Desfluran anestezisi uygulanan açýk kolesistektomi operasyonlarýndan sonra bulantý ve kusmanýn önlenmesinde midazolam ve propofolün etkilerinin karþýlaþtýrýlmasý amaçlandý.
Elektif kolesistektomi operasyonu planlanmýþ, ASA I-II, 20-70 yaþ arasý 120 hasta çalýþmaya alýndý. Monitörizasyonu takiben anestezi indüksiyonu fentanil 1mcg/kg, tiyopental 5 mg/kg ve vekuronyum bromid 0.1 mg/kg ile, anestezi idamesi % 2-8 konsantrasyonda desfluran ve % 50 N2O/O2 ile saðlandý. Operasyonun bitiminde hastalar rastgele 3 gruba ayrýldý. Ýlk cilt sütürüne baþlandýðýnda, Grup P'deki hastalara propofol 0.5 mg/kg, Grup M'deki hastalara midazolam 0.05 mg/kg ve Grup K'daki hastalara % 0.9 NaCl 5 ml iv. olarak uygulandý.
Postoperatif 1., 10., 20., 30., 40., 50., 60. dakikalarda ve 1.,2., 4., 8., 12., 24. saatlerde bulantý skoru, sedasyon skoru, KAH, OAB ve SpO2 deðerleri kaydedildi.
Grup içi baþlangýç deðerlerine göre ve gruplar arasýnda OAB, KAH ve SpO2 deðerleri açýsýndan fark yoktu. Grup K'nýn baþlangýç, 10., 20., ve 30. dk. bulantý skoru ortalamasý Grup P ve Grup M'den istatistiksel olarak anlamlý derecede yüksekti (p<0.05). 40. dk.'dan itibaren gruplar arasýnda bulantý skorlamalarýnda istatistiksel olarak anlamlý farklýlýk bulunmadý. Grup P ve Grup M'nin bulantý skoru ortalamalarý arasýnda farklýlýk bulunmadý. Grup M'nin baþlangýç, 10., 20. ve 30. dk. sedasyon skoru ortalamasý Grup P ve Grup K'ya göre; Grup P'nin baþlangýç, 10. ve 20. dk. sedasyon skoru ortalamasý Grup K'ya göre istatistiksel olarak anlamlý derecede yüksekti (p<0.01, p<0.05).
Midazolam ve propofol, desfluran anestezisi uygulanan açýk kolesistektomi operasyonlarýndan sonra sýk görülen bulantý-kusmayý önlemiþtir, ancak bu ilaçlarýn sedasyon etkisi göz ardý edilmemelidir.

It was aimed to compare the effects of midazolam and propofol in preventing nausea and vomiting in the patients undergoing open cholecystectomy with desflurane anesthesia.
120 patients aged 20-70 years with ASA physical status I-II scheduled for elective cholecystectomy were included. After standard monitorisation anesthesia induction was done with fentanyl 1 mcg/kg, thiopental 5 mg/kg and vecuronium 0.1 mg/kg. Anesthesia was maintained with 2-8 % desflurane in 50 % N2O-50 % O2. At the end of the operation the patients were divided randomly into three groups. When the skin closure was started patients in group P were given propofol 0.5 mg/kg, patients in group M were given midazolam 0.05 mg/kg and group K were given 5 ml isotonic saline intravenously. Vomiting and sedation scores, heart rate (HR), mean arterial pressure (MAP) and SpO2 values were recorded at postoperative 1st, 10th, 20th, 30th, 40th, 50th, 60th minutes and 1st, 2nd, 4th, 8th, 12th, 24th hours.
There was no differences between the groups with regard of HR, MAP and SpO2 values through out the study period. The mean vomiting scores of the patients in group K were statistically higher than the patients in group P and group M at the beginning, 10th, 20th and 30th minutes (p<0.05). After 40th minutes there was no difference in the vomiting scores between the groups. There was no statistically significant difference between the vomiting scores of group P and group M at any time. Sedation scores of the patients in group M were statistically higher than the patients in group P and group K at the beginning, 10th, 20th and 30th minutes, sedation scores of the patients in group P were statistically higher than the patients in group K at the beginning, 10th and 20th minutes, (p<0.01, p<0.05).
Midazolam and propofol were both effective in preventing nausea and vomiting in the patients undergoing open cholecystectomy with desflurane anesthesia. However their sedative effects must be taken into account.

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Çalýþmanýn amacý, demir eksikliði olan çocuklarda çinko eksikliðinin prevalansýný saptamaktýr. Bu çalýþmada demir eksikliði anemisi tanýsý konmuþ, yaþlarý 1-12 yýl arasýnda deðiþen 49'u erkek, 20'si kýz toplam 69 çocuk ile yaþlarý 1-12 yýl arasýnda deðiþen 16 erkek, 8 kýz toplam 24 saðlýklý çocuk çinko eksikliði açýsýndan incelendi. Tüm çocuklarýn iþtah durumlarý, anne sütü, inek sütü, çay, kýrmýzý et ve balýk tüketimleri sorgulandý. Demir eksikliði anemisi olan grupta serum çinko düzeylerini, kontrol grubunun ortalama serum çinko düzeyinden anlamlý bir þekilde düþük bulduk (p<0.05). Bununla birlikte, hasta grubunda serum çinko düzeyi düþüklüðünün prevalansý da oldukça yüksekti (% 49.2). Bu durum, çinko eksikliðini tanýmlayacak duyarlý ve basit taný testleri rutine girene kadar çocukluk çaðý gibi yüksek risk grubunda erken dönem destek programlarý düþünülmesi gereðini ortaya koymaktadýr.

The aim of this study is to detect the prevalence of zinc deficiency in children with iron deficiency anemia. In this study, sixty-nine children with iron deficiency anemia ages between 1-12 years (49 male, 20 female) and 24 healthy children, ages between 1-12 years (16 male, 8 female) were examined to investigate zinc deficiency. All children were investigated about level of their appetite, ingestion of cow's milk, tea, meat, fish and breast feeding. We detected statistically significant lower level of zinc in the group of iron deficiency anemia compared with the control (p<0.05). The prevalence of zinc deficiency was also significantly higher in iron deficiency group (49.2 %). This situation suggests the necessity of developing supplementation programs for high risk groups like childhood until
more sensitive and simple laboratory tests to detect zinc deficiency are available in routine clinical use.

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Operasyon odalarý ve yoðun bakým üniteleri gibi hastane bölümlerinde, oda hava kalitesi, hastane infeksiyonlarýnýn önlenmesinde ve hastalar ile hastane çalýþanlarýnýn ortam havasýný kirleten çeþitli kimyasal ve mikrobiyolojik ajanlardan korunmasýnda önemlidir. Cerrahi giriþim yeri infeksiyonunun önlenmesinde de operasyon odalarýnýn hava dezenfeksiyonu önem taþýmaktadýr. Ameliyat odalarýnda koridorlara ve diðer komþu alanlara göre pozitif basýnç saðlanmasý, ameliyathanelerdeki havalandýrma sistemlerinde iki ayrý filtre sisteminin bulunmasý, havanýn yüksek etkinliðe sahip bir filtre olan High Efficiency Particulate Air filter (HEPA)'den geçirilmesi, laminar hava akýmý saðlanmasý oda hava kalitesi içinde yer alan önlemlerdir.
Sarýkamýþ Asker Hastanesi ameliyathanelerinde pozitif basýnç uygulamasý ya da filtreli bir havalandýrma düzeneði bulunmamakta, oda havasý dezenfeksiyonu UV lambalarla ve diðer dezenfeksiyon yöntemleri ile saðlanmaktadýr. Çalýþmamýzda Sarýkamýþ Asker Hastanesi ameliyathanelerinde kullanýlan ultraviole ýþýnlarýnýn, ameliyathane havasýnda yer alan mikroorganizmalar üzerine etkinliðinin üç farklý yöntem ile araþtýrýlmýþtýr. Ameliyathanemizde UV ýþýnlarýnýn oda havasý dezenfeksiyonda etkin olduðu, 3 deðiþik yöntemle belirlenen etkinliklerde farklýlýk olmadýðý ve etkinliðinin daha önceki çalýþmalara benzer olduðu, ancak düþük penetrasyon gücü nedeniyle etkinliðinin çok sýnýrlý olduðu gözlenmiþtir. Ameliyathanelerde kullanýlan UV ýþýnlarýnýn etkinliði bu gibi yöntemlerle periyodik olarak belirlenmelidir. Ancak, ameliyathane havasý dezenfeksiyonunda, laminar akým ve HEPA filtreli klimatizasyon cihazlarýnýn kullanmanýn gerekli olduðu, ameliyathane içerisinde pozitif basýnç saðlanmasý gerektiði unutulmamalýdýr. Ülkemizdeki pek çok ameliyathanede olduðu gibi, sadece zayýf penetrasyona sahip UV ýþýnlarýnýn kullanýmý ile etkin hava dezenfeksiyonu ve operasyon sonrasý ciddi maliyet, morbidite ve mortalite artýþlarýna neden olan cerahi alan infeksiyonlarýnýn önlenemeyeceði unutulmamalýdýr.

In operating rooms or intensive care units, air quality is an important factor in preventing hospital infections and protecting patients and hospital staff from various chemical and
microbiological agents that contaminate the air. Likewise, disinfecting operating rooms also helps prevent surgical site infection. High air quality in hospitals can be ensured by providing more positive pressure in operating rooms when compared to corridors or other neighboring areas, installing two separate filter systems in operating room ventilation systems, moving the air through a High Efficiency Particulate Air filter (HEPA), and supplying laminar air flow.
In Sarýkamýþ Military Hospital operating rooms, where there is no positive pressure treatment or a filtered ventilation system, air disinfection is provided by UV lamps and other disinfection methods. This study investigated the effects of UV lights on the micro-organisms in the operating room air in Sarýkamýy Military Hospital by using three different methods. The results showed that UV lights in the operating room did indeed disinfect the air and that there was no difference between the efficiency levels measured by three different methods. Additionally, the efficiency levels obtained in this study were similar to those found in earlier studies, but it was also concluded that efficiency was highly restricted due to low penetration. The study thus suggests that the efficiency of UV
lights in operating rooms should be measured periodically through similar methods. At the same time, it should be remembered that laminar flow and HEPA filtered climatization
tools are also necessary for operating room disinfection, and that positive pressure is needed in operating rooms. The use of weak penetration UV lights alone, as is the case in
many operating rooms in Turkey, is not enough to ensure efficient air disinfection and may not prevent post-operative surgical site infections which are a major cause of patient injury, mortality, and health care cost.

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Bu çalýþma; romatoid artritli hastalarda, fonksiyonel yetersizliði deðerlendiren el göstergeleri ile romatoid artrite özgül ölçekler ve radyolojik skorlama arasýndaki iliþkileri deðerlendirmek amacýyla yapýldý.
Çalýþmaya 99 hasta alýndý. Her hastada Visuel Analog Skala (VAS), hastaya detaylý bir þekilde anlatýlarak deðerlendirildi. Buna göre Hastalýk Aktivite Skoru (Disease Activity Score, DAS-28) hesaplandý. Yine her hastada saðlýk deðerlendirme anketi (Health Assessment Questionnaires, HAQ), Duruöz El Skalasý (Duruöz's Hand Index, DHI), Modifiye Kapandji Ýndeksi (MKI) deðerlendirildi. Hastalarýn grafileri alýnarak Larsen yöntemine göre toplam skor alýndý.
HAQ, DHI, MKI fonksiyonel indeksleri karþýlaþtýrýldýðýnda aralarýnda anlamlý iliþki saptandý (p<0.001). Bu indekslerin her biri Larsen skoruyla iliþkiliydi (p<0.005, p<0.001, p<0.001). DHI ile MKI arasýnda negatif yönde ve istatistiksel olarak ileri düzeyde anlamlý iliþki bulundu (p<0.01). DAS-28 ile HAQ ve DHI arasýnda pozitif yönde ve istatistiksel olarak ileri düzeyde anlamlý iliþki bulunurken (p<0.01); DAS-28 ile MKI arasýnda negatif yönde ve istatistiksel olarak ileri düzeyde anlamlý iliþki saptandý (p<0.01).
Sonuç olarak; DHI ve MKI'nin, hem hastalarýn fonksiyonel düzeyleri ile hem de radyolojik evreleri ile iliþkili olmalarý nedeniyle, hastalarýn kliniðini deðerlendirmede ve hastalýk takibinde kullanýlmasý gerektiði düþüncesindeyiz.

This study is conducted on a group of patients suffering from rheumatoid arthritis, with the aim of obtaining the correlations between the manual tools that assess functionality disorders, and the scales specific to rheumatoid athritis and radiological
staging.
Each of the 99 patients participating the study were provided with a detailed explanation of the Visual Analogue Scale (VAS), before being evaluated. The Disease Activity score
(DAS-28) was then calculated accordingly. Also, for each patient, Health Assesment Questionnaires (HAQ), Duruoz Hand Index (DHI) and Modified Kapandji Index (MKI) were computed. The graphies of the patients were taken, and the total scores were calculated using the Larsen Method.
Comparison of the HAQ, DHI and MKI functionality indices showed meaningful correlations among these indices (p<0.001). Furthermore, each of these indices were correlated
with the Larsen score (p<0.005, p<0.001, p<0.001, respectively). Also, negative and statistically strong meaningful correlation among DHI and MKI was observed (p<0.01).
While there were positive and statistically strong meaningful correlations between DAS-28 and each of the HAQ and DHI (p<0.01), the correlation between DAS-28 and MKI, although still statistically strong and meaningful (p<0.01), was found to be negative.
We conclude, based on the fact that DHI and MKI are correlated with the functional states and the radiological stages of the patients, that it is necessary to use DHI and MKI for clinical evaluation and follow-up of the patients.

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Mastektomi ameliyatýný takiben en sýk gözlenen komplikasyonlar seroma, lenfödem, infeksiyon ve yara nekrozudur. Morbidite hastanede kalýþ süresinin uzamasýna neden olarak hastaya psikolojik ve ekonomik yük getirmektedir. Çalýþmanýn amacý, bu hastalarda morbiditeyi etkileyen faktörleri saptamaktýr. Adana Numune Eðitim ve Araþtýrma Hastanesinde 9 yýllýk bir süre içinde meme kanseri nedeni ile mastektomi ameliyatý uygulanan 58 hasta bu amaçla retrospektif incelendi. Postoperatif komplikasyonlarýn oraný, nedenleri ile bu komplikasyonlarý etkileyen faktörler log rank test ve cox regresyon analizi kullanýlarak saptand›. Toplam postoperatif komplikasyon oraný % 24.3 olup, seroma % 10.8, yara infeksiyonu % 5.4, nekroz % 4.5 ve lenfödem % 3.6 oranýnda saptandý.
Kapalý emici drenler, plastik drenler ile karþýlaþtýrýldýðýnda postoperatif komplikasyon oranýný azaltmakta istatiksel olarak anlamlý bulundu.

The most common complications following mastectomy were seroma, lymhoedema, infection and necrosis. Morbidity may cause prolonged hospital stay and physiological and economical burden to the patients. The aim of this study is to detect the factors affecting morbidity in these patients. Fifty eight patients who underwent mastectomy for breast cancer were retrospectively reviewed in a 9-year period at Adana Numune Seraching and Education Hospital. The rate and causes of postoperative complications (pc) and the effects of factors on these complications were analysed by using log rank test and
cox regression analysis. The overal rate of pc was 24.3 %. Seroma was detected at 10.8 %, wound enfection at 5.4 %, necrosis at 4.5 % and lympoedema at 3.6 % of patients. Surgically placed of closed suction drains had statistically reduced the the rate of pc when compared the plactic ones (p<0.05).

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Autogenous bone grafts from the ilium are frequently harvested for several purposes in orthopedic surgery. In this technique, some donor site complications may be unavoidable. Herniation of abdominal contents through the incision is a rare complication of the technique. We present the case of a 70-year-old female with an abdominal hernia through a peritoneal
perforation after bone graft harvesting for tibial pseudoarthrosis.

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Complicated colorectal carcinoma has several symptoms, the occasional one is the perforation to the adjacent structures. An unusual case of 63 years old male is described in which a thigh abscess was the initial symptom of sigmoid colon cancer.
Due to the patient's poor general condition, local drainage of the abscess with extensive debridement and broad spectrum antibiotherapy was performed on the admission day. But the septic complications which leading to the multiple organ failure result in death of the patient in the eighth day of the surgery. We present a review of the literature on this subject.

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Pilomatrixoma also known as calcifying epithelioma of Malherbe is a benign tumor mostly localized on the head, neck and upper extremities. They are characterized as solitary,
subcutaneous calcifying and growing slowly nodules originated from hair follicle. Multiple, familial, bullous, perforating and giant clinical types are reported in addition to solitary
nodules. Multiple lesions are seen 2-3.5% of the cases, majority of which are familial and occur in association with myotonic distrophy. Histopathologic features are diagnostic fort
he disease. A clinician managing a case of a firm mass localised particularly to upper extremities at younger age group should entertain the possibility of this adnexal tumor. Here we report a case having two nodules on his right arm diagnosed with histopathologic examination as pilomatrixoma.

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Blank cartridge guns, which are considered harmless, can be easily purchased by adults due to lack of legal regulations. We present this case because injuries caused by gunshot from modify blank cartridges may be fatal and are rarely encountered in emergency departments. A 20-year-old boy was brought to the emergency department since he had a wound on his left thorax by modify gunshot from blank cartridges. He had a moderate general condition, respiratory distress and pale appearance. There was an irregular edged, defective wound at left hemithorax localization with a dimension of 3x4 cm. Computed tomography of the thorax revealed contusion in the basal of the left lung. A mass education on danger and harm of these guns as well as legal regulations for restricted use seem to be necessary. Also, physicians should keep in mind that blank cartridge guns can cause fatal injuries.

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