Osteoartritli dizlerde çeþitli nedenlerle radikal cerrahi yöntemlerin uygulanmasý, endikasyonu konulmamýþ veya konservatif yöntemlerle yanýt alýnamayan olgularda daha az invaziv olmasý bakýmýndan artroskopik lavaj ve debridman iyi bir tedavi yöntemi olarak önerilmektedir. Çalýþmada SB Göztepe Eðitim Hastanesi 2. Ortopedi ve Travmatoloji Kliniðinde Nisan 2001/Nisan 2006 tarihleri arasýnda diz ekleminde dejeneratif osteoartrit nedeniyle artroskopik tedavi uygulanan 130 olgunun diz eklemi deðerlendirmeye alýndý. 115’i kadýn, 15’i erkek olan olgularýn yaþ ortalamasý 50,42 (SD 5,24) ve ortalama
takip süresi 36.1 (26-48) aydýr. Hastalarýn ameliyat öncesi ve erken postop (3. hafta) memnuniyet, Womac ve VAS kriterleri karþýlaþtýrýldýðýnda ameliyat sonrasý memnuniyet
skalasý 1.28, Womac 36.16 ve VAS 3.26 ile çok iyi düzeyde tespit edildi. Olgular Patel ve Aichroth deðerlendirme kriterine göre deðerlendirildiðinde postoperatif 3. ayda % 82.8 çok
iyi ve iyi, 11,6. ayda % 75.6 çok iyi ve iyi olmasýna raðmen ortalama 36.1 aylýk takipte bu oraný % 62.3’e düþtü. Diz dejeneratif osteoartritinde artroskopik tedaviyi takiben alýnan sonuçlar zamanla bozulacaktýr. Ancak, semptomlarýn seviyesinde bir azalma oluþturmasý ve majör açýk diz cerrahisinin geciktirilmesi sýrasýnda hasta açýsýndan çok önemli bir dönem kazanýlacaktýr. Komplikasyon oraný düþük, rehabilitasyon süresi kýsa ve tekrarlanabilir bir tedavi yöntemidir.

Arthroscopic debridment was suggested as a useful and less invasive treatment alternative for patients with osteoarthritis not responding to conservative treatment or patients not necessiating radical surgical procedures. In our study, 130 patients who had undergone arthroscopic debridment for their degenerative osteoarthritis of knee between april 2001 and april 2006 in Göztepe education and training hospital second orthopaedics
clinic were evaluated. 115 patients were female and mean age was 50.42 (SD 5.24). The mean followup time was 36.1 (26-48). When preoperative and postoperative (third week) satisfaction, Womac and VAS criterias were compared; the results were well with postoperative satisfaction scale was 1.28, Womac 36.16 and VAS 3.26. When cases were evaluated according to Patel and Aichroth criterias % 82.8 of patients were well at postoperative third months, % 75.6 of patients were well at postoperative 11.6 month but patients with satisfaction fell to % 62.5 at postoperative 36.1 month. The results of the arthroscopic debridment of knees with osteoarthritis will eventually detoriate with time. But it will gain time to patients with less symptoms until major surgical process. It is a
less invasive, repeatable procedure with a short rehabilitation program.

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Anne sütü, bebeðin bedensel, zihinsel, ruhsal yönden geliþimini saðlayan en ideal besin kaynaðýdýr. Annelerin, anne sütünün yararlarý ve emzirmeye yönelik bilgi düzeylerinin yetersiz olmasý, ilerleyen aylarda anne sütüyle beslenen bebek sayýsýný önemli ölçüde azaltmaktadýr. Anne sütüyle beslenemeyen 0-1 yaþ bebeklerde büyüme ve geliþmede gerilik, ileriki dönemde saðlýk ve beslenme sorunlarý ortaya çýkmaktadýr. Bu saðlýk sorunlarýnýn artmasýný önlemek için anne sütü ve kolostrumun önemi, bebeðin emzirilme süresi ve sýklýðý, sütten kesme zamaný hakkýnda annelere eðitim verilmesi gerekmektedir. Bu düþünceden yola çýkarak araþtýrmamýz 0-1 yaþ arasý bebeði olan annelerin anne sütü ve emzirme hakkýnda bilgi düzeylerini belirlemek amacýyla tanýmlayýcý olarak yapýldý.
Araþtýrma, “Amasya Kadýn-Doðum ve Çocuk Hastalýklarý Hastanesi’nde” yürütüldü. Araþtýrmanýn örneklemini 19-30 Aralýk 2005 tarihleri arasýnda bu hastaneye baþvuran ve 0-1 yaþ arasý çocuðu olan toplam 110 anne oluþturdu. Araþtýrma, sosyo-demografik veri formu ile ilgili literatür taranarak hazýrlanan, anne sütü ve bilgi düzeylerini deðerlendirmek amacýyla 42 sorudan oluþan bir anket formu uygulanarak toplandý.
Veriler, “SPSS for Windows” ‹statistik Programýnda deðerlendirilerek sayý-yüzde daðýlýmlarý elde edildi. Veriler genel olarak deðerlendirildiðinde, annelerin genel olarak bebekleri emzirdikleri saptandý. Ancak, annelerin ortalama % 8.2’sinin kolostrum vermediði, % 14.5’inin kolostrum hakkýnda bilgi sahibi olmadýðý, % 43.6’sýnýn anne sütü hakkýnda bilgi almadýðý, ortalama % 5.5’inin doðumdan 24 saat sonra emzirmeye baþladýðý saptandý. Bu sonuçlar doðrultusunda, annelere kolostrum ve anne sütünün önemi, erken emzirmenin yararlarý hakkýnda hemþirelerin düzenli olarak eðitim yapmasý gerektiði önerilmektedir.

A mother’s milk is the ideal way of feeding for a baby regarding to physically, mentally and pschologically. As the knowledge level of a mother about the benefits of mother’s milk and suckling, the number of babies fed with mother’s milk is reducing in following months after birth. The deficiency in growing and improving is seen in infants and babies who are not fed with mother’s milk and in following years health and nutrition problems appear. In such increasing cases the importance of mother’s milk and colostrum, the suckling time and period and stoping suckling time should be taught to the mothers. This study is carried out to determine the knowledge level of mothers about mother’s milk and suckling.
The study is carried out in “Amasya Women and Childen Hospital”. The sample of the study consist of 110 mothers who have babies between the age of 0-1 between the dates
19th-30th, December 2005. The date was obtained through a questionaire consisting of 42 questions to determine the knowledge level of mothers on mother’s milk. The questions were prepared by surveying the related literature.
The data is evaluated by SPSS for Windows Statistical Programme and the number percentage distributions are obtained. When the data evaluated generally, it is seen that mothers feed their babies with mother’s milk. However 8.2 % of them did not give colostrum, 43.6 % of them didn’t have any knowledge about mother’s milk and 5.5 % of them started suckling 24 hours after birth. At the end of the study it is advised to
educate mothers regularly on the importance of colostrum, mother’s milk and the benefits of early suckling by nurses.

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GÝRÝÞ ve AMAÇ: Fotodinamik lazer tedavisinde bir yýllýk sonuçlarýmýzý sunmak.

YÖNTEM ve GEREÇLER: Nisan 2005- Eylül 2006 tarihleri arasýnda kliniðimizde fotodinamik lazer tedavisi uygulanmýþ hastalar çalýþmaya dahil edildi. Olgular yaþa baðlý maküla dejenerasyonu
(YBMD) grubu ve yaþa baðlý maküla dejenerasyonu dýþý (YBMDD) grubu olarak iki gruba ayrýldý Hastalarýn, ETDRS eþeli ile deðerlendirilen görme keskinliklerinin logMAR eþdeðerleri hesaplandý. Uygulama öncesi ve takiplerde tüm hastalara Fundus Þoresein Anjiyografi (FA) ve Optik koherens tomografi (OCT) uygulandý. Elde edilen sonuçlar iki grup arasýnda karþýlaþtýrýldý.

BULGULAR: YBMD grubunda uygulama öncesi 0.94±0.36 olan görme keskinliði logMAR (GKlogMAR) deðeri uygulama sonrasý 0.95±0.37 olarak saptandý. YBMDD grubunda ise uygulama
öncesi GKlogMAR 1.01±0.34, sonrasýnda ise 0.55±0.44 olarak hesaplandý. Uygulama sonrasý GKlogMAR deðerleri YBMDD grubunda YBMD grubuna göre ileri derecede anlamlý
düzeyde düþük olarak saptandý (p<0.01). YBMD olgularýnda uygulama sonrasý GK’sý sabit kalanlar istatikstiksel olarak yüksek oranda görülürken, YBMDD grubunda ise GK’da
6 harften fazla artýþ saptanan olgular istatiksel olarak daha fazla oranda idi.

TARTIÞMA ve SONUÇ: Bu çalýþmada fotodinamik lazer tedavisi idiyopatik, yaþa baðlý maküla dejenerasyonuna ve fort miyopiye ikincil geliþen koroid neovasküler membran (CNV) tedavisinde etkili
bulundu.

INTRODUCTION: To present our one year results of Photodynamic laser treatment for Choroidal neovascularisation
METHODS: We included the patients treated with photodynamic laser between the dates April 2005 and September 2006. The patients were devided in two groups-choroidal neovascularization due to age-related macula degeneration group and the other group included patients with idiopathic CNV and choroidal neovascularisation due to pathologic
myopia. The visual acuities (VA) measured with ETDRS chart were converted to the corresponding logMAR acuities. Fundus Fluorescein Angiography (FFA) and Optic Coherence Tomography (OCT) scans were taken before the treatment and during the follow up. The results were compared between the two groups.
RESULTS: The VA in the AMD group was measured as 0.94±0.36 logMAR units before, and 0.95±0.37 after the photodynamic laser treatment. In the non-AMD group the VA log-
MAR score was 1.01±0.34 before, and 0.55±0.44 after the treatment. TheVA logMAR scores in the non-AMD group were significantly lower than the scores of the AMD group
(p<0.01). The patients with stable vision were in majority in the AMD group,and the patients whose VA increased more than 6 letters were in majority in the non-AMD group.
DISCUSSION AND CONCLUSION: Photodynamic laser treatment is an effective tool for the treatment of CNV due to myopia and idiopathic CNV as it is for the treatment of CNV due to AMD.

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Bu çalýþma, subakromiyal sýkýþma sendromlu hastalarda omuza özgül fonksiyonel durum ve özürlülüðü içeren ölçeklerle, yaþam kalitesi ölçeði SF-36 arasýndaki iliþkileri incelemek
amacýyla planlandý.
Çalýþmaya 100 hasta alýndý. Hastalara ayrýntýlý bilgi verildikten sonra, Constant, University of California at Los Angeles (UCLA), Omuz Özürlülük Sorgulamasý (OÖS) ve SF-36 sorgulamalarý yapýldý.
Constant ve UCLA’nýn her ikisiyle SF-36’nýn fiziksel fonksiyon, fiziksel rol, emosyonel rol parametreleri arasýnda anlamlý pozitif iliþki vardý (p<0.001). OÖS ile SF-36’nýn fiziksel
fonksiyon, fiziksel rol, emosyonel rol parametreleri arasýnda negatif anlamlý iliþki bulundu (p<0.001). Ölçeklerin kendi aralarýndaki karþýlaþtýrmalarýnda ise; Constant ve UCLA arasýnda, anlamlý pozitif iliþki (p<0.001), Constant ve OÖS arasýnda negatif anlamlý iliþki (p<0.001), UCLA ile OÖS arasýnda negatif anlamlý iliþki (p<0.001) olduðu görüldü.
Subakromiyal sýkýþma sendromlu hastalarda deðerlendirme; hem genel saðlýðý deðerlendiren hasta yanýtlarýna dayalý yaþam kalitesi anketini hem de omuza özgül fonksiyonel deðerlendirmeleri içermelidir.

The aim of this study is to evaluate the comparison between the functional status, disability and quality of life questionnaires in subacromial impingement syndrome.
One hundred patients were included in this study. The patients were applied Constant, University of California at Los Angeles (UCLA), Shoulder Disability Questionnaire (SDQ) and Short form-36 (SF-36) questionnaires after given detailed information.
SF-36 parameters of physical function, role physical and role emotional parameters showed a significiant correlation with the Constant and UCLA scores (p<0.001). When compared with the SDQ, SF-36 showed a significiant negative correlation in parameters physical function, role physical and role emotional parameters (p<0.001). There was a significiant positive correlation between Constant and UCLA (p<0.001), negative
significiant correlation between Constant and SDQ (p<0.001) and negative significiant correlation between UCLA and SDQ (p<0.001).
As a result; the assessment of subacromial impingement syndrome should include the quality of life questionnaires based on patients replies as well as the shoulder spesific functional evaluations.

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Hastanemizde 1998-2000 yýllarýnda izole edilen 290 ve 2003-2004 yýllarýnda izole edilen 280 Staphylococcus aureus suþunun direnç oranlarýndaki deðiþiklikler araþtýrýldý.
S. aureus suþlarýnda her iki dönemde de vankomisine direnç saptanmadý, ikinci dönemde amikasin, teikoplanin, gentamisin, tetrasiklin, oksasilin ve eritromisine karþý istatistiksel olarak anlamsýz, siproþoksasin ve rifampisine karþý ise anlamlý bir direnç artýþý saptandý.

In our hospital, sensitivity tests of 290 Staphylococcus aureus strains isolated in 1998-2000 years and 280 Staphylococcus aureus strains isolated in 2003-2004 years were performed
and investigated the alterations on resistance rates. At two periods the resistance was not established to vancomycin; but, it was established an increase statistically unsignificant at the
second period, amikacin, teicoplanin, gentamicin, tetracycline, oxacillin and eritromycin but increase in to ciprofloxacin and rifampicin significantly.

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Diyabetes mellitus, koroner arter hastalýðý geliþmesinde önemli bir risk faktörüdür. Bu çalýþmada HP-75 kalkülatörü ile hesaplanan KAH risk skoruna tip 2 DM’un etkisini belirlemek amaçlandý.
2004-2005 yýllarý arasýnda kliniðimizde takip edilen, 50 yaþ üzeri, 98 bayan hasta [50’si (% 51) diyabetik, 48’i (% 49) nondiyabetik (kontrol grubu)] çalýþmaya alýndý. Normotensif ve normolipidemik olgular çalýþma dýþý býrakýldý. Tüm olgularýn beden kitle indeksleri (BK‹), vücut yað yüzdeleri (VYY) ölçüldü. “HP-75 Coronary Risk Calculator“ markalý kalkülatör
ile hastalarýn yaþ, cinsiyet, sistolik ve diyastolik kan basýncý, total kolesterol, HDL-kolesterol deðerleri, sigara içimi ve DM varlýðý parametreleri kullanýlarak 10 yýllýk KAH risk skoru hesaplandý. Çalýþma ve kontrol grubu ki-kare testi, student t testi ve pearson korelasyon testleri kullanýlarak 10 yýllýk KAH riski açýsýndan karþýlaþtýrýldý.
Çalýþma grubunun yaþ ortalamasý 63.7±6.6, ortalama VKÝ 29.5±4.3, ortalama VYY 34.2±6.3 iken; kontrol grubunda yaþ ortalamasý 65.7±10.5, ortalama VK‹ 32.4±5.0, ortalama VYY 35.3±7.7 idi. VKÝ kontrol grubunda çalýþma grubuna göre anlamlý
yüksekti (p<0.01). KAH riski çalýþma grubunda kontrol grubuna göre anlamlý yüksekti (sýrasýyla; 20±6, 11.9±4.7; p<0.001). VKÝ ve VYY ile KAH riski arasýnda iliþki saptanmadý.
DM varlýðý, pratikte sýk kullanýlan kalkülatörlerle belirlenen 10 yýllýk KAH risk skorunu, diðer parametrelerden baðýmsýz olarak iki kat artýrýr.

Diabetes mellitus is a risk factor for coronary arter disease significantly. We investigated the effect of type 2 diabetes mellitus on risk score of coronary arter disease that measured with HP-75 calculator in this study.
Ninety-eight women patients aged over 50, followed up between 2004 to 2005, were included in the study. Fifty (51 %) patients were diabetic, 48 (49 %) non-diabetic (control group). Cases who were normotensive and had normal lipid values were excluded. BMI and body fat percentages of all patients were recorded. Age, sex, systolic and diastolic blood pressure, total cholesterol, HDL cholesterol, smoking and diabetes mellitus were parameters that used for measure risk score of coronary artery disease with HP-75 calculator for ten years. Risk of coronary arter disease fort ne years in diabetic and
control groups compared with tests of chi-square, student t and pearson correlation test.
The mean age was 63.7±6.6; VKÝ was 29.5±4.3, VYY 34.2±6.3 in the study group. The mean age was 65.7±10.5; VKÝ was 32.4±5.0, VYY 35.3±7.7 in the study group. VKÝ in
the control group was higher than diabetic group (p<0.01).
The risk of coronary arter disease in study group was higher than control group (20±6, 11.9±4.7; p<0.001, respectively). The association between VKÝ, VYY with KAH were not significantly (p=0.79, p=0.33, p=0.44, respectively).
Diabetes mellitus increases the risk of coronary artery disease fort ne years that was measured by calculators used frequently independent of other parameters, two times.

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Eritrosit kitlesinde anormal artýþ olarak tanýmlanan polisitemi, hedef organlarda mikrotrombüs ve hipoksiye zemin hazýrlayarak, yenidoðanda ciddi morbiditeye neden olabilen, önemli bir hematolojik sorundur. Çalýþmamýzda, yenidoðanlarýn polisitemi sýklýðýný, risk faktörlerini ve klinik yaklaþýmýmýzý saptamayý amaçladýk. Hastanemizde 2004 yýlýnda doðan 2755 bebekten santral venöz hematokrit deðeri % 65 ve üzerinde olan, bu nedenle polisitemi tanýsý alan bebeklerin dosyalarý incelendi. Polisitemi sýklýðýmýz % 1.96 (54/2755) olarak belirlendi. Klinik bulgusu olan ve asemptomatik olup santral venöz hematokrit deðeri 70 ve üzerinde olan 18 (% 31) bebeðe % 09 NaCl ile Kýsmi Kan Deðiþimi (KKD) yapýldý.
Kýsmi kan deðiþimi yapýlan ve yapýlmayan polisitemik yenidoðanlar arasýnda gebelik haftasý, doðum aðýrlýðý, boy ve baþ çevresi, cinsiyet, doðum þekli, 1 ve 5’inci dakika APGAR skoru, anne yaþý, annede hastalýk öyküsü, ilaç öyküsü, eðitim ve mesleki durum arasýnda istatiksel olarak anlamlý fark yoktu (p>0.05). KKD yapýlan olgularýn % 27.8’sinde, yapýlmayanlarýn % 58.3’ünde uygun antenatal bakým vardý (p>0.05). Klinik bulgu (emmeme, beslenme güçlüðü, pletore) gösteren ve metabolik sorun (hipoglisemi, hiperbilirübinemi) yaþayan bebeklerde KKD sýklýðý anlamlý derecede yüksek bulundu (p<0.05). Kýsmi kan deðiþimi yapýlan yenidoðanlarda, gebelik haftasýna göre düþük doðum aðýrlýklý bebeklerin, fetal malnutrisyonlu term yenidoðanlarýn ve gebelikte sigara içen anne bebeklerin sýklýðý yapýlmayanlara göre anlamlý derecede yüksekti (p<0.05). Polisitemik olgularýn çoðunluðunda, KKD yapýlan olgularýn ise üçte birinde klinik bulgu olmamasý, riskli yenidoðanlara polisitemi açýsýndan rutin tarama yapýlmasýnýn önemini göstermektedir.

Polycythemia, defined as an increase in red cell mass, is an important hematologic problem as ensuring microtrombus and hypoxia at target organs and so may contribute to morbidity in neonate. The study was aimed to evaluate the incidance, magnitude of perinatal risk factors and menagment of polycythemia in newborns. This study includes charts of 54 polycythemic newborns (Htc>65 %) of total of 2755 babies born in our hospital in 2004. PET with normal saline was performed in all symptomatic cases or asymptomatic but central hematocrit values? 70 % polycythemic newborns, in total 18
(31 %) newborn.
There were no statistical difference between the groups (PET performed versus not performed) according to their gestational weeks, birth weights, lenghts and head circumferences, routes of delivery, 1’ and 5’ APGAR scoring, and mothers’ age, diseases, education and occupation status (p>0.05). Antenatal care incedence were 27.8 % and 58.3 % in PET performed and not performed group, respectively (p>0.05). Clinical
findings (poor sucking, feeding difficulty, plethora etc.) and metabolic derrangements (hypoglycemia, hypocalcemia etc.) were statisticaly higher in PET performed group
(p<0.05). The small for gestational age newborbns, term neonates with fetal malnutrition and neonates of mothers who smoked were signaficantly higher in PET performed group
than PET not performed polycythemic newborns (p<0.05). Knowledge of the etiology, pathophysiology, and clinical signs and symptoms may contribute to the early identification and treatment of infants with polycythemia

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An isolated fracture of the lateral portion of the distal tibial physis is Salter- Harris type 3. fractures and it’s called Juvenil Tilloux fracture. The mechanism of injury of Juvenil Tilloux
is forced external rotation of the foot. The lateral physeal fragment is pulled by the anterior tibiofibular ligament. The aim of this article is to review our knowledge about this uncommon
fracture which we have had a chance to treate.

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Penetran thoracic wall traumas due to sharp devices are important injuries because of the intrathoracic vital organs and blood vessels anatomic locations. Because of these, these
types of traumas should be examinated carefully, and might be needed surgical operations. Cases of intrathoracic organ injury, thoracic wall injury, been of foreign body are the many
causes of the surgery. Delayed diagnosing or misdiagnosing increase the mortality and morbidity in such traumas. We would like to report our delayed diagnosed, transthoracic and
extrapleural penetran trauma due to large sized broken glass.

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Moya moya syndrome (MMS) is a rare cerebrovascular disorder caused by segmentary stenosis and occlusions of the small vessels around the circle of Willis and distal branches of carotid arteries. The name of “moyamoya” means “puff of smoke” in Japanese and describes the look of the tangle of tiny vessels formed to compensate for the blockage. This disorder may presented transient paresis, headache, epilepsy, dementia, aphasia, ataxia and subarachnoid hemorrhage. Although MMS is considered a disease of unknown etiology, infectious and genetic causes have been blamed. In this article, we described a 48 year-old woman who diagnosed as MMS after investigation for etiology of transient ischeamic attacks and epileptic seizure. Also, clinical and radiological findings of this case are discussed in the light of the literature.

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Venous leg ulcers constitute 70 % of all leg ulcers which is a serious consequence of postthrombotic syndrome. Immobilisation, surgery, trauma, pregnancy, oral contraceptive drugs and some coagulation defects have been reported to be risk factors for venous thrombosis. Activated protein C resistance is the most frequent cause of hereditary thrombophilia which is mostly associated with a point mutation in factor V protein. Risk of venous thrombosis is substantially increased in patients with factor V Leiden mutation.
Herein we report two cases with factor V Leiden mutation which responded dramatically to oral anticoagulation therapy.

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Each year HBsAg seroconversion appears spontenously between the range of 1-2 percent and also antiHBs appears in 1/3 of these cases. HBsAg seroconversion is % 4 for the treatment with convensional interferon and this rate is also similar for the treatment with pegylated interferon. Here we present a patient with chronic hepatitis B who treated with pegylated interferon, had seroconversion of HBsAg.

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In a couple who had been investigated because of infertility, oligo-asthenozoospermia was diagnosed in man, by sperm analysis. Cytogenetic analyse, the karyotype of man was exhibited as 46,XY, t(9;15) (pter ›q21.1: : q11.1›qter), der(9)(ptel›q21.1), whereas his wife's was 46,XX. To our knowlodge, this is the first case, which was determined by conventional cytogenetic techniques, reported in the literature associated with severe male infertility. The degree of the efficiency of this rare karyotype on abortions and genetic counselling period that includes evaluating the view of unbalanced segragations of this karyotype was argued based on the literature.

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Diabetes mellitus is a heterogeneous group of disorders that have the common feature of a relative or absolute lack of insulin. The disease is characterized by a multitude of hormoninduced metabolic abnormalites, by a diffuse microvasculer lesion and by long-term end-organ complications. Diabetes is associated with microangiopathy, peripheral neuropathies and autonomic dysfonction. Diabetic autonomic neuropathy is associated increased risk of gastroparesis, haemodynamic instability, prolonged QTc interval, ventricular arrhythmias, torsade-de-point and also sudden cardiac death in the perioperative period.
In this case report, because of a case have diabetic autonomic neuropathy; we discussed about the general properties of anesthetic managment of diabetic autonomic neuropathy and autonomic function tests.

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