Çalýþmanýn amacý, asit aspirasyonuyla oluþturulan akut akciðer hasarýnýn (AAH) tedavisinde kullanýlan metilprednizolon ve lidokain’in PaO2, PaCO2, pH, lökosit ve trombosit deðerlerine etkilerini araþtýrmaktýr.
30 erkek tavþan; grup K (n=10), grup L (n=10) ve grup M (n=10) olarak üç gruba ayrýldý. Tüm deneklerde % 3 izofluran + % 100 oksijen karýþýmý ile sedasyon saðlandýktan sonra
trakeotomi yapýldý, venöz ve arteriyel kateter takýldý. 0.l N HCl 3 ml.kg-1 intratrakeal damla damla verilerek AAH oluþturuldu. Grup K’ya 2 ml.kg-1.st iv. bolus ve 2 ml.kg-1 infüzyon izotonik NaCl, grup L’ye 2 mg.kg-1.st i.v. bolus ve 2 mg.kg-1 infüzyon lidokain, grup M’ye 30 mg.kg-1 tek doz iv. Metilprednizolon verildi. Altý saat süresince mekanik ventilasyon yapýldý. 0., 1., 2., 3., 4., 5. ve 6. saatlerde arter kan gaz analiziyle PaO2, PaCO2, pH, lökosit ve trombosit deðerleri belirlendi.
PaO2 grup K, grup L ve grup M’de 0. saate göre 6. Saatte azaldý (p<0.001). PaCO2 grup K (p<0.001) ve grup L’de (p<0.05) azaldý. pH grup K’da 6. saatte 0. saate göre azaldý (p<0.001). Lökosit deðerlerinde deðiþiklik olmadý (p>0.05). Trombosit deðerleri grup K ve grup L’de azaldý (p<0.05), grup M’de deðiþmedi (p>0.05)
Sonuç olarak; asit aspirasyonuna baðlý AAH’nýn tedavisi amacýyla erken dönemde kullanýlan lidokain ve metilprednizolonun PaO2’deki azalmayý kýsmen kontrol ettiði, PaCO2, pH ve lökosit deðerlerinde önemli deðiþikliklere neden olmadýðý, metilprednizolonun trombosit sayýsýndaki azalmayý önlediði tespit edildi.

The aim of the study is to determine the effects of methylprednisolone and lidocaine given for the treatment of Acute Lung Injury (ALI) which was induced with acid aspiration on PaO2, PaCO2, Ph, leukocyte and platelet levels.
Thirty male rabbits were divided into 3 groups as group K (n=10), group L (n=10) and group M (n=10). Tracheotomy was applied to all rabbits under sedation with 3 % isoflurane in 100 % Oxygen, and arterial and venous cateters were placed. ALI was induced by giving 0.1 N HCl 3 mL.kg-1 drop by drop intratracheally. The rabbits in group K received bolus 2 mL.kg-1 and 2 mL.kg-1.hr-1 infusion of saline; those group L received bolus 2 mg.kg-1 and 2 mg.kg-1.hr-1 lidocaine infusion intravenously; and those in group M received a single dose of 30 mg.kg-1 methylprednisolone intravenously. Mechanical
ventilation was applied for 6 hours. PaO2, PaCO2, pH values and leukocyte and platelet levels were determined by analysis of arterial blood gases taken at the 0, 1st, 2nd, 3rd,
4th, 5th and 6th hours.
PaO2 decreased at 6th hour when compared to control in all 3 groups (p<0.001). PaCO2 decreased in group K (p<0.001) and in group L (p<0.05). pH decreased at 6th hour when
compared to control in group K (p<0.001). There was no change in leukocyte values (p>0.05). Platelet levels decreased in group K and L (p<0.05), but it didn’t change in group M (p>0.05).
Finally, with the purpose of treatment of ALI depending on acid aspiration, it was detected that lidocaine and methylprednisolone used in early stage controlled partially the reduction in PaO2, which it did not lead to significant changes in the values PaCO2, pH and leukocyte, and methylprednisolone prevented the reduction in the number of platelet.

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Menopoz polikliniðine baþvuran doðal menopoz olgularýnda menopoz baþlangýç yaþ ortalamasýný, parite, sigara içimi ve sosyoekonomik durumun menopoz yaþ ortalamasý üzerine etkisinin olup olmadýðýný deðerlendirmeyi amaçladýk. Þiþli Etfal Eðitim ve Araþtýrma Hastanesi menopoz polikliniðine baþvuran toplam 542 postmenopozal hasta deðerlendirmeye alýndý. Cerrahi menopozda olduðu tespit edilen 171 hasta çalýþma kapsamý dýþýnda býrakýldý. Çalýþma grubunu oluþturan hastalarýn menopoz yaþý, paritesi, sigara kullanýmý ve sosyoekonomik durumu prospektif olarak incelendi. Doðal menopoz grubunu oluþturan hastalarýn yaþ ortalamasý 47.4±2.9 olarak tayin edildi. Çalýþmaya alýnan olgularýn 32’si (% 8.6) nullipar, 339 (% 91.4) hasta multipar idi. Nullipar ve multiparlarýn menopoz baþlangýç yaþ ortalamalarý sýrasýyla 45.1±2.1, 47.6±3.0 olarak saptandý. ‹ki grup arasýndaki fark istatistiksel olarak anlamlý idi (p<0.05). Menopoz baþlangýç yaþ ortalamasýný düþüren etkenlerin bilinmesi menopoza giriþ yaþ ortalamalarýný yükseltmeye çalýþmanýn yanýnda, olgularýn erken dönemde taný ve tedavisini saðlayarak hastalarýn postmenopozal dönemdeki yaþam kalitesini artýracaðýndan, ülkemizde bu konuda daha fazla ve büyük serili çalýþmalar yapýlmasý gerektiðine inanmaktayýz.

To determine the median age of natural menopause who have attended to fiiflli Etfal Hospital Menopause Outpatient Clinic and whether smoking, socioeconomic status and parity affecting that age. A total of women who have attended to Þiþli Etfal Hospital Menopause Outpatient Clinic are investigated. 371 of patients who had had natural menopause defined as cessation of menstruation for at least 12 months at the end of
reproductive years were evaluated. Data were collected using a structured questionnaire and face to face interviews and included smoking, parity and socioeconomic variables. The median age of the natural menopause in our patients is 47.4±2.9 years. This is significantly lower than the median age reported from the Western countries (50.3 years). 32 of our patients were nulliparous (8.6 %); 339 of those were multiparous (% 91.4). The median age of menopause in nulliparous and multiparous was 45.1±2.1, 47.6±3.0 respectively (p<0.05). Smoking and socioeconomic status did not related to menopausel age (p>0.05). Nowing the factors that decreases the avarege menopausal age will help us to increase this age together with the proper and time the diagnosis all the cases will also increase life quality after manopausal age and in circumtances of our country this study showes that we will need to have many more studies with many more cases. The subject median age of the menopause was signiticanfly related to parity (p<0.05).

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GÝRÝÞ ve AMAÇ: Tip 2 diyabetli hastalarda random idrarda ölçülen albumin/ kreatinin oraný ile diyabetik retinopati arasýndaki iliþkiyi incelemek ve en iyi ‘A/K (Albumin/Kreatinin) eþik deðerini saptamak.
YÖNTEM ve GEREÇLER: Türk Diyabet Cemiyeti Diyabet Hastanesinde Tip 2 diyabetli 94 hastadan alýnan random idrarda Bayer DCA 2000 Albumin/Creatinine Analiser ile A/K oraný saptandý ve retina uzmaný tarafýndan hastalarýn fundus muayeneleri yapýldý. Birçok A/K eþik deðerinde (5-100 mg/g arasýnda) duyarlýlýk, özgüllük, yalancý pozitif ve negatif oranlar ile yalancý pozitif ve negatif öngörü deðerleri saptandý.

BULGULAR: Diyabetik retinopatiyi öngörmede en iyi ‘A/K eþik’ deðerleri 10 ve 12 mg/g olarak bulundu. 10 mg/g en yüksek pozitif (% 72,9) ve 12 mg/g en iyi negatif (% 66,7) öngörü deðeri olarak saptandý. 10 mg/g alýndýðýnda retinopatiyi öngörmede en iyi duyarlýlýk ve özgüllük deðerleri sýrasýyla % 75 ve % 61,9 olarak bulundu. 12 mg/g deðerinde duyarlýlýk ve özgüllük sýrasýyla % 67,3 ve % 69,1 olarak bulundu.
TARTIÞMA ve SONUÇ: Nispeten ucuz, kolay ve noninvazif bir yöntem olan random idrarda A/K saptanmasý kabul edilebilir bir doðruluk ve öngörü ile diyabetik retinopati derecesini tahminde kullanýlabilir.

INTRODUCTION: To investigate the correlation between albumin/creatinine (A/C) ratio in random urine samples with the retinopathy status in type 2 diabetics and to determine the best “A/C cutoff ” for identifying those patients with retinopathy.
METHODS: A/C ratio was measured in random urine samples by using Bayer DCA 2000 Albumin/Creatinine Analyser® and fundus examination was performed by a retinal specialist in 94 type 2 diabetic patients at a foundation hospital specialized in diabetes
care. Sensitivity, specificity, false positive and negative rates with positive and negative predictive values of several A/C cutoffs (between 5 and 100 mg/g) was calculated.
RESULTS: 10 and 12 mg/g were found to be as the most useful A/C cutoffs for prediction of diabetic retinopathy. “10 mg/g” yielded the highest positive (72.9 %), while “12 mg/g” gave the best negative (66.7 %) predictive values. Sensitivity and specificity for prediction of retinopathy were calculated as “75 and 61.9 %” respectively, if “10 mg/g” was selected. Sensitivity and specificity would be “67.3 and 69.1 %” respectively, for a cutoff
of “12 mg/g”.
DISCUSSION AND CONCLUSION: This relatively simple, noninvasive and inexpensive laboratory test of A/C ratio in random urine would be useful for assessing diabetic retinopathy status with reasonable accuracy and precision.

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Papanicolaou smear tarama testi pozitif gelen veya direkt inspeksiyon ile þüpheli servikal lezyon görülen olgularýn servikal biyopsi patolojilerini deðerlendirmeyi amaçladýk.
Ocak 2003 ile Mayýs 2003 tarihleri arasýnda SSK Göztepe Eðitim Hastanesi Septik servisinde toplam 51 hastaya servikal biyopsi yapýldý. Alýnan doku örnekleri, 7 hasta dýþýnda hastanemiz patoloji kliniðinde incelendi. Servikal biyopsi sonuçlarýna ulaþýlabilen 44 olgunun histopatolojik tanýlarý retrospektif olarak incelendi. Sonuçlar yüzde oranlarýyla deðerlendirildi.
Olgularýn 27’sinde (% 61.36) kronik servisit, 8’inde (% 18.18) endoservikal polip, 1’inde (% 2.27) granülamatöz reaksiyon, 1’inde (% 2.27) endoservikal glandüler proliferasyon, 1’inde (% 2.27) koilositoz, 1’inde (% 2.27) servikal intraepitelyal neoplazi (CIN I) saptanýrken 5 olgu (% 11.36) ise serviks kanseri tanýsý aldý. Serviks kanseri olgularýnýn dördünde biyopsi öncesi servikal smear testi yoktu, bir olgunun ise Pap smear sonucu negatifti.
Serviks kanseri, günümüzde prekürsör lezyonlarýnýn erken taný ve tedavisinin yapýlmasý sonucunda önlenebilen bir kanserdir. Ýnvazif kanser sýklýðýný azaltmak amacýyla Pap smear tarama testi daha yaygýn ve programlý bir þekilde uygulanmalýdýr.

To evaluate cervical biopsy pathologies of patients with suspicious cervical lesions by direct visuel inspection or positive on routine Papanicolaou smear tests.
Cervical biopsies were performed on totally 51 patients between January 2003 and May 2003 in SSK Göztepe Educational Hospital, Clinic of Obstetrics and Gynecology.All tissue specimens except seven cases were examined in our hospital’s pathology clinic. Of 44 patients who were able to be achieved to the results of cervical biopsies, their histopathological diagnosis were reviewed. The results were evaluated on percentage ratios.
Histopathological examination of the cervical biopsies of 51 cases revealed chronic cervicitis in 27 (61.36 %), endocervical polyp in 8 (18.18 %), granulamatous reaction in 1 (2.27 %), endocervical glandular proliferation in 1 (2.27 %), coilositosis in 1 (2.27 %), cervical intraepithelial neoplasia I (CIN I) in 1 (2.27 %) and cervical cancer in 5 (11.36 %). While 4 cases with cervical cancer did not have Pap smears before biopsy, only one of them had cytologic test negative.
Today, cervical cancer is a preventable type of cancer due to early diagnosis and treatment of precursor lesions. Routine Pap smear test should be performed more widely and community-based on program to decrease the invasive cancer incidence.

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Habis plevral mezotelyoma (MPM) lokal yayýlým gösterir. Perikard tutulumu hakkýnda bilgiler kýsýtlýdýr. Bu çalýþmada hastalýðýn þiddeti ile perikard tutulumu arasýndaki iliþki araþtýrýlmýþtýr.
Ocak 2001-Aralýk 2003 yýllarý arasýnda Dicle Üniversitesi Týp Fakültesi Göðüs Hastalýklarý ve Göðüs Cerrahi kliniklerinde takip edilen 9’u (% 33) kadýn, 18’i (% 67) erkek 27 MPM hastasý çalýþmaya alýndý. Yaþ ortalamasý 51.8±12.3 (22-82) olarak bulundu. Hastalardan 23’ünün (% 85) asbest temasý mevcuttu ve bu temas çevreseldi. 22 (% 82) hastaya kapalý plevral biyopsi ile, 5’ine ise (% 18) operatif yöntemlerle taný kondu.
Olgulardan 11’inde epitelial tip, üçünde mikst tip ve birinde sarkomatöz tip olduðu saptandý. 12 hastada ise tip tayini yapýlamadý. 18 (% 67) hasta evre 1, 8 (% 29) hasta evre 2 ve 1 (% 4) hasta evre 3 olarak saptandý.
Perikardial tutulum ekokardiografik incelemeyle araþtýrýldý. Toplam 19 (% 70) hastada ekokardiyografide perikardiyal tutulum saptandý. Bu olgulardan 9’unda perikardial kalýnlaþma, 8’inde perikardial ekojenite artýþý, 2’sinde perikardial kitle ve 2’sinde ise perikardial efüzyon saptandý. Hastalýðýn evresi ile ekokardiyografik perikardial tutulum arasýnda bir iliþki yoktu. Hastalarýn toraks BT’lerinde 4 hastada perikardial tutulum saptandý.
MPM hastalarýnda perikard tutulumuna sýk rastlanýr. Bu tutulum ekokardiyografi kolayca saptanabilir. Bu olgularda rutin ekokardiyografik inceleme non invaziv, ucuz ve yararlý bir iþlemdir.

Malignant pleural mesothelioma (MPM) tends to progress locally. Data relating pericardial involvement is limited.In this study, the relationship between pericardial involvement and
the severity of the disease was investigated.
Total of 27 MPM patients; 9 (33 %) female, 18 ( 67 %) male who were followed-up between January 2001-December 2003 in Chest Diseases and Thoracal Surgery departments of Dicle University Hospital were included to the study. The mean age was found as 51.8+- 12.3 (22-82). Of patients 23 ( 85 %) had asbestos exposure and it was environmental. Of patients, 22 (82 %) was diagnosed by pleural biopsy, 5 (18 %) by operative methods.
Epithelial type was detected in 11 cases, mixed type in 3 cases and sarcomatous type in 1 case. Type detection could not be done in 12 patients. Stage 1 included 18 ( 67 %) patients, stage 2 included 8 ( 29 %) patients and stage 3 included 1 ( 4 %)
patient.
Pericardial involvement was investigated by echocardiographic method. Totally 19 ( 70 %) patients were found to have pericardial involvement. Of these cases; 9 patients had pericardial thickening, 8 had increasement of pericardial echogenity, 2 had pericardial mass and 2 had pericardial effusion.No relationship was detected between the stage of the disease and echocardiographic pericardial involvement. Torax CT of 4 patients showed pericardial involvement.
Pericardial involvement in MPM patients occurs frequently. This involvement can be detected by echocardiography easily. In these cases, routine echocardiographic investigation is a non-invasive, cheap and usefull method.

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Çocukluk çaðý anemi nedenleri arasýnda, sýklýk yönünden demir eksikliði anemisinden sonra ikinci sýrayý akut inflamasyon anemisi almaktadýr. Atatürk Üniversitesi Týp Fakültesi Pediatri
Polikliniði’ne Þubat 2002-Ekim 2002 tarihleri arasýnda baþvuran 6 ay-6 yaþ arasý çocuklardan, son bir ay içinde geçirilmiþ infeksiyonu olanlarý belirledik. Bu olgulardan eritrosit sedimantasyon deðeri 20 mm/saat üzerinde olanlar çalýþma kapsamýna alýndý. 1004 olgunun 79’unda inflamasyon anemisi tespit ettik. Ancak, bu gruptaki 33 olguda ayný zamanda demir eksikliði mevcuttu. Hiçbir hematinik tedavi vermeden bir ay sonra kontrole çaðýrdýðýmýz bu grupta hemoglobin deðerlerinde anlamlý artýþ tespit edildi (p<0.001).

Acute inflamation anemia after ýron deficiency anemia remains a significant cause of childhood anemia worldwide. 1004 children aged 6 months to 6 years referred to Ataturk University Pediatric Department for an infection in the last one month whose erythrocyte sedimantation rates greater than 20 mm/hour were enrolled in this study. Of the 1004 cases, inflamation anemia was detected in 79 of them with coexisting iron deficiency in 33 cases. After one month; we detected significant increse in hemoglobin concentration without any treatment.

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Romatoid artrit (RA) morbidite ve mortalitesi yüksek, kronik, inflamatuar bir hastalýktýr. RA’da en sýk ölüm nedeni kardiyovasküler olaylardýr. Bu çalýþmada RA’lý hastalarda kardiyovasküler hastalýk (KVH) risk faktörleri ve metabolik sendrom sýklýðýný araþtýrarak RA ile KVH insidansý arasýndaki iliþkiyi bu açýdan deðerlendirmeyi amaçladýk.
Çalýþma; SSK Göztepe Eðitim Hastanesi Romatoloji polikliniðinde takip edilen ve çalýþma kriterlerine uyan romatoid artritli 100 hasta ile benzer yaþ ve cinsiyet özelliklerine sahip
gönüllü 91 kiþi üzerinde yapýldý.
Her iki grup arasýnda total kolesterol, HDL kolesterol, LDL kolesterol, trigliserid düzeyi, diyabet sýklýðý, sigara kullanýmý, ailede erken KVH öyküsü açýsýndan anlamlý fark yoktu. RA’lý hastalarda hipertansiyon sýklýðý kontrol grubuna göre daha yüksekti (% 49’a karþýlýk % 27; p<0.05). Metabolik sendrom sýklýðý RA grubunda % 9 daha yüksekti (p>0.05).
Bulgular RA’lý hastalarda hipertansiyon ve metabolik sendrom sýklýðýndaki artýþýn bu hastalarda KVH riskinin artmýþ olmasýnda etkili olabileceðini düþündürmektedir.

Rheumatoid artritis (RA) is a chronic inflammatory disease with high morbidity and mortality. The most frequent mortality reason in RA is cardiovascular events. In this study we aimed to investigate cardiovascular disease (CVD) risk factors and frequency of metabolic syndrome in patients with RA and to determine the relationship between RA and CVD incidence in this respect.
One hundred patients with RA followed in SSK Göztepe Education Hospital Rheumatology Clinic and eligible to study protocol and 91 voluntary cases having similar age and sex
characteristics were enrolled in the study.
There was no statistically significant difference between two groups according to total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride levels, frequency of diabetes mellitus, smoking history and family history of early CVD. Frequency of hypertension was higher in RA group than control group (49 % versus 27 %; p<0.05). Frequency of metabolic syndrome was higher in RA group, but the difference was not statistically significant from control group (37 % versus 28 %; p>0.05). Frequency of metabolic syndrome was 9% higher in RA group (p>0.05).
These findings suggest that increased frequency of hypertension and metabolic syndrome may play a role in high prevelance of CVD in patients with RA.

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Yatarak tedavi gören fiziksel hastalýðý olanlarda eþ zamanlý olarak ruh saðlýðýný önemli ölçüde etkileyen ruhsal bozukluklarýn olduðu, buna karþýn bu hastalarla ilgili olarak psikiyatri konsültasyonu isteme oranlarýnýn oldukça düþük olduðu bildirilmektedir. Bu nedenle, tedavi sürecini ve süresini olumsuz yönde etkileyen ruhsal bozukluklarýnýn psikiyatrlar kadar psikiyatri dýþý hekimler tarafýndan da bilinmesi son derece önemlidir. Biz de bu amaçla hastanemizdeki psikiyatrik konsültasyonlarýnýn durumunu araþtýrmayý amaçladýk.
Hastalara Psikiyatri Anabilim Dalý tarafýndan hazýrlanan ve hastanýn sosyodemografik özellikleri, mevcut týbbi tedavi, konsültasyon isteme amacý, önceki psikiyatrik öykü, ruhsal muayene bulgularý, taný ve tedaviyi içeren konsültasyon formu ve Hastane Anksiyete-Depresyon Ölçeði ilgili araþtýrmacýlar tarafýndan uygulandý. Hastalarýn tanýlarý DSM-IV taný ölçütlerine uygun olarak uzman hekim görüþü alýnarak konuldu.
Toplam 91 hasta (203’ü erkek, 190’i kadýn, yaþ aralýðý 18-94, yaþ ortalamasý 46.17+17.4) konsülte edildi, konsültasyon isteklerinin % 57.1’i dahili dallara, % 42.9’u cerrahi dallara aitti.
Genel hastanelerde yatarak tedavi gören hastalarýn psikiyatrik sorunlarýnýn hastalarýn hastanede yatýþ sürelerini, tedavi süreçlerini olumsuz yönde etkilediði bilinmesine raðmen, ülkemizdeki diðer çalýþmalarda da belirtildiði gibi konsültasyon isteme oranlarý henüz istenilen düzeyde deðildir.

Research shows that there are certain mental disorders that affects the mental disorders that affects the mental health of the inpatients who have physical diseases. On the other hand, the number of patient who attempt to ask for psychiatric consultation in quite low. Therefore, it is essential that psychiatrist as well as the other doctors know the mental disorders affeting the procedure of treatment. To achieve this we aim to investigate the psychiatric consultations in our hospital.
The Hospital Anxiete and Depression Scala and the consultation form was prepaed by the Psychiatry PH.D. and appled to the patient by the related researchers with respect to the diagnosis and treatment, socio-demographic features of the patient, current medical treatment, aim of request for consultation, previous psychiatric story, and mental examination findigs. The diagnoses of the patients were set in conformity with the DSM-IV diagnosis criteria by consulting to specialist physician.
Totally 91 patients (37 were male, 54 were female at 17-83 ages, avarage age (43.17+17.4) were applied consultation, and it was determied that 57.1 % of the consultation requests belonged to internal branches, 42.9 % belonged to surgical
branches.
Although it was already known that the psychiatric disorders of inpatients in the general hospitals affected their staying period and traetment process negatively, the rate of request for consultation were not at the requred level as referred to in other studies in our country

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Çalýþmamýzda amacýmýz, insanýn standart bir sandalyenin üzerine çýkabilmesi için gereken diz fleksiyonunun boya göre tespitidir.
Deðiþik boy uzunluðunda, dizlerinden sorunu olmayan 200 kiþi çalýþmaya alýndý. Bu kiþiler piyasada satýlan 15 sandalyenin ortalama yüksekliði olan 42 cm’lik sandalyenin üzerine çýkarken gerekli olan maksimum diz fleksiyonlarý ölçüldü. Sandalyenin üzerine çýkma her hastada ayný prosedüre uygun yapýldý. Deneklerin ihtiyaç duyduklarý diz þeksiyonu ile boy uzunluklarý kayýt edildi.
Dizin fleksiyondaki deðiþimlerinin boy ile ters orantýlý olduðu gözlendi. Deneklerin boylarý 10’ar cm.’lik gruplara ayrýlarak sandalye üzerine çýkarken gerek duyulan fleksiyonlarý ile tablo oluþturuldu.
Özellikle total diz artroplastisinde hastalarýn en önemli beklentilerinden biri de dizinin yeterli fleksiyona gelmesidir. Ameliyat öncesi planlamada en geniþ hareket açýklýðý hedeflenirken fonksiyonel alt sýnýr bilinmelidir.
Hastalarýn en önemli fonksiyonlarýndan biri olan yükseðe týrmanma hareketi için “gerekli diz fleksiyonu-hastanýn boyu ile deðiþimi” tablosu oluþturulmuþtur.

In this study our aim is to identify knee flexion required for climbing a standard chair according to the body height of a person.
200 people having no problems with their knees in different body heights are included in the study. Maximum knee flexions that are required to climb over a 42 cm chair, which is the average height of 15 chairs sold in the market, have been measured. The procedure for climbing over the chair is conducted in the same manner with every patient. Knee flexions required by the subjects and their body heights have been recorded.
It has been observed that the changes in knee flexion is in inverse proportion with body height. A table is constituted by separating the body heights of the subjects into groups of
10cm and recording the amounts of flexions required while climbing to the chair.
Particularly, one of the most important expectations of total knee arthroplasty patients is to have sufficient knee flexion. The functional lower limit should be known when the widest movement range is targeted preoperatively.
A table has been produced for “required knee flexion-change according to the body height” regarding the movement of climbing to a height, which is one of the most important functions of the patients.

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GÝRÝÞ ve AMAÇ: Overin berrak hücreli karsinomu (CCC) olgularýnýnýn klinik özellikleri, tedavi ve prognozlarýnýn incelenmesi.
YÖNTEM ve GEREÇLER: 1991-2003 tarihleri arasýnda histopatolojik olarak CCC tanýsý almýþ 19 olgu retrospektif olarak analiz edildi.
BULGULAR: Yaþlarý 40 ile 72 arasýnda deðiþen 19 olguda ortalama yaþ 55.2 olarak saptandý. Altý olgunun yaþý 50’nin altýnda idi. Karýn þiþliði en sýk (% 77) ifade edilen semptomdu. Preoperatif olarak 19 olgunun 15’inde yapýlan CA-125 ölçümlerimde 8 olguda (% 53.3) deðerler 35 Ü/ml’nin üzerindeydi. Olgularýn USG tetkiklerinde boyutlarý 3.5 cm ile 30 cm arasýnda deðiþen kistik veya semisolid adneksiyal kitleler tespit edildi. Olgularýn hepsi primer olarak cerrahi ile tedavi edildi. En sýklýkla Ic evresindeki olgular saptandý (n=7, % 36.8). Olgularýn ortalama takip süreleri 38 aydý (8 ile 138 ay arasý). Evre I- II olgularýn ortalama takip süresi 39.6 ay, evre III ve IV olgularýn ise 22.5 aydý. Evre IIIc ve IV olan iki olgu ortalama 30.5 ayda exitus oldu.
TARTIÞMA ve SONUÇ: Sonuç olarak, CCC olgularda erken taný konulmasý, iyi bir cerrahi evreleme yapýlmasý ve optimal tedavi uygulanmasý prognoz açýsýndan çok önemlidir.

INTRODUCTION: To analyse clinical features, treatment and prognosis of women with ovarian clear cell carcinoma.
METHODS: 19 cases with ovarian clear cell carcinoma diagnosed histopathologically between 1991-2003,
were analysed retrospectively.
RESULTS: Mean age was 55.2 in 19 cases (range 40-72 ). Ages were under 50 in 6 cases. The most common symptom was abdominal distansion (77 %). CA-125 levels were measured in
15 of 19 cases preoperatively, in 8 cases levels were over 35 U/ml (53.3 %). At US examinations, cases had an adnexial semisolid or cystic masses which ranged 3.5 -30 cm in diameter. Primary treatment was surgery for all cases. Most commonly stage 1c cases were determined (n=7, 36.8 %). Mean follow up time was 38 months (range 8-138). In stage I-II cases mean follow up time was 39.6 months, in stage III-IV cases it was 22,5 months.Two cases in stage IIc and IV, death in a mean period of 30.5 months.
DISCUSSION AND CONCLUSION: As a conclusion, in CCC cases, early diagnosis, correct surgical staging and optimal treatment are very important for prognosis.

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Hastanemizde uygulanan kardiyopulmoner resüsitasyon (KPR) hizmetinin kalitesini belirlemek, karþýlaþýlan sorunlarý irdelemek ve KPR eðitiminin gerekliliðini vurgulamak amacýyla müdahale edilen kardiyopulmoner arrest (KPA) olgularý deðerlendirildi.
Ekim 1999-Haziran 2002 arasýnda KPR uygulanan 365 olgu çalýþmaya dahil edildi. Olgularýn kliniklere göre daðýlýmý, arrest tanýsý konulduktan sonra kliniðimize haber verilme süresi, olguya ulaþým süresi, olguya klinik personeli tarafýndan yapýlan ilk müdahaleler ve alýnan sonuçlar kaydedildi.
KPA tanýsý konulduktan sonra haber verilme süresi ortalama 7.04±3.66 dk, ulaþým süresi ortalama 4.06 ±2.50 dakika bulundu. Ulaþým süresine kliniklerin reanimasyon kliniðine olan uzaklýklarýnýn etkili olduðu tespit edildi. Olgularýn % 52.8’inde kardiyopulmoner arrest, % 29.5’inde sadece solunum arresti, % 17.7’sinde çeþitli solunum problemi mevcuttu. Olgularýn % 30.7’sine klinik personeli tarafýndan hiçbir iþlem yapýlmamýþtý. Tüm olgularýn % 73.2’si ex oldu, % 17.6’sý yoðun bakýmda, % 9.2’si servisinde takibe alýndý.
Sonuç olarak, KPR uygulanan olgularýn saðkalým oranlarý literatür verilerine göre düþük bulundu. Bu durumun nedenleri, özetle; olayýn geç haber verilmesi, olgularýn tümünün monitör yetersizliðine baðlý asistoli olarak kabul edilmesi ve ilk müdahale yapan klinik mensuplarýnýn KPR konusunda yetersiz bilgi ve deneyime sahip olmasýdýr. Bu da özellikle asistan ve hemþirelerin Temel ve ‹leri Yaþam Desteði eðitimini almalarý ve etkili KPR için gerekli olan donanýmlarýn tüm kliniklerde bulundurulmasý gerekliliðini göstermektedir.

To evaluate the quality of cardiopulmonary resuscitation (CPR) in our hospital, problems encountered and to point out the necessity of CPR tutorial we examined retrospectively the files of patients who received CPR.
Retrospective analysis of 365 patients who received CPR from October 1999 to June 2002 was performed. Patient number per department, call time of the CPR team and arriving
time to the department, if any intervention to the patient was done before the arrival of the CPR team and the quality of CPR were analysed by chi- square and Annova tests.
The mean call time of the CPR team was 7.04±3.66 min., the arrival time of the CPR team was 4.06 ±2.50 min. Departments proximity to our clinic was a statistically significant parameter for the arrival time (% 95 CI: 3.79-4.32, F: 1.331). The diagnosis were cardiopulmonary arrest in 52.8 % of patients, in 29.5 % there was only a pulmonary arrest, in 17.7 % there were various respiratory problems. In the CPR performed patients 30.7 % had no intervention performed before our arrival. 73.2 % of the patients who received died, 17.6 % were taken to our ICU and 9.2 % were observed in the ward.
The rate of survival is lower in our hospital than the literature. Our explanations for this situation are the delay in calling the CPR team, inadequate monitoring in the wards and untrained ward doctors and nurses. Thus in all clinics in hospitals especially in emergency services basic and advanced life-support tutorial should have been constituted to all physicians and nurses.

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Tanýmlayýcý bir araþtýrmayla annelerin emzirme konusundaki bilgilerinin ve bu bilgileri etkileyen faktörlerin belirlenmesi amaçlandý. Çalýþma, Ýstanbul Üniversitesi Týp Fakültesi Kadýn Doðum kliniðinde altý aylýk süre içinde ileriye yönelik sistematik örnekleme ile seçilen annelerden görüþmeyi ve hazýrlanan anketi yanýtlamayý kabul edenlerle gerçekleþtirildi. 300 anneden miadýnda doðum yapan 211 anne çalýþmaya alýndý. Annelerin 42'si (% 20.2) sezaryen, 169'u (% 79.8) normal doðum yapmýþtý. Öðrenim düzeyleri % 79.9'unda ilkokul ve altý, % 20.1'inde ortaokul ve lise, % 10’unda ise üniversite ve yüksekokul idi. Normal doðum yapan annelerde bebeðini ilk iki saatte emzirme oraný (% 60.4), sezaryenle doðum yapan annelere (% 30.3) göre yüksek bulundu (p<0.01). Normal doðum yapan annelerde doðumdan sonraki iki saate kadar bebeðini emzirme oraný, ilkokul ve altý öðretimlilerde % 63.2, ortaokul ve lise öðretimlilerde % 67.8 iken, üniversitelilerde % 65.4 idi. Anne öðrenim düzeyleri ile bebeðe ilk altý ay boyunca anne sütünün tek baþýna yeterli olduðu hakkýndaki bilgi ve bebeklerini emzirmeyi planladýklarý süre arasýnda anlamlý iliþki bulunmadý. Sonuç olarak, “baþarýlý emzirme için 10 öneri” uygulamasýnýn yaygýnlaþtýrýlmasý sonucu anne ve bebek saðlýðýnda elde edilecek faydalar için, emzirme eðitimi bir danýþmanlýk hizmeti þeklinde sürekli olarak hem doðum öncesi hem de doðum sonrasýnda verilmesi gerektiði düþüncesindeyiz.

This descriptive study was designed to evaluate the insight and attitude of mothers about breast feeding and the factors influencing it. The study was carried out in Istanbul University of gynecology and obstetrics clinic during a six-month period. Mothers were selected by means of systematic sampling. They all want to participate in face-to-face interviews and responding to a questionnaire. Of three-hundred mothers, 211 mothers with term delivery were inclueded into the study. Fourty-two mothers (20.2 %) underwent caesarean section delivery and 169 mothers (79.8 %) normal spontaneous delivery, respectively. Education levels were primary school or lower in 79.9 %, secondary school or gymnasium in 10.1 % and university % 10. The incidence of breast feeding within the
first two hours of delivery was higher in mothers with normal births (60.4.0 % vs. 30.3 %). The incidence of breast feeding until after two hours of normal delivery was 63.2 % in those with primary school or lower education, and 67.8 % in those with secondary school and 65.4 % in university degree. Mothers' education levels were not correlated with their knovvledge on the sufficiency of breast milk during the first six months and the planned periods for breast feeding.‘Ten rules for succesful breast feeding’ must be widespread through whole country to improve both infant and mother health, therefore
breast feeding counselling should be continuously given particularly during antenatal and the early postpartum periods.

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Sickle cell anemia is a chronic hemolytic anemia with vasoocclusive crisis and is the most common symptomatic event that causes tissue hypoxia in many systems. Pulmonary crisis
is one of them and its the major cause of mortality and morbidity in sickle cell anemia. Furthermore, pulmonary crisis is the second clinical situation for hospitalization. Pneumoia must be thought in differential diagnosis and is too difficult to rule out. Two cases with pulmonary crises with sickle cell anemia were presented with up to date knowledge.

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In this report, 61 year old male patient with the verrucous carcinoma of the larynx has been discussed in the view of the latest literature.
Verrucous carcinoma is a rare variant of the well differentiated squamous cell carcinoma. These tumors can be extensively locally invasive but no metastase has been reported. In some cases, there is HPV positivity in the tumor and surrounding tissue. Verrucous hiperplasia, papilloma and squamous cell carcinoma should be considered in differential diagnosis. The preferred treatment modality is surgery.

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Inverted papilloma is a benign tumor of the nasal cavity and paranasal sinuses. Its recurrence rate is frequently evaluated in literature and new surgical approaches are performed to decrease this rate. In this paper, two patients (2 males) with inverted papilloma are presented. Their ages are 67 and 57 years. We performed medial maxillectomy and anterior posterior ethmoidectomy by lateral rhinotomy and midfacial degloving approaches due to wide extension of the tumor. No recurrences were detected in the regular clinical and radiological controls.

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To purpose of our study is to describe the ultrosonographic findings, postnatal results and operation necessities for the fetuses with prenataly determined ovarian cyst.
Between the years of 2002-2003, three cases with suspected ovarial cyst determined by prenatal ultrosonograpy were followed up and reevaluated during postnatal period. All three cases are diagnosed in third trimester. Diameters of ovarian cysts for two cases and the other one are 5 cm and 2 cm, respectivelly. Cases with 5 cm cyst diameter are undergone operation during postnatal period. Whereas cyst with 2 cm diameter is regressed during postnatal follow up.
Fetuses with suspected ovarian cyst during perinatal period should be monitorised by serial ultrosonographic examinations. As some ovarian cyst show regression in their size, some others remain stable and they have to be reevaluated and confirmed by postnatal ultrosonography and operation should be considered with these findings.

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The incidence of congenital mullerian anomalies is as high as 3.2 % in population. Uterus didelphus is one of most frequent anomalies among mullerian anomalies.
We present a case of uterus didelphus with a blind vaginal pouch. The patient 24 years old was referred to our hospital with a pelvik mass of 5 cm. diameter. She had congenital unilateral renal agenezia and a history of cesarean section 2 years ago. After US and MRI, the diagnosis was uterus didelphus. Even though there are several treatment modalities in literature, we decided on hemihisterectomy by laparotomy.
As a result, in differential diagnosis of unilateral pelvic, mullerian anomalies must also be considered and USG and MRG may be of important in investigation of such cases.

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Infantile myofibromatosis is a rare myofibroblastic tumor in which soft tissue, bone and rarily visceral involvement can be seen. It is usually a solitary tumor, however, multicentric
involvement may also be present. The cases with solitary or multiple lesions but no visceral involvement have good prognosis and spontaneous regression can often be seen. Nevertheless, multicentric visceral tumors are associated with high mortality.
In this report, imaging findings of a case of infantile myofibromatosis with liver and both adrenal glands involvement; and another case with involvement of posterior thoracal and
servical region muscles are presented.

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Barbexaclone (Maliasin®); which is an antiepileptic agent, is a compound of phenobarbital and levopropylhexedrine. We couldn’t find any literature about barbexaclone intoxication.
Our patient who had taken in 10 grams of barbexaclone orally to commit a suicide has classic phenobarbital intoxication symptoms. We admitted symptomatic and supportive treatment, gastic lavage, active carbon to our patients. She discharged at 9 th day of her admission.
As a result we can say that acute barbexaclone intoxication can be treated with symptomatic supportive tratment.

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Lyme disease is a multisystem infection caused by the spirochete Borrelia burgdorferi which is usually transmitted to humans via the bite of tick.
A 38 year-old woman had presented to us with arthralgia, myalgia, anxiety, vomiting and fatigue. One month later, she developed an erythematous rash on her legs and arms. This
lesion was diagnosed as multiple annular secondary skin lesion of Lyme disease. Laboratory findings were normal. B. burgdorferi serologies were ELISA IgG positive. Our patient
was successfully treated with doxycycline, 200mg/day for 30 days. Her systemic symptoms and her skin lesions resolved in 3 days.

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The presence of a double haemostatic defect in patients presenting with bleeding is extremely rare. The presence of atypical bleeding should consider us the association of dual haemostatic pathology. In this paper, 17 months of a male patient who is brought with bleeding from idiopathic thrombocytopenia with low factor 8 level is described.

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