Trakeal ekstubasyon geçiçi olsa da önemli hemodinamik deðiþikliklere neden olabilir. Çalýþmamýzda, esmolol ve diltizemin bu hipertansif ve taþikardik yanýtý baskýlamadaki etkinliklerinin, karþýlaþtýrmalý olarak incelenmesi amaçlanmýþtýr.
Çalýþmamýz, Etik Kurul ve hastalarýn yazýlý onayý alýnarak, 20-60 yaþ aralýðýnda, ASA I-II, 45 elektif cerrahi olgusunda gerçekleþtirildi. Standart monitörizasyon uygulanan tüm hastalarda, anestezi; fentanil 2 μg/kg, tiyopental 5 mg/kg, vekuronyum 0.2 mg/kg ve % 66/33 N2O/O2 + isoþuran % 0.5-1.5 ile saðlandý. Rezidüel kas gevþemesi için neostigmin+atropin uygulanan hastalara bundan 3 dk. önce 15’er kiþilik gruplar halinde çalýþma ilaçlarý verildi (diltizem 0.2 mg/kg, esmolol 1.5 mg/kg, Serum fizyolojik). Hemodinamik ölçümler; baþlangýç, operasyon sonu, ekstubasyondan önce, 1, 5 ve 10 dk. Sonra yapýldý. Veriler ANOVA ve Tukey Kramer testleriyle karþýlaþtýrýldý. p<0.05 anlamlý olarak kabul edildi.
Kalp atým hýzýnda baþlangýç deðerlerine göre; diltizem grubunda ekstubasyon sonrasýnda anlamlý deðiþiklik saptanmazken, esmolol grubunda ekstubasyon öncesi, ekstubasyondan 1 ve 5 dk. sonra anlamlý azalma (p<0.001), kontrol grubunda ise ayný sürelerde anlamlý (p<0.001) artýþ saptandý. Kan basýncý, kontrol grubunda baþlangýca göre ekstubasyon sonrasý (1 ve 5. dk.) anlamlý (p<0.001) artýþ gösterirken, esmolol ve diltizem gruplarýnda deðiþmedi.
Esmolol ve diltizem daha önce ekstubasyona karþý hemodinamik yanýtý baskýlamada iyi birer seçenek olarak bildirilmiþtir. Sonuçlarýmýza göre, diltizem ve esmolol ekstubasyona karþý oluþan hemodinamik yanýtý baskýlamada da baþarýlý bulundu.

Tracheal extubation may lead temporary, but important haemodynamic changes. Our study was aimed to evaluate the attenuating effects of esmolol and diltizem comparatively on this hypertensive and tachycardic response.
Our study was done on 20-60 aged, ASA I-II 45 elective surgery cases with the written permission of the patients and the Ethical Commitee. Anaesthesia was performed with: fentanyl 2 μg/kg, thiopental 5 mg/kg, vecuronium 0.2 mg/kg and % 66/33 N2O/O2 + isoflurane % 0.5-1.5 in all of the patients whom were monitored in a standarded manner. Study drugs were given to all of the patients 3 minutes before the reversal to 15 cases of the groups (esmolol 1.5 mg/kg, diltizem 0.2 mg/kg). Systolic, diastolic blood pressure, heart rate, SpO2 values were recorded for statistical comparisons at determined intervals
as following: baseline, at the end of the surgery, at the time of extubation; 1, 5, 10 min after extubation. The data were compared with ANOVA and Tukey Kramer Multiple Coparison Tests. P<0.005 accepted as significant.
The heart rate didn’t change significantly in the diltizem group after extubation comparing with the baseline value. It was decreased significantly (p>0.001) in the esmolol group and
increased (p<0.001) in the control group after extubation. The blood pressure was increased (p<0.001) in the control group; and didn’t change in the esmolol group and the diltizem group after extubation. Esmolol and diltizem were recently stated as good choises in depressing the haemodynamic response against extubation. Our results have found diltizem and esmolol as successfull to attenuate the haemodynamic response against the extubation too.

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GÝRÝÞ ve AMAÇ: Diffüz diyabetik makula ödeminde pars plana vitrektomi (PPV) ve intravitreal triamsinolon uygulamasýnýn makula kalýnlýðýna etkisini araþtýrmak.
YÖNTEM ve GEREÇLER: Laser fotokoagülasyona raðmen düzelmeyen diffüz diyabetik makula ödemli 11 hasta optik koherens tomografi ile prospektif olarak deðerlendirildi. Tüm hastalara iç limitan membran (ILM) soyulmadan arka hiyaloid dekole edilip vitreus korteksi alýnarak pars plana vitrektomi ve operasyon bitiminde 4 mg intravitreal triamsinolon uygulandý. Hastalar ortalama 36 hafta takip edildiler.
BULGULAR: Ortalama retinal kalýnlýkta belirgin azalma gözlendi; preop: 502±141 μm, 1. ay: 231±44 μm ve 3. ay: 234±92 μm. 6. ayda ortalama retinal kalýnlýk preop kalýnlýða göre daha azdý: 410 μm.
TARTIÞMA ve SONUÇ: Bu çalýþmada laser tedavisine dirençli diffüz diyabetik makula ödeminde göziçi steroidlerin hýzlý ve olumlu etkisi kanýtlanmaktadýr. Ayný anda vitre korteksinin alýnmasý triamsinolonun tekrar enjeksiyon ihtiyacýný azaltýyor gözükmektedir.

INTRODUCTION: To ascertain the efficacy of combined surgical and pharmacological treatment for refractory diffuse diabetic macular edema.
METHODS: 11 patients with clinically significant macular edema (CSME) resistant to prior laser treatment were prospectively evaluated with optic cohererence tomography (OCT). All patients underwent vitrectomy, removal of attached vitreous cortex without peeling of the ILM and, at the end of the operation, an injection of 4 mg of triamcinolone into the vitreous cavity. They were followed up for a median 36 weeks.
RESULTS: A marked reduction in median retinal thickness could be detected from baseline: 502±141 μm, at 1 month: 231±44 μm and 3month: 234±92 μm. At 6 months the median retinal thickness was decreased compared to baseline: 410±170 μm.
DISCUSSION AND CONCLUSION: The rapid and benefical effect of intraocular steroid in diffuz diabetic macular edema that persists after laser treatment was confirmed. Simultaneous removal of the vitreous in diabetic eyes appears to reduce the need for re-injections of triamcinolone.

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Kas iskelet sistemi üzerine etkili en önemli hormonlardan birisi tiroid hormonudur. Tiroid fonksiyon bozukluklarýnýn kas güçsüzlüðü, yorgunluk, osteopeni gibi romotolojik semptom ve bulgulara neden olduðu bilinmektedir. Bu sebeple, romatizmal hastalýklarýn ortaya çýkmasýna tiroid fonksiyon bozukluklarýnýn ne oranda katkýda bulunduðunu ve birlikteliklerini araþtýrmak istedik.
Çalýþmaya tek bir romatizmal hastalýðý olan 873 hasta alýndý. Osteoartrit olgularýnýn % 1.01’inde subklinik hipotiroidi, % 3.03’ünde subklinik hipertiroidi, % 1.77’sinde hipertiroidi
vardý. Osteoporoz olgularýnýn % 2.5’inde subklinik hipotiroidi, % 11.95’inde subklinik hipertiroidi, % 2.17’sinde hipertiroidi saptandý. Yumuþak doku romatizmalý olgularýn % 0.8’inde subklinik hipotiroidi, % 5.3’ünde subklinik hipertiroidi ve disk hastalýðý olan olgularýn da % 3.84’ünde subklinik hipertiroidi bulundu. FM olgularýnýn % 2.08’inde (1) subklinik hipotiroidi, % 2.08’inde (1) TSH seviyesinde düþüklük saptandý. RA olgularýnýn % 11.76’sýnda (2) TSH düzeyinde düþüklük saptanýrken, AS hastalarýnda bu oran % 3.3 (1), KTS hastalarda ise % 7.6 (1) olarak gözlendi. Sistemik skleroz ve çakýþma sendromlu 2 hastanýn tiroid fonksiyon testlerinde herhangi bir bozukluk saptanmadý.
Sonuç olarak; romatolojik hastalýklarla tiroid patolojileri çakýþabileceðinden romatizmal þikayetlerin kökenine inildiðinde tiroid patolojileri göz ardý edilmemeli ve uygun tedaviyle klinik sonuçlarýn çok daha iyi olabileceði unutulmamalýdýr.

Thyroid hormones are one of the most effective hormones on musculoskeletal system. It is well known that thyroid gland dysfunctions cause a variety of rheumatologic signs and symptoms including muscle weakness, fatigue and osteopenia. We aimed to evaluate the effects of thyroid function diseases on the occurrance of rheumatological diseases and coincidency of these two entities.
873 patients with rheumatological disorders were involved to the study. 1.01 % of patients with osteoarthritis had subclinical hypothyroidism, 3.03 % had subclinical hyperthyroidism, 1.77 % had clinical hyperthyroidism. 2.5 % of patients with osteoporosis had subclinical hypothyroidism, 11.95 % had subclinical hyperthyroidism, 2.17 % had clinical hyperthyroidism. 0.8 % of patients with soft tissue rheumatological diseases had subclinical hypothyroidism, 5.3 % had subclinical hyperthyroidism and 3.84 % of patiens with discus diseases had subclinical hyperthyroidism. 2.08 % of patients with fibromyalgia had subclinical hypothyroidism, 2.08 % of patients with fibromyalgia had subclinical hyperthyroidism. 11.76 % of patients with rheumatoid arthritis, 3.3 % of patients with ancylosing spondylitis, 7.6 % of patients with carpal-tunnel syndrome had subclinical hyperthyroidism. Two patients with syctemic sclerosis and overlap syndrome had normal thyroid functions.
As a result, a variety of rheumatological and thyroid pathologies may overlap and thyroid diseases should always be in mind when evaluating rheumatological diseases. With proper
combined treatment we can get better results.

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Bu çalýþmada, klinik özellikler ve preoperatif deðerlendirmeye göre operabl olan 78 birincil akciðer kanserli olgu prospektif olarak incelendi. Hastalarýn yaþ, sigara alýþkanlýklarý, semptomlarý, posteroanterior (PA) akciðer grafisi ve bilgisayarlý göðüs tomografisi (BT) bulgularý, taný yöntemleri, histopatolojik tipleri deðerlendirildi. Olgularýn 1’i kadýn, 77’si erkekti ve yaþ ortalamasý 58.32±8.5 (40-76 yaþ) idi. ‹ki hasta sigara içmemiþ, 63 hasta sigarayý býrakmýþ ve 13 hasta halen sigara içmekteydi. Ýçilen sigara miktarý 0-150 paket/yýl arasýnda deðiþirken ortalama 54.77±35.66 (0-150) paket/yýldý.
En sýk rastlanan semptom öksürüktü (% 75.6). Akciðer grafisinde lezyon daha çok saðda (% 53.8) ve santral (% 56.4) yerleþimli idi. PA akciðer grafisi ve bilgisayarlý tomografide en sýk kitle lezyonu (% 80.8), 2. sýklýkta ise hiler geniþleme (%43.6) tespit edildi. En sýk kullanýlan taný yöntemi fiberoptik bronkoskopi (% 65.4) idi. En sýk saptanan histopatolojik tip ise epidermoid karsinomdu (% 60.3).

In this prospective study we examined 78 primary lung cancer cases who were operable according to clinical assesment and preoperative evaluation. We evaluated the age, smoking history, symptoms, chest X-ray and thoracic computed tomography (CT) findings, diagnostic procedures and histopathologic types. One case was female and 77 cases were male. Mean age was 58.32±8.5 (40-76 years of age). Two patients had no smoking history, 63 patients were exsmokers and 13 patients were still smoking. The range of smoked cigarette were 0-150 pack/years and mean was 54.77±35.66 (0-150) packs/years.
The most frequent symptom was cough (75.6 %). The tumor was most commonly located in the right lung (53.8 %) and centrally (56.4 %). In chest X-ray and thorax CT solid lesion was the most common (80.8 %) and hilar enlargement was the second common radiological appearence (43,6 %). Most frequently used diagnostic tool was fiberoptic broncoscopy (65.4 %) and epidermoid carcinoma was the most frequent histopathalogic diagnosis (60.3 %).

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01 Þubat 2002 ile 31 Ocak 2003 tarihleri arasýnda hastanemiz Pediatrik Gastroenteroloji Birimi’ne korozif madde içme yakýnmasý ile baþvuran 85 hasta, retrospektif olarak deðerlendirildi. Hastalarýn ayrýntýlý fizik muayeneleri yapýldý, gerekli görülen hastalarýn akciðer grafileri çekildi. Ýçilen korozif maddeler sýnýflandýrýldýðýnda en sýk içilen korozif maddenin çamaþýr suyu % 40.2 (n=35) olduðu görüldü. Tüm hastalarýn özofagogastroduedonoskopileri yapýldý. Endoskopi sonuçlarý Savary-Miller sýnýflamasýna göre deðerlendirildi. Endoskopi bulgusu evre IIb ve III ile uyumlu olan 27 olguya ortalama üç hafta süreyle kortikosteroid (metilprednizolon) tedavi verildi. Ýki hafta arayla kontrol endoskopileri yapýldý. Erken dönem komplikasyon olarak iki olguda (% 2.3) sepsis, geç dönem komplikasyon olarak bir olguda (% 1.2) özofagus alt uçta striktür geliþimi saptandý.

During the period of February 2002-January 2003, 85 cases with accidental corrosive ingestion who were come to department of pediatric gastroenterology in our hospital were evaluated retrospectively. The roentgenographic examination of chest was applied to the patients who were needed to be examine. The most frequent corrosive substance was household bleach (40.2%) (sodiumhypochloride) in this study. Upper gastrointestinal tract endoscopy was performed all patients within the first 48 hours of caustic ingestions. Endoscopy results were evaluated according to Savary-Miller Clasifications. Twenty-seven children with a second b-(n=15) or thirddegree (n=12) esophagus burns were treated with methylprednisolone. Control endoscopy was performed that children
with two weeks intervals. We determinated sepsis as an early complication that two patient and development of esophageal stricture as an late complication that one patient.

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GÝRÝÞ ve AMAÇ: Kollum femoris kýrýklý yaþlý hastalarda ameliyat öncesi hazýrlanacak kan miktarýnýn tahmin edilebilmesi ve ameliyat süresinin kan ihtiyacýna etkisinin belirlenmesi.
YÖNTEM ve GEREÇLER: Kliniðimizde kollum femoris kýrýðý nedeniyle yatýrýlarak parsiyel endoprotez ameliyatý yapýlan 60 yaþ ve üstü, ASA (Amerikan Anestezi Derneði fiziksel durum sýnýflamasý) grup I-II olan 117 hastanýn ameliyat öncesi alýnan kan örneklerinde hemoglobin ve hematokrit deðerlerinin ortalamalarýnýn, ameliyat sonrasý alýnan kan örneklerindeki ortalamalar ile karþýlaþtýrýlmasý ve ameliyat sürelerinin bu ortalamalar arasý fark ile korelasyonu araþtýrýlmýþtýr. Transfüzyon hemoglobin 8.5 g/dl’nin altýnda olunca yapýlmýþtýr.

BULGULAR: Ameliyat öncesi hemoglobin 10.7 g/dl’nin altýnda veya hematokriti % 32.3’ün altýnda olan hastalarýn hepsinde ameliyat sonrasý en az 2 ünite eritrosit süspansiyonu transfüzyonu ihtiyacý olmuþtur. Ameliyat süresi ile hemoglobin ve hematokrit düþüklükleri arasýnda herhangi bir korelasyon bulunmamýþtýr. Ameliyat süreleri ortalama 81 dakikadýr.
TARTIÞMA ve SONUÇ: Ameliyat sonrasý kan transfüzyonu ihtiyacýný ameliyat süresinden daha fazla hastanýn ameliyata giriþ hemoglobin ve hematokrit deðerleri belirlemektedir.

INTRODUCTION: To estimate the amount of blood to be prepared before operation in old patients with collum femoris fracture and to identify the effect of the duration of operation on the need for blood.
METHODS: Average hemoglobin and hematocrit values of blood samples taken preoperatively from 117 patients with 60 years of age and over, who are hospitalized in our clinic due to collum femoris fracture and operated for partial endoprosthesis and who are in group I-II according to ASA have been compared with the average of those in blood samples taken postoperatively and correlation of the duration of operations with the difference in between have been investigated. Transfusion is performed when hemoglobin is below
8.5 g/dl.
RESULTS: In all patients having hemoglobin below 10.7 g/dl or hematocrit below 32.3 % preoperatively, at least 2 units of erythrocyte suspension transfusion was needed postoperatively. No correlation is detected between the duration of operation and low levels of hemoglobin and hematocrit. Average duration of operation is 81 minutes.
DISCUSSION AND CONCLUSION: The need for postoperative blood transfusion is determined by preoperative hemoglobin and hematocrit values of the patient rather than the duration of operation.

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Bu ön çalýþmada, birinci ve ikinci basamakta çalýþan hemþirelerde kronik yorgunluk sendromu sýklýðýnýn ve sosyodemografik ve eðitim ile ilgili deðiþkenlerle iliþkisinin belirlenmesi için bir anket çalýþmasý planlandý. Dicle Üniversitesi Týp Fakültesi Aile Hekimliði AD tarafýndan düzenlenen, açýk uçlu sorulardan oluþan, iki veya daha fazla seçmeli sorularýn yer aldýðý yarý yapýlandýrýlmýþ bir anket formu demografik özellikler, çalýþma koþullarý, alýþkanlýklar ve boþ zaman uðraþýsý ile ilgili 14 soru içermekteydi. Ankete CDC’nin kronik yorgunluk sendromu (KYS) deðerlendirme kriterleri de eklendi. Nisan 2004’te, Dicle Üniversitesi Atatürk Saðlýk Yüksekokulu (DÜ-ASYO)’ndan iki Öðretim Üyesi tarafýndan yüzyüze görüþme yöntemiyle yapýlan anket çalýþmasýna, Diyarbakýr Devlet Hastanesi (DDH), Diyarbakýr Çocuk Hastanesi (DÇH), Diyarbakýr Göðüs Hastalýklarý Hastanesi (DGHH) ve Batýkent Saðlýk Ocaðý (BSO)’ndan 33 hemþire katýldý.
Hemþirelerin ortalama yaþý 29.2±7.9 yýldýr. KYS’nin CDC kriterlerini karþýlayan olgu sayýsý 4 (4/33, % 12.1) olup, kronik bir hastalýkla iliþkilendirilemedi. Toplam 10 olgu (10/33, % 30.3) KYS + idiyopatik kronik yorgunluk (IKY) + uzamýþ yorgunluk (UY) baþlýðý altýnda toplandý. IKY kriterlerini karþýlayan olgu sayýsý üçtür (3/33, % 9.1). Bir olgu (1/33, % 3.0) ise uzamýþ yorgunluk (UY) olarak deðerlendirildi. KYS bulunmayan 24 olgunun ikisinde ise ek bulgulardan bazýlarý bulundu.
Hemþireler, iþ yerinde stresli iþ vardiyasý veya diðer olasý stres kaynaklarý nedeniyle KYS, IKY ve UY gibi saðlýk problemlerine sahiptir. Ancak, medeni durum ve öðrenim düzeyinin kronik yorgunluk üzerinde etki oluþturmadýðý gözlendi.

In this preliminary study, a public survey was planned to investigate frequency of chronic fatigue syndrome (CFS) among nurses employed in primary and secondary health care centers and its relationship with sociodemographic factors and education. The poll designed by Family Medicine Department of Dicle University Medical Faculty involved 14 open-ended and multiple-choice questions about demographic features work conditions habits and hobbies. The criteria of Center for Disease Control (CDC) for defining chronic fatigue syndrome were also added into the poll. In April2004, 33 nurses from Diyarbakýr State Hospital, Diyarbak›r Children Hospital, Diyarbakýr Chest Disease Hospital and Bat›kent Primary Health Care Clinic participated the survey. Two academicians from Dicle
University Atatürk Health Institute worked as polestars to complete the survey face-to-face interviews with each nurse.
Mean age of the nurses was 29.2±7.9 years. There were four cases (4/33, 12.1 %) matching the criteria of CDC for CFS and none of them were found to be related with a chronic disease state. A total of 10 cases (10/33 30.3 %) were grouped with diagnosis of CFS, chronic idiopathic fatigue (CIF) and prolonged fatigue (PF). Number of cases with CIF were three (3/33, 9.1 %) and one nurse was found to have PF (1/33, 3.0%). Among 24 cases without CFS, two had some of additional findings.
Nurses have CFS, CIF and PF due to stressed work shift and other sources of stress. However, it was observed that marital status and education level did not occur any effect on chronic fatigue.

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Burun taþýyýcýsý hastane çalýþanlarý Staphylococcus aureus epidemilerinden büyük oranda sorumlu tutulmaktadýr. Hemodiyaliz (HD) hastalarý, kronik böbrek yetersizliði nedeniyle infeksiyonlara yatkýn olmakta ve bu hastalarda S aureus burun taþýyýcýlýðýnýn sonlandýrýlmasý önem kazanmaktadýr. Bu çalýþmada, Dicle Üniversitesi Týp Fakültesi HD merkezinde programda olan 18 HD hastasý (16 bayan, iki erkek) ile ayný merkezde görev yapan 16 hemþirenin burun stafilokok taþýyýcýlýðýný belirlemek amacýyla burun sürüntü kültürü alýndý. Ýzole edilen suþlar Vitek Bio-Meriéux ve klasik yöntemle tanýmlandý. Antibiyotik duyarlýlýðý Vitek Bio-Meriéux‚ mikrodilüsyon yöntemiyle belirlendi. Sekiz HD hastasý ile 6 hemþirede S aureus burun taþýyýcýlýðý tespit edildi. Hemþirelerden izole edilen 6 S aureus suþundan ikisinde, diyaliz hastalarýndan izole edilen 8 suþun dördündemetisiline direnç vardý. HD hastalarýndan ve hemþirelerden izole edilen toplam 14 suþ incelendiðinde, vankomisin ve teikoplanine % 100 duyarlý bulunurken, izole edilen tüm suþlar penisilin G ve ampisiline dirençli idi.

Staphylococcus aureus carriage in hospital staff members are more responsible for epidemy of S aureus. Hemodialysis (HD) patients are tender to the infections due to chronic renal failure (CRF) and in this patients, eradication of S aureus nasalcarriage
is important. In this study, in Hemodialysis Center of Dicle University, Faculty of Medicine, from 18 patients in HD program (16 female, two male) and from 16 nurses, cultures of nasal swab were taken to determine the nasal carriage of S. aureus on their nose.
The strain of isolated microorganism was defined by Vitec Bio-Meriéux‚ and classic method. Antibiotic susceptibility was determined by the method of Vitec Bio-Meriéux‚ nasal carriage of S aureus was determined 8 of 18 HD patients and 6 of 16 nurses. A methicillin-resistant strain of S aureus (MRSA) isolated in 2 of 6 strain of S aureus isolated from hospital staff member, and 4 of 8 strain isolated from HD patients. When
totally 14 strain isolated from HD patients and nurses were investigate to susceptibility, of these strains were found to susceptible to vancomisin and teicoplanine as 100 %, respectively; however, the all strains were resistant to penicilline G and ampiciline.

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Humerus’un distal ucunun bir konjenital varyasyonu olan processus supracondylaris, humerus’un anteromedial yüzünden, epicondylus medialis’in yaklaþýk 5 cm yukarýsýndan çýkar. Bazen bu çýkýntýnýn ucundan bir ligament (Struthers ligamenti) çýkarak epicondylus medialis’e tutunabilmektedir. Genellikle asemptomatik olan bu çýkýntý ve ligament, bazen altýndan geçen nörovasküler yapýlara basý yapabilmektedir. Bu çalýþma, processus supracondylaris’i geniþ bir kemik seride araþtýrarak Türk popülasyonundaki sýklýðýný bildirmek ve klinik olarak önemli olan bu yapýnýn literatüre genel bir bakýþ ile gözden geçirilmesini amaçlamaktadýr.
Çalýþmada yaþ ve cinsiyeti belirsiz 106’sý sað 103’ü sol olmak üzere toplam 209 eriþkin humerus kemiði incelenerek, her bir kemikte processus supracondylaris varlýðý, çýkýntýnýn uzunluðu ve çýkýntý kökünün epicondylus medialis’in üst ucuna olan mesafesi dijital kumpasla ölçüldü. Ýncelenen kemiklerde, bir adet sol humerus kemiðinde 10.6 mm uzunluðunda ve epicondylus medialis’in 37 mm yukarýsýnda bariz tam geliþmiþ bir processus supracondylaris; biri sað diðeri sol olmak üzere iki kemikte ise 1.8-2 mm uzunluðunda minimal formda iki çýkýntý tespit edildi.
Bu çalýþma sonucunda elde edilen bulgular, literatürde bildirilen diðer araþtýrma sonuçlarý ile uyumlu olup, toplam 3 adet processus supracondylaris saptanarak, popülasyonumuzdaki sýklýðý % 1.44 olarak belirlenmiþtir.

Supracondylar process, a congenital variation of the distal humerus, arising from the anteromedial surface 5 cm proximal to the epicondylar process. From the tip of the process, a ligament (Struthers ligament) may arise and connect to the medial epicondyle. The process and ligament are usually asymptomatic, and occasionally may cause compression on underlying neurovascular structures. This study investigates the incidence of the supracondylar process in the Turkish population on a large series of bony specimens and review the literature on this clinically important structure.
This study was performed on 209 (106 right, 103 left side) adult humerus bony specimens of unknown sex. The incidence of the process was investigated, and length of the process, and the distance of the process to the upper tip of the medial epicondyle were measured using digital millimeter graph.
In the series investigated, a well-developed supracondylar
process 37 mm proximal to the medial epicondyle, 10.6 mm in length was observed on a left humerus; two minimal form supracondylar processes were observed on a right and left humerus as small bumps 1.8-2 mm in length.
The results of this study are in accordance with the earlier studies and determine the incidence of the supracondylar process in Turkish population as 1.44 %.

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Çalýþmanýn amacý, periton kapanýrken uygulanan tramadol ve morfinin, derlenme ve erken postoperatif dönemdeki aðrý ile solunum parametreleri üzerine etkilerinin karþýlaþtýrýlmasýdýr.
Abdominal cerrahi uygulanacak 60 hastaya standart anestezi uygulandý. Olgular 3 gruba ayrýlarak, periton kapanma aþamasýnda Grup I’e 0.1 mg/kg morfin, Grup II’ye 1.5 mg/kg tramadol ve Grup III’e ise 3 mg/kg tramadol intravenöz olarak verildi. Operasyon bitiminde, oryantasyon ve komutlara cevap zamanlarý ile 15-30-60-90. dk’larda aðrý þiddeti, solunum sayýsý, yan etkiler (bulantý ve kusma) kaydedildi; ekstübasyon sonrasý, 10, 15 ve 30. dk.’larda arteri kan gazý analizi yapýldý.
Komutlara cevap ve oryantasyon zamaný Grup I’de en kýsaydý (p<0.05). Aðrý skorlarý ise 1.5 mg/kg tramadol uygulanan hastalarda diðer gruplara göre anlamlý yüksekti (p<0.05), diðer gruplar birbirine benzerdi. 3 mg/kg tramadol uygulanan hastalarda bulantý sýklýðý yüksekti.
Sonuç olarak; 0.1 mg/kg morfin ve 3 mg/kg tramadolun etkili ve benzer analjezi saðladýðý, derlenmenin ise morfin grubunda daha iyi olduðu kanýsýna varýldý.

The aim of the study is to compare the effects of tramadol and morphine administrated during wound-closure on recovery and immediate postoperative pain relief with respiratory parameters.
Sixty patients undergoing abdominal surgery were given standart anaesthesia. The patients were divided into three groups. At wound closure, patients in Group I was given
iv morphine 0.1 mg/kg, in Group II tramadol 1.5 mg/kg and in Group III tramadol 3 mg/kg. At the end of the operation, the time of orientation and the time of response to the commands were recorded. At 15-30-60-90 minutes after the operation pain scores, respiratuary rate, and adverse effects (vomiting and nausea) were recorded. At 10,15 and 30 minutes after extubation arterial blood gases analysis were done. The time of
response to the commands and the time of orientation were the shortest in Group I (p<0.05). Pain scores were significantly higher in patients who received tramadol 1.5 mg/kg than the other groups (p<0.05). The other groups were similar. Vomitus incidence was high in the patients who received tramadol 3 mg/kg. In conclusion; 0.1 mg/kg morphine and 3 mg/kg tramadol provided effective and similiar analgesia. Recovery
was better in the morphine group.

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GÝRÝÞ ve AMAÇ: Retina dekolman tedavisinde subretinal sývý drenajýndan önce kriyoterapi uygulamasýnýn göziçi hemoraji (GÝH) sýklýðýna etkisini araþtýrmak.
YÖNTEM ve GEREÇLER: Regmatojen retina dekolmanlý subretinal sývý drenajý yapýlan 40 hastanýn 40 gözü çalýþmaya alýndý. 16 olguya kriyoterapiden önce drenaj (DACE), 24 olguya ise kriyoterapiden sonra drenaj (CDAE) uygulandý. Tüm olgularda transkleral drenaj 5/0 dakron iðnesi ile yapýldý.
BULGULAR: Her iki grupta da GÝH sýklýðý düþüktü. Aralarýnda anlamlý bir fark yoktu; DACE: % 6, CDAE: % 4.5 (p=0.41). Her iki grupta da tek operasyon sonucunda anatomik baþarý oranýnda anlamlý bir fark yoktu.
TARTIÞMA ve SONUÇ: SRF drenajýndan önce kriyoterapi uygulamasý emniyetli ve etkili bir yöntemdir.

INTRODUCTION: To investigate the effect of performing cryotherapy before drainage of subretinal fluid (SRF) on the incidence of intraocular haemorrhage (IOH) in the management of retinal detachment.
METHODS: 40 eyes of 40 patients with rhegmatogenous retinal detachment requiring SRF drainage were recruited 16 cases were randomised to receive drainage before cryotherapy (DCAE) while 24 cases had drainage after cryotherapy (CDAE). All cases had transcleral drainage of SRF using a 5/0 dacron sutur needle.
RESULTS: There was low incidence of IOH associated with drainage in both groups with no significant difference between the groups; DACE group: 6 % CDAE group: 4.5 % (p=0.41). There was no significant difference between the groups in the rate of anatomical success with a single operation.
DISCUSSION AND CONCLUSION: It was concluded that the surgical sequence of applying cryotherapy before drainage of SRF can be safely effectively performed.

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Selektif IgA eksikliði serumda IgG ve IgM düzeyleri normal iken, IgA düzeyinin 5 mg/dl’nin altýnda olmasýdýr. En sýk tanýmlanan birincil humoral immün yetersizlik tipidir. Sýklýðý 1/600-1/800 olarak bilinmektedir.
Bu çalýþmada Aralýk 2001-Nisan 2004 tarihleri arasýnda kliniðimizde IgA eksikliði tanýsý alan 40 hasta baþvuru anýndaki yaþlarý, cinsiyet daðýlýmý, baþvuru þikayetleri, immün yetersizlik tipi, infeksiyon odaklarý, infeksiyon tipleri, ek patolojiler ve komplikasyonlar açýsýndan retrospektif olarak deðerlendirildi. Amacýmýz IgA eksikliði düþündürecek klinik bulgularý belirlemek ve IgA eksikliðinin komplikasyonlarýný tanýmlamaktý.
Hastalarýmýzda gözlenen baþlýca þikayetler; tekrarlayan infeksiyonlar (% 65), alerjik hastalýklar (% 32.5) ve otoimmün hastalýklardý (% 10). ‹nfeksiyonlardan en çok solunum sistemi etkilenmiþti (% 77.5). En sýk gözlenen alerjik semptomlar ise astým ve rinitti.
Geniþ klinik varyasyonlarla karþýmýza çýkan IgA eksikliðinde amaç erken tanýya gitmek olmalýdýr. Bu þekilde infeksiyonlar ve alerji için önlem alýnýp hastalarda morbidite azaltýlýp, yaþam kalitesi artrýlabilinir.

Selective IgA deficiency is defined as less than 5 mg/dL of serum IgA in the presence of normal concentrations of IgM and IgG. Among the B-cell disorders it is the most commonly identified deficiency. It occurs in one in every 600 to 800 individuals.
In this study, 40 patients with IgA deficiency followed in our clinic between January 1997- April 2004 are analyzed retrospectively in terms of age at presentation, gender, symptoms, type of disorders, origin of infections, type of infections, accompanying diseases and complications. The aim was to evaluate the main clinical findings that suggest IgA deficiency and describe the complications observed.
The main observed complaints were: recurrent infections (65 %), allergies (% 32.5) and autoimmune diseases (% 10). The respiratory system was the most affected by infections, and asthma and rhinitis were the most frequent allergic symptoms.
IgA deficiency which has a large clinical spectrum should be diagnosed early to initiate prophylaxis for infections and allergy. So in this way we can decrease morbidity and rise guality in life of patients.

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CK isoenzymes provide more spesific information about injured tissue because of their tissue distribution. CK-linked immunuglobulins are recognized as macro CK because of their large molecular size. Clinical importance of macro CK lies in its potential to create confusion during the investigation of possible myocardial injury. Although the better approach is to measure CK-MB mass by using immunometric assay with monoclonal
antibodies for the M or B subunit, CK-MB mass method is also not free of interference with CK-BB, CK-MM, mitochondrial and macro CK. In this report, since we determined false positivity in two cases that applied to our department, we aimed to reveal particular points that will be taken into consideration in connection with interpretation of CKMB activity assay.

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Bartter Syndrome, is characterized by hypokalemic metabolic alkalozis, increased renin and aldosterone levels in spite of normal blood pressure with unknown aetiology. Here we report a 5 month old boy admitting with growth retardation and vomiting, diagnosed as Bartter Syndrome in associaion with craniosnostasis and microcephaly.

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We report a case with subcutaneous abscess and sepsis due to Staphylococcus aureus. A 65-year-old man with a history of cytostatic therapy due to small cell lung carcinoma presented to us with sign and symptoms referable to the arms, including pain, tenderness, induration and increased warmth in the arm. Methicillin susceptible S. aureus was isolated from the cultures. Debridement and surgical drainage of the abscess were done. Patient received adequate antibiotic treatment. Her systemic symptoms resolved in 3 days. At the 10thday of the treatment, patient had fever again. Although vancomisin therapy started, patient has died at the 11th day of the treatment.

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Hirsutism is a common and often distressing condition and can be abnormal when it is associated with menstrual disturbances and infertility. Although hirsutism is usually clinical
sign of a benign condition, it may be harbinger of a serious underlying pathology such as androgen producing tumor. We present a case of virilized girl caused by PCOS and succesfully treated with oral contraceptive and flutamide combination.

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Pilomatricomas are benign tumoral masses originated from skin hair matrix and presented as hard subcutanous masses. It is very rare that these tumors,which are mostly encountered in the head and neck area, are seen in multiple localizations within the same patient.

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In ectopic pregnancy, a fertilized ovum implants in an area other than the endometrial lining of the uterus. Primary ovarian pregnancy is a rare variant of ectopic pregnancy. Incidence is
reported as 1/7.000-1/60.000. Primary ovarian ectopic pregnancy is 1-3 % of all ectopic pregnancies. It is difficult to diagnose clinically and even intra operatively. Ovarian pregnancy is diagnosed only after pathologic examination of the specimen.

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The aim of this article is to report second Kawasaki disease case which in a complication leptospirosis in literature. The severity of leptospira infections varies from subclinical illness to severely potential fatal status spectrum of renal and liver failure. Less common features include Kawasaki syndrome, cerebrovascular accidents, rhabdomyolysis, thrombocytopenic purpura, acute cholecytitis and erythema nodosum. Kawasaki disease is a form of vasculitis with several unusual aharacteristics. Its epidemiologic and clinical features strongly suggest an infectious etiology.
Case: Two years old previously healthy boy, admitted to our clinic with sudden onset of fever (39°-40°) lasting a week. In physical examination, he had cervical lymphadenitis, conjunctivitis, tonsillitis, maculopapular rash and dry fissured lips. Few days later edema of both hands and feet was observed. Laboratoty studies revealed Hb 10 gr/dl, Htc % 28.7, leukocyte count was 16.790 mm3, platelet 1.172.000 mm3, erythrocyte sedimentation rate was 50 mm/saat, CRP 28 mg/dl. Physical examination and laboratory investigations led to the diagnosis of Kawasaki disease. IVIG 2 gr/kg and aspirin 80 mg/kg/day was given as treatment modality. Two dimentional echocardiogram
was observed normal. Serologic investigation revealed L. Heptomandis and L. Canicola. High dose penicilin (400.000 U/kg/day) was given for 10 days.

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