectomy for tractional diabetic macular edema, satisfactory visual results are often not achieved. In our series, significant gain in visual acuity was not able to be achieved by vitreoretinal surgical procedures especially in eyes with only light perception visual acuity before
surgery.

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Bu prospektif çalýþmada termdeki gebelerde servikal olgunlaþma ve doðumu indüklemek için intravaginal misoprostol uygulamasýnýn etki ve güvenirliliðini araþtýrmayý amaçladýk.
Serviksi olgun olmayan (Bishop’s skor ²5) 30 gebeye doðumu indüklemek için 50 μg prostoglandin E1 (misoprostol) intravaginal olarak her 3 saatte bir maksimum 6 dozda, aktif doðum baþlamasýna veya membranlarýn açýlmasýna kadar tekrarlanarak uygulandý. Ýndüksiyondan doðuma kadar geçen süre, doðum þekli, komplikasyonlarý ve yenidoðandaki sonuçlarý deðerlendirildi.
Misoprostol ile indüklenen hastalarda vajinal doðuma kadar geçen süre ortalama 13.2±2.5 saat olup, 5 hastaya (% 20.8) oksitosin ile indüksiyon takviyesi gerekti. Sezaryenle doðum oraný % 20 iken bir olguda kordon prolapsusu nedeniyle perinatal bebek ölümü meydana geldi. Taþisistol 9 olguda (% 30), koyu mekonyum gelmesi % 16.6 olguda görüldü ve bir olgu da yenidoðanýn yoðun bakým ünitesine sevk edildi.
Ýntravaginal misoprostol servikal olgunlaþma ve doðum indüklemesinde etkili, güvenli ve pahalý olmayan bir ajan olarak görülmektedir. Fakat, uterin taþisistol ve fetal distres gibi
komplikasyonlarý daha aza indirecek bir doz rejiminin ve uygulama yolunun belirlenmesi için daha fazla çalýþmalara gerek vardýr.

Our aim was to investigate the efficiency and safety of intravaginal misoprostol application for cervical ripening and labor induction at term pregnancy.
Misoprostol (prostaglandin E1) was applicated at 50 μg doses intravaginally in every 3 h for cervical ripening and labor induction in 30 pregnant women with unfavorable cervix
(Bishop’s score ²5). Dose was repeated for a maximum 6 times until begining active labor contractions or occuring rupture of membrans. The time from induction to delivery, mode of delivery, side effects of drug, maternal and neonatal outcomes were recorded.
The elapsed time after induction to delivery were 13.2±2.5 hours and five patients (20.8 %) required oxytocin augmentation. Cesarean delivery rate was 20 %, in one case perinatal death occurred due to cord prolapsus. Percentage of occurence tachysystole and thick meconium passage were 30 % and 16.6 %, respectively. One baby was needed to refer to the neonatal intensive care unit.
It is concluded that intravaginal administration of misoprostol is effective, safe and cheap agent for cervical ripening and labor induction in case of unfavorable cervix. But further
study is needed to determine an optimal dosing regimen and application route for preventing complications such as uterine tachysystole and fetal distress.

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Metabolik sendrom (MS) koroner arter hastalýðý (KAH) için majör risk faktörüdür. Ülkemizde MS prevalansý yüksektir. Bu çalýþmada koroner arter hastalarýnda MS sýklýðýný araþtýrmak amacýyla anjiyografik olarak KAH saptanmýþ olgularda MS parametreleri deðerlendirildi.
Çalýþmaya koroner anjiyografi yapýlmýþ ve koroner arterlerden en az birinde ³ % 50 lezyon saptanan 64 olgu ile koroner anjiyografisi normal olan 48 olgu ardýþýk olarak alýndý. Lipid düþürücü tedavi alan olgular çalýþma dýþý tutuldu. Olgularýn kan basýncý, bel çevresi, açlýk plazma glukozu, trigliserit ve HDL kolesterol düzeyleri ölçüldü. MS tanýsý için Amerikan Ulusal Kolesterol Eðitim Programý Eriþkin III Tedavi Panelinde belirtilen MS kriterlerinden en az üçünün bulunmasý yeterli kabul edildi.
MS sýklýðý KAH olan grupta % 48.4 (31 olgu), KAH olmayan grupta % 27.1 (13 olgu) bulundu (p<0.05). KAH olan grupta sigara içme oraný, bel çevresi, açlýk plazma glikozu ve trigliserit düzeyleri KAH olmayan gruba göre daha yüksek, HDL kolesterol düzeyi daha düþüktü. Kan basýncý bakýmýndan iki grup arasýnda anlamlý bir fark yoktu.
Anjiyografik olarak KAH saptanmýþ olgularýn yaklaþýk yarýsýnda en az üç MS kriterinin bulunduðu gözlendi. Lipid düþürücü tedavi alan hastalarýn çalýþma dýþý tutulduðu göz önüne alýndýðýnda MS sýklýðýnýn çok daha fazla olduðu öngörülebilir.

Metabolic syndrome (MS) is the major risk factor for coronary artery disease (CAD). Prevalance of MS is high in our country. In this study in order to detect prevalance of MS in patients with CAD, MS parameters were examined in patients with angiographically detected CAD.
Sixty four cases who had coronary angiography and a lesion of ³ 50 % in at least one of the coronary arteries and 48 patients with normal coronary angiography were recruited respectively into the study. Patients who were taking lipid lowering therapy were exluded. Blood pressure, waist circumference, fasting plasma glucose, triglyceride and high density
lipoprotein cholesterol levels of the patients were measured. Presence of at least 3 of the MS criteria in National Cholesterol Education Program Adult Treatment Panel III was accepted as sufficient for the diagnosis of MS.
MS prevalance was found to be 48.4 % in the group with CAD (31 cases), 27.1 % in the group without CAD (13 cases) (p<0.05). In the group with CAD, rate of smoking, waist circumference, levels of fasting plasma glucose and triglyceride were higher and the levels of high density lipoprotein cholesterol were lower according to the group without CAD. Regarding blood pressure there wasn’t a statistically significant difference
between the two groups.
Presence of at least 3 of the criteria of MS was detected in half of the cases with angiographically detected CAD. If it is considered that patients who were taking lipid lowering therapy were excluded it can be anticipated that prevalance of MS is higher.

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Kliniðimizde anterior dekompresyon, strut greftleme, enstrümantasyon yapýlan 36 torakolomber burst kýrýklý hasta bu çalýþmaya dahil edildi. Olgularýn nörolojik durumlarýný deðerlendirmede Modifiye Frankel dereceleme sistemi kullanýldý.
Hastalarýn 20’si erkek, 16’sý kadýn ve ortalama yaþ 30.6 idi. Strut greft olarak 18 olguda trikortikal iliak otogref, 5 olguda fibular allogreft ve 13 olguda ise Harms cage kullanýldý. Ýzlem süresi en az 48 ay olarak bulundu. Sagittal indeks preoperatif 32° iken postoperatif ortalama 15.1° olarak bulundu. Vertebra korpus anterior yükseklik kaybý preoperatif ortalama % 48 olarak saptandý. Kanal iþgali ise preoperatif ortalama % 51.1 postoperatif % 4 olarak bulundu. Hastalar Modifiye Frankel Skalasýna göre deðerlendirildiðinde; 36 hastanýn 34’ü (% 94.4) en az bir seviye düzelme gösterdi. Hiçbir hastada nörolojik kötüleþme ve major torakoabdominal komplikasyon görülmedi.

The selection of surgical approach for thoracolumbar trauma patients depends on the type of the fracture, neurological status and the experience of the surgeon involved. In our study on indications of anterior decompression and stabilization, we evaluated data from treating 36 patients. Patients demographics were as follows: 20 males, 16 females. The mean of their age is 30.6. Neurological status was assessed by Frankel classification. All patients had anterior decompression through vertebrectomy and strut grafting. We used tricortical iliac autograft in 18 (50 %) patients, fibular allograft in 5 (13 %) patients, titanium mesh in 13 (36 %) patients. All patients had postoperative CT scanning to evaluate the canal decompression. Final canal involvement was 4 %. The sagittal contour
was restored. All but one patients improved at least one Frankel grade. They were mobilised after suture removal with a custom made TLSO orthose. No neurological deterioration, major thoracoabdominal complication or implant failure was seen. Upon this review, we concluded that, when appropriate indications are considered, anterior decompression, strut grafting and instrumentation is a safe and effective method in the treatment of unstable thoracolumbar burst fractures.

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Bu çalýþmanýn amacý, farklý yaþ ve vücut kitle indeksine sahip bir grupta Yeme Tutumu Testi'nin puan daðýlýmýnýn araþtýrýlmasýdýr. Tanýmlayýcý tipte planlanan araþtýrmanýn kapsamýna Þiþli Etfal Eðitim Araþtýrma Hastanesi Obezite Polikliniðine baþvuran hastalar ile hastanemizde çalýþan toplam 200 kiþi alýnmýþtýr. Kiþilerin vücut kitle indeksi ortalamasý ve standart sapmasý 26.72±6.64, Yeme Tutumu Testi ortalamasý ve standart sapmasý ise 23.41±10.24'dir. Özellikle kadýnlarda ve genel olarak obezlerde vücut kitle indeksi ve yeme tutumu testi arasýnda pozitif korelasyon saptanmýþtýr (r=0.39, p=0.000). Sonuç olarak, Yeme Tutumu Testi puaný ile vücut kitle indeksi artýþý arasýndaki pozitif korelasyon bu testin kullaným alanýnýn sorgulanmasý gerektiðini ve obezite tedavisinde yeme bozukluðunun irdelenmesi ve uygun tedavisinin gerekli olduðunu düþündürmektedir.

The aim of this study is to investigate the score distribution of Eating Attitude Test in individuals vvho have different age and body mass indices. 200 individuals who were treated in the Obesity Policlinic and also the persons working in Þiþli Etfal Education and Research Hospital, were the study group of this descriptive study. The mean and the standard deviation for the body mass index was 26.72±6.64, and 23.41±10.24 for the Eating Attitude Test. A positive correlation betvveen the body mass index and Eating Attitude Test was found in females (r=0.39, p=0.000). As a conclusion it can be said that the application area of Eating Attitude Test should be questioned because of its positive correlation with body mass index.

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Amaç: Mide adenokarsinomlarýnýn çeþitli prognostik faktörleri ile hücresel prolifersyonu gösteren Ki-67 arasýndaki iliþkiyi saptamak.
Materyal ve metod: Adenokarsinomlarý tümör tipi açýsýndan Lauren sýnýþamasýna göre intestinal, diffüz, mikst, lenf nodu tutulumu açýsýndan tutulumun olmasý (L1) veya olmamasý (L0), tümör derinli¤i açaýsýndan TNM’ye göre pT1, pT2, pT3, nöral invazyon ve vasküler tutulum mevcudiyeti, nekroz varlýðý ve inflamatuvar yanýtýn varlýðý yönünden sýnýflandýrýlarak bu kriterlerin varlýðý ve immünhistokimyasal olarak Ki-67 pozitivitesi karþýlaþtýrýldý. Ki-67 pozitivitesi de boyanma olmayanlar K0, K1 <% 30 boyanma olanlar, K2 % 30-60 boyanma olanlar ve K3>% 60 olarak sýnýflandýrýldý.
Sonuçlar: Olgularýn % 13.3’ü K0, % 33.3’ü K1, % 33.3’ü K2 ve % 20’si K3 olarak tespit edildi. Öngörüsel faktörlerle karþýlaþtýrýldýðýnda sadece inflamatuvar yanýt mevcudiyeti ile istatisitksel olarak (p<0.05) anlamlý iliþki saptandý.

Aim: To investigate the correlation of Ki67 immunoreactivity with histological prognostic parameters in gastric adenocarcinomas.
Methods: 45 stomach adenocarcinoma cases are re-evaluated and classified as intestinal, diffuse and mixed types according to Lauren classification. Presence and absence of lymph node metastasis is detected and grouped as L1 and L2 respectively. Depth of tumor invasion is determined according to TNM classification as pT1, pT2 and pT3. Perineural and vascular invasion, presence of necrosis and inflammatory stromal reaction
are also evaluated. These prognostic parameters are compared with Ki67 proliferative index of the tumor. Tumors without Ki67 positivity (K0), tumors with less than 30% of immunoreactivity (K1), tumors expressing 30-60 % of immunoreactivity (K2) and tumors with a Ki67 index over 60 % (K3) are determined.
Results: 13.3 % of tumors were K0, 33.3 % were K1 and 20 % were K3. Ki67 index of these adenocarcinomas was not found to be correlated with other prognostic factors of stomach cancer. Only stromal inflammatory reaction statistically correlated with Ki67 immunoreactivity.

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Kliniðimizde yatan hastalar arasýnda mortalite sýklýðýný ve nedenlerini araþtýrmak amacýyla Ocak 2001-Ocak 2004 tarihleri arasýnda ölen hastalar retrospektif olarak incelendi. Demografik bilgiler ve ölüm nedenleri hasta dosyalarý ve vefat kaðýtlarýndan retrospektif olarak tarandý. Ölüm nedeninin doðru yazýlýp yazýlmadýðý ve Dünya Saðlýk Örgütü (DSÖ) tarafýndan önerilen temel, ara ve son ölüm nedeni þeklindeki sýnýflamaya uyulup uyulmadýðý da kontrol edildi.
Kliniðimizde son 3 yýl içinde toplam 2629 hasta yatýrýldýðý, bunlarýn 150’sinin (% 5.7) ölümle sonuçlandýðý saptandý. Olgularýn 104’ü (% 69) erkek, 46’sý kadýn (% 31), ortalama yaþ 60.4±15.3 (15-86) idi. Mortalite oraný en yüksek 2002 yýlýnda (% 7.6) saptandý (2001’de % 3.9, 2002’de % 7.6 ve 2003’de % 5.7). Ölüm nedeni 99 (% 66) hastada doðru yazýlmýþtý. Ancak hiçbirinde temel, ara ve son ölüm nedeni þeklinde bir sýnýflamaya rastlanmadý. Hastalarýn ölüm nedenleri temel ve son ölüm nedeni olarak sýnýflandýrýldýðýnda, temel ölüm nedeni olarak sýrasýyla kronik kor pulmonale (% 31), akciðer kanseri (% 19) ve kronik obstrüktüf akciðer hastalýðý (% 14) en sýk görülürken; son ölüm nedeni olarak ise sýrasýyla kronik kor pulmonale (% 23), akciðer kanseri (% 16) ve solunum yetersizliði (% 11) saptandý. Kardiyopulmoner arrest olarak son ölüm nedeni belirtilen hastalarýn tamamýnda temel ölüm nedeni farklýydý.
Sonuç olarak, mortalite oraný ve nedenlerinin bilinmesinin ve ölüm nedeni belirtilirken DSÖ tarafýndan önerilen temel, ara ve son ölüm nedeni þeklindeki yaklaþýmýn epidemiolojik çalýþmalar ve mortalite verileri açýsýndan gerekli ve faydalý olduðunu düþünmekteyiz.

We retrospectively evaluated the death cases of our clinics between January 2001 and January 2004 to determine the rate and causes of mortality. Demographic characteristics and causes of death were obtained from the patients’s files and death report paper retrospectively. The documentation of the accuracy of death cause and the order of basic,intermediate and final causes of death as proposed by WHO were also checked.
In the last 3 years,150 (% 5.7) of total 2629 patients died in our clinics.Of cases, 104 (% 69) were men and 46 (% 31) were women, the mean age was 60.4±15.3 (15-86 years).
The mortality rate was highest in 2002 (% 7.6), (% 3.9 in 2001, % 7.6 in 2002 and % 5.7 in 2003). The cause of death was accurately documented in 99 (% 66) cases but classification of basic,intermediate and final causes of death were not documented.As classified according to basic and final causes of death,the basic causes of death were chronic cor pulmonale (% 31), lung cancer (% 19) and COPD (% 14); the final causes of death were chronic cor pulmonale (% 23), lung cancer (% 16) and respiratory failure (% 11). All the patients who had final death cause report as cardiopulmonary arrest
had different basic death cause.
As a conclusion, we think that the knowledge of rates and causes of mortality and the documentation of basic,intermediate and final causes of death proposed by WHO are necessary and useful for the epidemiological studies and mortality data.

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NdYAG lazer kapsulotomi katarakt cerrahisi sonrasýnda geliþen arka kapsül opasitesinin tedavisinde etkin bir yöntemdir, fakat uygulama sonrasýnda geliþen en sýk komplikasyonlarýndan biri göziçi basýnç artýþýdýr. Bu çalýþmada posterior kapsülotomi
sonrasýnda yükselen göz içi basýncýný (GÝB) önlemede topikal timolol maleat % 0.5, timolol maleat % 0.5+dorzolamid kombinasyonu ve plasebonun etkinli¤ini karþýlaþtýrýlmayý
amaçladýk
Katarakt cerrahisi sonrasýnda posterior kapsül opasitesi geliþen 75 hastaya Nd: YAG lazer posterior kapsülotomi uygulandý. Kapsülotomiden bir saat önce VO, TO ölçüldü, biyomikroskobik muyene yapýldý. Hastalar üç gruba ayrýldý. I gruba timolol maleat % 0.5, II. gruba timolol maleat % 0.5+dorzolamid kombinasyonu, III. gruba plasebo uygulandý. Uygulamadan sonraki 1. ve 3. saat, 1. ve 7. gün VO, TO, tindal, flare deðerlendirildi.
Yag lazer kapsülotomi sonrasý bir haftalýk takip süresince birinci ve ikinci grupta GÝB’ýnda anlamlý bir yükselme olmadý, plasebo grubunda GÝB diðer iki gruba göre daha yüksek seviyelerde seyretti. Bu grupta üç hastada birinci saatte GÝB’ýnda yükselme tespit edilmesine raðmen birinci gün kontrollerinde GÝB <22 mmHg ölçüldü. Gruplar arasýnda þut sayýsý, þut baþýna enerji, toplam enerji ile GÝB deðiþiklikleri arasýnda istatistiksel olarak anlamlý fark tespit edilmedi.
Kapsülotomi sonrasý yükselen G‹B’ný önlemede bir saat önce uygulanan birer damla timolol maleat % 0.5 ve timolol maleat % 0.5+dorzolamid kombinasyonunun plaseboya göre istatistiksel olarak daha etkili olduklarý tespit edildi.

NdYAG laser capsulotomy is an efficient way of treating the posterior capsule opacity developing as a complication of cataract surgery, but increase in intraocular pressure is its frequent complication. In this study we aimed to compare the effectiveness of timolol maleat 0.5 %, the combinatiom of timolol maleat 0.5 % and dorzolamide versus placebo in decreasing intraocular pressure after Nd: Yag laser posterior capsulotomy.
Seventy five patients who developed posterior capsule opasity after cataract surgery underwent Nd: Yag capsulotomy. An hour before the capsulotomy the visual acuity, intraocular pressure were noted and a biomicroscopic examination was performed to each patient. The patients were allocated to three treatment groups. The first group was treated with timolol maleat 0.5 %, the second with the combination of timolol maleat 0.5 % and dorzolamide and the third with placebo. The visual acuity,intraocular pressure and anterior chamber inflammation were evaluated on the first and third hours and also on the first and seventh day postoperatively. After the procedure all patients received a drop of Dexametazone five times daily. During the follow up period no significant IOP elevation occured in the first and second groups, while a significant IOP elevation was noted in the Placebo group. There were three cases of IOP elevation during the first hour postoperatively (all of which belonged to the placebo group) though on the first postoperative day examination of these patients the IOP measurements were below 22 mmHg. There was no relation between the change in IOP and the number of laser
pulses,energy per pulse or total energy.
The results indicate that timolol maleat 0.5 % or the combination of timolol maleat 0.5 % and dorzolamide instilled an hour before Nd: Yag laser capsulotomy were significantly more effective in decreasing the IOP compared to the placebo. There was no difference between timolol maleat 0.5 % and the combination of timolol maleat 0.5 % and dorzolamide in decreasing the IOP related to Nd: Yag laser capsulotomy.

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GÝRÝÞ ve AMAÇ: Misoprostol’un geçirilmiþ sezaryanlý preklamptik gebelerin ölü fetuslarýnýn doðum indüksiyonundaki etkinliðini deðerlendirmek
YÖNTEM ve GEREÇLER: Geçirilmiþ sezaryanlý preeklamptik, intrauterin ölü fetusu olan 6 gebe kadýn retrospektif olarak araþtýrýldý. Kullanýlan ilaç dozu, uygulama zamanýndan doðuma kadar geçen süre ve komplikasyonlar deðerlendirildi.
BULGULAR: Gebeler 320-2880 dakika arasýnda doðum yaptýlar. 50-400 μgr arasýnda misoprostol intravaginal ve oral uygulandý. Uterus rüptürü ve baþka komplikasyonla karþýlaþýlmadý.
TARTIÞMA ve SONUÇ: Misoprostol, geçirilmiþ sezaryanlý preeklamptik gebelerin ölü fetuslarýnýn doðurtulmasýnda etkili ve güvenilir bir indüksiyon metodudur.

INTRODUCTION: To evaluate the efficacy of misoprostol for induction of labor in preeclamptic women with previous section and intrauterine fetal death
METHODS: 6 preeclamptic women with previous section and intrauterine fetal death were researched retrospectivly. Misoprostol doses, time from first dose to expulsion and complications were evaluated.
RESULTS: All women had been delivered between 320-2880 minutes. Patients received 50-400 μgr misoprostol orally and intravaginally. No uterin rupture and other complications occured
among 6 women.
DISCUSSION AND CONCLUSION: Intravaginal and oral Misoprostol is an efficacious and safe method of induction of labor in preeclamptic women with previous sectio and intrauterine fetal death.

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Ýatrojenik nedenlerle meydana gelen damarsal (vasküler) yaralanmalar ve bunlara yönelik uygulanan cerrahi giriþimler retrospektif olarak deðerlendirildi.
1984-2004 yýllarý arasýnda, 52 olgu iatrojenik damar yaralanmalarý sebebiyle ameliyat edildi. Otuzüçü erkek ve ondokuzu kadýn olan hastalarýn yaþ ortalamasý 52 idi. Damarsal yaralanma, 45 hastada kardiyak kateterizasyon giriþimi, 4 hastada çevrel (periferik) anjiografi giriþimi, 3 hastada ise arteryel kanülasyon giriþimi sonrasý meydana geldi. 29 hastada tromboz, 18 hastada rüptür ve kan toplaðý (hematom), 2 olguda yalancý (pseudo) anevrizma, 2 olguda stent giriþimi sonrasý sol ön inen (LAD) arter rüptürü, 1 olguda ise yine stent giriþimi sonrasý sirkumfleks (CX) arterde diseksiyon tespit edildi. 28 hastaya embolektomi, 14 olguya kan toplaðý boþaltýlmasý ve damarýn birincil onarýmý, 2 hastada yalancý-anevrizmanýn eksizyonu, 2 olguda LAD arter ve 1 olguda CX arter onarýmý, 3 olguya soldan saða femoro-femoral yangeçit (baypas), 2 olguda da iliofemoral yangeçit operasyonu uygulandý.
Kalp kateterizasyonu giriþimi, damarsal yaralanmaya neden olan en sýk prosedürdü (% 86.53). Yaralanmanýn en sýk görüldüðü damarsal yapý sað femoral atardamardý (% 55.76). Ýki hastada diz üstü ve 1 hastada total kalça dezartikülasyonu olmak üzere 3 hastaya amputasyon uygulandý (% 5.7). Diðer hastalar tamamen iyileþti.
Ýatrojenik damar yaralanmalarý, erken taný konulduðu taktirde, düþük mortalite ve morbidite oranlarý ile tedavi edilebilirler.

We are providing here a retrospective evaluation of vascular injuries occuring due to iatrogenic reasons and the surgical operations performed in the treatment.
Surgical operations were performed on 52 cases with iatrogenic vascular injuries between 1984-2004 at our cardiovascular surgery clinic. The patients included 33 males and 19 females, with a mean age of 52. Vascular injury occured at 45 patients during cardiac catheterization and angiography attempts, at 4 patients during peripheric angiography and at 3 patients during femoral arterial canulation attemps. Vascular injury led to thrombosis at 29 cases, ruptur and hematoma at 18 cases, pseudoaneurysm at 2 cases and LAD (Left anterior descending) artery at 2 cases and circumflex (Cx) artery at 1 case. Embolectomy was performed on 28 cases, drenage of hematoma and primary repair of the vessel was performed on 14 cases, excision of pseudoaneurysm on 2 cases, LAD artery and Cx artery repair in 3 cases, femoro-femoral bypass from
left to right at 3 cases, and iliofemoral bypass operation was performed at 2 cases.
Cardiac catheterization and angiography attempt was the precedure leading to the highest rate of injuries (86.53 %). Right femoral arterial was most prone to injuries. Amputation were performed on 3 patients, 2 of these were at the top of the knee and 1 was total hip desarticulation (5.7 %). The rest of the patients fully recovered.
Iatrogenic vascular injuries are important surgical matters requiring early detection and treatment. This is the only way of achieving reduced mortality and morbidity.

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Gaziantep Týp Fakültesi Çocuk Saðlýðý ve Hastalýklarý Kliniði Yenidoðan Servisinde yapýlan bu çalýþmada, sepsis öntanýlý 24 hasta ve 23 saðlýklý toplam 47 yenidoðanýn plazma örneklerinde IL-10 konsantrasyonlarý araþtýrýldý. Çalýþma ve kontrol grubundan bir kez analiz için kan alýndý. Sepsisli yenidoðanlarýn plazma IL-10 düzeylerinin (21±38 pg/ml), kontrol grubunu oluþturan saðlýklý infantlara göre (12±14 pg/ml) yüksek olmadýðý belirlendi (p>0.05). Ölen hastalarýn plazma IL-10 konsantrasyonlarýnýn sað kalanlara göre yüksek olmadýðý da belirlendi (p>0.05). Elde ettiðimiz sonuçlar; sitokin ailesinin önemli bir üyesi olan IL-10’un yenidoðan sepsisi erken tanýsýnda ve prognozunda önemli bir role sahip olmadýðýný göstermektedir.

This study has been carried out on the 24 newborns who were preliminary diagnosed as neonatal sepsis in the NICU (Newborn Intensive Care Unit) as well as 23 healthy newborns at the Medical Faculty Hospital of Gaziantep University to investigate the role of plasma IL-10 concentration in early diagnosis of neonatal sepsis and its relation with the prognosis. In the study and control group plasma samples were taken only for once. Plasma IL-10 concentrations of the newborns with sepsis (21±38 pg/ml) were not significantly higher than the control group (12±14 pg/ml) (p>0.05). Plasma IL-10 concentrations of the patients who died were not significantly higher than the survivors (p>0.05). These data suggest that IL-10, an important member of the cytokine family, hasn’t an important role in the early diagnosis and prognosis of neonatal sepsis.

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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 etiyolojik 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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Pseudotumor cerebri or benign idiopathic intracranial hypertension is a disease characterized by increased intracranial pressure without any lesion with mass effect or hydrocephaly. In etiology beside several factors, we want to present a case with pseudotumor cerebri after steroid withdrawal because its rarely seen.

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Isoniaside is a bactericidal drug used in the treatment of tuberculosis. Acute high doses can be fatal. Typical triad consists of recurrent convulsions resistant to anticonvulsants, metabolic acidosis with anion gap and coma. Pridoxine(B6) which is used for treatment is the specific antidot. If the administered dose isoniaside is unknown, 5 grams of pridoxin
is recommended IV. If the dose is known antidot is given in equal amounts. Pridoxin administration is the best way of treating convulsions and recovery from metabolic acidosis.
We present 2 cases regarding this subject.

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Glutaric aciduria type 1 is a rare metabolic disorder that is caused by deficiency of glutaryl-coenzyme-A dehydrogenase. Early diagnosis and intensive management of this disease
could alter the naturel of the disorder. We report a 8 months old case with glutaric aciduria type 1 who presented as macrocephaly to emphazise the importance of the cranial MRI findings to diagnose this disease. Since his cranial MRI findings were suggestive of glutaric aciduria type 1, metabolic analyse was planned to establish the diagnosis of this disorder.

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Preeclampsia is characterized with hypertension, proteinuriaand generalized edema. Eclampsia is very rare and most severe form of preeclampsia and presented with tonic clonic seizures. Eclampsia complicates 3 in 1000 pregnancies, with higher incidence rates in twin pregnacies, nulliparous patients younger than 20 years or multiparous patients older than 35 years, women of low socioeconomic status or in developing countries (1).
Postpartum eclampsia is very rare and dramatic complication of pregnancy induced hypertension disorder and usually occur after 48 hours of delivery. We present a woman who
referred to our hospital with symptoms of preeclampsia. She developped late eclampsia after 5 days of ceaserian section.

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Syncope is defined as transient loss of consciousness due to reduced blood flow. It may occur suddenly or can be associated with alarming symptoms like weakness, confusion, nausea, visual blurring. The purpose of this report is to makes primary care physicians to pay more attention of case of bradycardia and syncope that caused by hypothyroidism.
The patient who experienced a faint period lasting half an hour after wake up at the morning and remained unconscious for 10-15 minutes, complaining dizziness, confusion and vomiting at the end of the faint admitted to Family Practice Outpatient Clinic of Dicle University, Medical Faculty. From medical history, it was learned that patient had total thyroidectomy operation in 1997 and had been using thyroxin tb 2x1 regularly, except the last month. Physical examination revealed heart rate 56/min and rhythmic. At ECG sinus bradycardia and low T3, T4 and high TSH levels were detected. The syncope was attributed to hypothyroidism resulting sinus bradycardia because of thyroidectomy in post medical history not using thyroxin replacement for last month. At central visit it was seen that patient restarted thyroxin replacement and has no clinical problem

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Osteopetrosis, also known as marble bone disease, is a rare in which osteoclast dysfunction causes defective bone resorption and increased bone mass. This disease has been classified
into four types. The most severe and rare form is infantile malignant osteopetrosis. So we reported and discussed two siblings patients with infantile malignant osteopetrosis with
new knowledge in the literature.

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