Ülkemizde birçok çocuk ve genç sosyal ve eðitsel haklarýndan yararlanabilmek için hastanelerdeki “özürlü saðlýk kurullarýna” baþvurmaktadýr. Bu kuruldan özürlü yönetmeliðinde yer alan özür oranlarý cetvelinde bulunan özür oranlarýna göre yüzde (%) içeren saðlýk kurulu raporu alýrlar. Çalýþma-mýzda Göztepe Eðitim ve Araþtýrma Hastanesi'nde 2010 yýlýndaki Özürlü Çocuk Heyeti'nin sonuçlarý irdelenmiþtir.

In our country, many children and youth apply to “the health board for the disabled" in hospitals to get their social and educational rights. At these committees, they will receive health board reports including disability rates (%) according to regulation for the handicapped. In our study, the results from the health board for the disabled children at Goztepe Training and Research Hospital related to year 2010 were investigated.

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GÝRÝÞ ve AMAÇ: Çalýþmada elektif þartlarda opere olan, spinal, epidural veya kombine spinal-epidural anestezi uygulanan hastalarda, uygulanan tekniðin prospektif olarak komplikasyonlarýnýn incelenmesi amaçlandý.
YÖNTEM ve GEREÇLER: On sekiz-60 yaþ arasý, ASA I-II grubu, uygulanan anestezi yöntemine göre rastgele 3 gruba ayrýlan 113 hasta çalýþmaya dahil edildi. Hastalara rejyonel anestezi öncesi hidrasyon amacýyla kristalloid solüsyonu 10 ml/kg ve premedikasyon amacýyla midazolam 0.03 mg/kg intravenöz olarak verildi. Spinal anestezi için (Grup S); Hiperbarik Bupivakain % 0.5 15 mg kullanýldý. Epidural anestezi için (Grup E); Levobupivakain 70 mg ve Fentanil 100 mcg kullanýldý. Kombine spinal-epidural anestezide (Grup K), spinal anestezi için; Levobupivakain 10 mg ve Fentanil 50 mcg, epidural anestezi için; Levobupivakain 35 mg ve Fentanil 50 mcg kullanýldý. Hastalarda duyusal blok seviyesi “Pin-Prick” testi, motor blok seviyesi “Bromage” skalasý ile deðerlendirildi. Rejyonel anestezi öncesi ve sonrasý, preop ve operasyon sonuna kadar ilk 15 dk. süresince 5 dk.'da bir, daha sonra 10 dk.'da bir operasyon bitimine kadar SAB, DAB, OAB, KAH deðerleri kaydedildi. Peroperatif ve postoperatif hemodinamik ve nörolojik komplikasyonlar, bel aðrýsý, baþ aðrýsý, infeksiyon bulgularý, kulak çýnlamasý, aðýzda metalik tat ve kaþýntý oluþmasý kaydedildi. Operasyon bitiminde cerrahi süre kaydedildi.
BULGULAR: Gruplar arasý karþýlaþtýrmalarda olgularýn yaþ, ASA deðerleri ve ortalama operasyon süreleri arasýnda anlamlý fark bulunurken (p<0.05), demografik verilerin daðýlýmlarý arasýnda fark saptanmadý. Gruplar arasý karþýlaþtýrmalarda rejyonel anestezi öncesi SAB, 30. dk., 40. dk., 50. dk., 60. dk. DAB, rejyonel anestezi öncesi, 60. dk. OAB, 60. dk. ve 70. dk. KAH deðerleri anlamlý bulundu (p<0.05). Bu çalýþmada, komplikasyonlar açýsýndan spinal anestezi grubunda; % 11,6 baþ aðrýsý, % 2,3 bel aðrýsý, % 9,3 bulantý-kusma, % 4,7 bradikardi, % 2,3 kaþýntý, epidural anestezi grubunda; % 5,3 bel aðrýsý, % 2,6 bradikardi, % 34,2 kaþýntý, kombine spinal-epidural anestezi grubunda; % 6,3 bel aðrýsý, % 6,3 bradikardi, % 14,2 kaþýntý saptandý.
TARTIÞMA ve SONUÇ: Sonuç olarak, üç grup içerisinde komplikasyonlar açýsýndan % 4,4 baþ aðrýsý, % 4,4 bel aðrýsý, % 3,5 bulantý-kusma, % 4,4 bradikardi, % 14,2 kaþýntý saptandý.

INTRODUCTION: The aim of this study is to determine the complications of spinal, epidural and combined spinal-epidural anaesthesia in patients who received elective surgery
METHODS: In this study, 113 patients, 18-60 years of age and ASA I-II, were randomized into 3 groups. Before regional anaesthesia, crystalloid solutions (10 ml/kg IV) were administered to patients for hydration and midazolam (0.03 mg/kg IV) for sedation. For spinal anaesthesia (Group S) hyperbaric bupivacaine (% 0.5 15 mg) was used. For epidural anaesthesia (Group E), 70 mg levobupivacaine and 100 mcg fentanyl were used. In combined spinal-epidural anaesthesia, 10 mg levobupivacaine and 50 mcg fentanyl for spinal anaesthesia, 35 mg levobupivacaine and 50 mcg fentanyl for epidural anaesthesia were used. Sensory block and motor block levels were evaluated by “Pin-Prick” test and “Bromage” scale respectively. Before regional anaesthesia, after regional anaesthesia and end of the surgery, the parameters SAP, DAP, MAP, HR were recorded at every 5 minutes. Peroperative and postoperative neurological complications (paraplegia, cauda equina syndrome, radiculopathy), hemodynamic complications (hypotension, syncope, bradycardia, cardiac arrest), back pain, headache, findings of infection (local, meningitis), tinnitus, metallic taste, itching were recorded. At the end of surgery, the duration of surgery was recorded.
RESULTS: While comparisons between age, ASA and operation times of groups revealed significant differences, distribution of demographic values were similar. Comparison between SAP before regional anaesthesia, and 30., 40., 50. and 60. min -DAP, MAP before regional anaesthesia, and 70., 60., and 70. min- HR values of groups were found significant (p<0.05). Rates of complications in the spinal anaesthesia group were headache (11.6 %), back pain (2.3 %), nausea-vomiting (9.3 %), bradycardia (4.7 %), itching (2.3 %), while in the epidural anaesthesia group back pain (5.3 %), bradycardia (2.6 %), and itching (34.2 %) were detected in indicated frequencies.The corresponding frequencies of these latter complications in the combined spinal-epidural anaesthesia group.were 6.3, 6.3, and 14.2 %, respectively.
DISCUSSION AND CONCLUSION: In this study several complications of central blocks such as headache (4.4 %), back pain (4.4 %), nausea and vomiting (3.5 %), bradycardia (4.4 %) and itching (14.2 %) were observed.

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GÝRÝÞ ve AMAÇ: Malign Plevral Mezotelyoma (MPM) kötü prognoza sahip bir kanser türüdür ve hastalarýn yalnýzca az bir kýsmý tedaviden yarar görür. Eser elementler birçok hastalýðýn patogenezinde doðrudan veya dolaylý olarak rol oymaktadýr. Bu çalýþmada MPM hastalarýnda eser element ve oksidatif parametrelerin düzeyinin araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Üniversite hastanesinde takip edilen 48 MPM hastasý ve herhangi bir kronik hastalýðý olmayan 52 kontrol olgusu çalýþmaya alýnmýþtýr. Çalýþmaya 24 erkek ve 24 kadýn hasta dahil edilmiþtir. MPM hastalarýnýn yaþ ortalamasý 55,8 yýldý. Toplam 39 hastanýn asbest temasý vardý (% 81,3) ve ortalama asbest temas süresi 34 yýldý. Toplam 33 hastada epitelyal tip (% 68,8) saptandý. Plevral sývý sitolojisi ise 13 hastada pozitifti (% 27,1).
BULGULAR: Eser element seviyelerine bakýldýðýnda Bakýr (Cu) düzeyi MPM hastalarýnda kontrol grubuna göre yüksek saptandý. Çinko (Zn) düzeyleri arasýnda ise her iki grup arasýnda fark yoktu (Tablo 1). Ayrýca Malonil dialdehit (MDA) düzeyleri MPM grubunda yüksek ve Nitrik oksit (NO) ise MPM grubunda düþük olarak saptandý (Tablo 1).
TARTIÞMA ve SONUÇ: MPM hastalýðýnda hastalýðýn takibinde ve prognozda eser element ve oksidatif parametrelerin rolleri konusunda geniþ serili çalýþmalara gereksinim vardýr.

INTRODUCTION: Malignant pleural mesothelioma (MPM) is a type of a cancer with a poor prognosis and patients can benefit form the treatment of only partially. Trace elements play a direct or indirect role. in the pathogenesis of many diseases. In this study levels of trace elements and oxidative parameters. were analyzed in MPM patients
METHODS: Forty-eight MPM patients and 52 control cases without any chronic diseases who were followed up in our University Hospital followed were included in the study. The study included 24 male and 24 female patients. The mean age of patients with MPM were 55.8 years. Total of 39 patients had asbestos exposure (81.3 %) and mean duration of exposure to asbestos was 34 years. Total epithelial types in 33 patients (68.8 %) were detected. Pleural fluid cytology was positive in 13 patients (27.1 %).
RESULTS: Levels of copper (Cu) levels were higher than the control group in patients with MPM. Zinc (Zn) levels did not differ between the two groups (Table 1). In addition, malonyl dialdehyde (MDA) levels were higher in theMPM group, and nitric oxide (NO) was lower in the MPM group (Table 1).
DISCUSSION AND CONCLUSION: The role trace element and oxidative parameters in the follow up, progression and prognosis of MPM should be investigated in larger scale studies.

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GÝRÝÞ ve AMAÇ: Triangular fibrokartilaj kompleks (TFKK) hasarlanmasý el bileðinin ulnar taraf aðrýlarý ve distal radioulnar eklem instabilitesinin baþlýca nedenidir. Bu çalýþmada, artroskopik olarak onarýlan TFKK periferik (Palmer tip 1B) yýrtýklarýnýn tedavi sonuçlarý retrospektif deðerlendirildi.
YÖNTEM ve GEREÇLER: TFKK periferik (palmer tip 1B) yýrtýðý nedeniyle 2007-2011 seneleri arasýnda baþvuran ve 6 R portal 1 cm altýndan açýlan ayrý bir portalden dýþarýdan içeriye teknik ile artroskopik tamir uygulanan 11 hasta (6 erkek, 5 kadýn, ortalama yaþ: 27,6 (Daðýlým: 19-42) deðerlendirildi. Tüm hastalarda konservatif tedavi ile sonuç alýnamayan el bileði aðrýsý ve hareket kýsýtlýlýðý mevcuttu. MRG (magnetik rezonans görüntüleme) incelemesinde hastalarýn tümünde periferik TFKK yýrtýðý saptandý. Yakýnmaya baþlama zamanlarý ile operasyon arasýnda geçen süre ortalama 16.2 (Daðýlým: 4-46) ay, ameliyat sonrasý ortalama takip süresi ise 11.6 (Daðýlým: 6-21) aydý. Fonksiyonel deðerlendirmede “Türkçe Quick DASH” ölçeði ve VAS (Görsel analog skala) kullanýldý. Ameliyat öncesi ve takip dönemine ait veriler istatistiksel olarak kýyaslandý.
BULGULAR: Ameliyat öncesi ortalama 20.45 (Daðýlým: 9,09-38,63) olan Quick-DASH semptom skorlarýnýn ameliyat sonrasýnda ortalama 4.33’e gerilediði (Daðýlým: 2,27-9,09) saptandý. Ameliyat öncesi VAS deðerleri ortalamasý 6.53 (Daðýlým: 4,5-8,2) olup, ameliyat sonrasý bu deðer 1.48 (Daðýlým: 0,3-3,1) olarak bulundu. Sonuçlar arasýnda istatistiksel açýdan ileri derecede anlamlý fark mevcuttu.
TARTIÞMA ve SONUÇ: Artroskopik teknikle minimal hasarlanma ile TFKK tamiri yapýlabilmekte; eklemin tüm yapýlarýnýn daha iyi görüntülenmesi ve deðerlendirilmesi saðlanabilmektedir. 6 R portalin 1 cm altýnda açýlan portalden uygulanan dýþarýdan içeriye dikiþ tekniði ulnar sinir yüzeyel dalýnýn etkilenme olasýlýðýnýn olmadýðý minimal travmatik yöntemdir. Bu yöntem ile DRUE instabilitesi ve ameliyat öncesi aðrý yakýnmalarýnýn anlamlý olarak giderilmesi olasýdýr.

INTRODUCTION: Injury to the triangular fibrocartilage complex (TFCC) is one the major causes of ulnar sided wrist pain and distal radioulnar joint instability. In this study, the results of arthroscopic repair of peripheral (Palmer Type 1) TFCC tears were retrospectively analyzed.
METHODS: The results of eleven patients (6 males, 5 females, mean age: 27.6 years (range: 19-42 yrs)) who presented with peripheral (Palmer type 1B) TFCC tears and underwent arthroscopic repair between 2008-2011 using a separate portal opened 1 cm below the 6R portal and outside-in suture technique were retrospectively analyzed. All patients had wrist pain and limited range of motion that did not respond to conservative treatment. MRI (Magnetic resonance imaging) revealed peripheral TFCC tear in all patients. Mean interval between onset of symptoms and surgery was 16.2 (range: 4-46) months, and mean follow up after surgery was 11.6 months (range: 6-21 months). Functional assessment was made with “Quick DASH in Turkish” and VAS (Visual Analog Scale). Preoperative and follow up data were statistically compared.
RESULTS: Mean Quick DASH symptom scores decreased from 20.45 (range: 9.09-38.63) before surgery to 4.33 (range: 2.27-9.09) after surgery. Mean VAS decreased from 6.53 (4.5-8.2) before surgery decreased to 1.48 (range: 0.3-3.1) after surgery. The difference between the results were statistically highly significant.
DISCUSSION AND CONCLUSION: Arthroscopy enables repair of the TFCC with minimal injury, allows better visualization and evaluation of all joint structures. The outside- in suture technique applied from a portal opened 1 cm below the 6R portal is a minimally traumatic method where injury to the superficial branch of the ulnar nerve is not a possibility. Using this technique, significant reduction in DRUJ instability and preoperative pain can be achieved.

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Tiroglossal kanal kisti tiroid glandýn dil kökünden boyuna doðru olan embriyolojik göçü sýrasýnda bu kanalýn patent kalmasýyla oluþan konjenital bir oluþumdur. Bu göç fetal yaþamýn 7. haftasýnda gerçekleþir. Bu kanaldan malignite geliþme oraný çok düþük olmakla birlikte, en sýk karþýlaþýlan malign tümör papiller tiroid karsinomdur.
Bu çalýþmamýzda, boyunda orta hatta kitle ile prezente olan ve operasyon sonrasýnda yapýlan histopatolojik deðerlendirme sonucu tiroglossal kanal kisti içinden köken alan papiller tirod karsinomu tespit edilen 48 yaþýndaki kadýn hastamýzý literatür eþliðinde sunduk.

Thyroglossal duct cyst is a congenital patent duct remnant during embryological migration of thyroid gland from tongue to neck via foramen ceacum. This migration starts during the 7th gestational week. Malignancy arising from this duct is very rare. In case of malignancy, the most probable diagnosis is papillary thyroid carcinoma.
In this paper we discuss a 48-year-old female patient who referred to our clinic with a midline neck mass whose histopatological evaluation diagnosed this mass as a papillary thyroid carcinoma arising from the thyroglossal canal cyst

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Bu çalýþmada dirençli konvülziyon, serebral hemiatrofi, kontralateral hemiparezi, sinüslerde hiperpnömatizasyon ve dirençli nöbet nedeniyle takip ettiðimiz Dyke- Davidoff-Mason Sendromu (DDMS) tanýsý konan iki hasta etiyoloji, klinik, radyolojik özellik ve tedavi açýsýndan gözden geçirildi.

In this study, two patients with cerebral hemiatrophy, contralateral hemiparesia, hyperpneumatisation of synisus and drug resistant epileptic seizures were diagnosed as having Dyke- Davidoff-Mason Syndrome (DDMS) and both patients were evaluated as for clinical, radiological and etiological aspects of the disease and the responses to the treatment were determined.

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Jinekolojik cerrahide da Vinci robotik cerrahi sistemi (Intuitive Surgical Corporation, Sunnyvale, CA) artan hýzla kullanýlmaya baþlanmýþtýr. Robotik teknoloji; yapýlan cerrahide artmýþ hýz, el becerilerinin artmýþ kullanýmý ve hýzlý sütürasyon gibi avantajlarýyla konvansiyonel laparoskopiye göre daha az hata sayýsý ile çok çeþitli üstünlükler saðlamaktadýr. Bu makalemizde Evre 1 serviks kanseri olan bir hastamýza da Vinci robotu ile yaptýðýmýz ilk ameliyat olan radikal histerektomiyi sunuyoruz.

The da Vinci Robotic surgical system (Intuitive Surgical Corporation, Sunnyvale, CA,USA) has been used at an accelerated pace in gynecological surgery. Robotic technology, provides a wide variety of advantages shorter duration of the surgery, increased use of hand skills, rapid suturing, lesser number of errors relative to the conventional laparoscopy. In this report we presented our first experience of radical hysterectomy with the da Vinci robotic surgical system performed on a patient with stage 1 cervical cancer.

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Elastofibroma dorsi, sýklýkla göðüs duvarýnýn subskapular bölgesinde görülen, kapsülsüz olduðu için sýnýrlarý iyi ayýrt edilemeyen, nadir görülen, fibröz dokudan kaynaklanýp yavaþ büyüme eðiliminde olan yumuþak doku tümörüdür. Etyolojisi tam olarak tanýmlanamamýþtýr. Sýklýkla skapulanýn alt köþesinde latissimus dorsi ile serratus anterior kaslarý arasýnda, toraks duvarýnýn periostuna yapýþýk olarak bulunur.
Bu çalýþmada, klinik yakýnmalarý olan ve cerrahi tedavi uyguladýðýmýz bilateral elastofibroma dorsi tanýsý alan bir hasta sunulmuþtur.

Elastofibroma dorsi, a rare soft tissue tumor often seen in the subscapular chest wall, is unencapsulated with indistinguishable borders, and originates from fibrous tissue and tends to grow slowly. Its etiology is not identified fully. It is commonly seen on the inferior corner of the scapula adherent to the chest wall between latissimus dorsi and serratus anterior muscles.
In this study a case of bilateral elastofibroma dorsi in a female patient which was treated surgically is presented.

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