GÝRÝÞ ve AMAÇ: Böbrek fonksiyon testleri olarak da kullanýlan kan üre ve kreatinin seviyelerinin uterin prolapsus için bir biyokimyasal belirteç olup olmadýðýný araþtýrmak.
YÖNTEM ve GEREÇLER: Çalýþma vajinal histerektomi (VH) ve abdominal histerektomi (AH) yapýlan toplam 101 olgunun dosyalarý retrospektif olarak incelenerek gerçekleþtirildi. Olgularýn preoperatif kan üre ve kreatinin düzeyleri taranarak not edildi.
BULGULAR: VH grubundaki 50 olgudan 30’u (% 60) evre II, 17’si (% 34) evre III, 3’ü (% 6) ise evre IV uterin prolapsuslu iken, AH grubundaki 51 olgudan 3’ü (% 6) evre 0, 48’i (% 94) evre I uterin prolapsuslu idi. VH ve AH gruplarý arasýnda preoperatif kan üre deðerleri arasýnda istatistiksel anlamlý bir fark yok iken (p=0.168, p>0.05), preoperatif kreatinin deðerleri açýsýndan iki grup arasýnda istatistiksel olarak anlamlý bir fark bulundu (p=0.042, p<0.05). Kreatinin için yapýlan ROC eðrisi (receiver operator curve) analizinde kestirim deðer (cut-off), en yüksek sensitivite ve spesifisite ile en düþük yalancý pozitif prediktivitenin olduðu 1mg/dl olarak bulundu.
TARTIÞMA ve SONUÇ: Postmenopozal kadýnlarda yapýlan kan biyokimya çalýþmasýnda kreatinin deðeri 1 mg/dl’den yüksek ise olgu uterin prolapsus açýsýndan deðerlendirilmelidir.

INTRODUCTION: To investigate whether blood urea and/or creatinine levels which are also used as renal function tests could be a biochemical marker for uterine prolapse.
METHODS: The resarch has been realized by retrospectively scrutinizing the patient files of 101 cases that have had undergone vaginal or abdominal hysterectomy. The preoperative blood urea and creatinine levels were noted.
RESULTS: In the vaginal hysterectomy group; 30 (60 %), 17 (34 %), and 3 (6 %) cases out of 50 women had stage II, stage III and stage IV uterine prolapse, respectively whereas in the abdominal hysterectomy group, 3 (6 %) and 48 (94 %) cases out of 51 women had stage 0 and I uterine prolapse, respectively. There was no statistically significant difference between vaginal and abdominal hysterectomy groups in terms of preoperative blood urea levels (p=0.168, p>0.05), however there was a statistically significant difference between vaginal and abdominal hysterectomy groups in terms of preoperative blood creatinine levels (p=0.042, p<0.05). In the receiver operator ROC curve analysis for creatinine, the cut-off value which had the highest sensitivity and specifity and lowest false positive predictivity was found to be 1 mg/dl.
DISCUSSION AND CONCLUSION: A postmenopausal woman who had a blood creatinine level higher than 1 mg/dl at random biochemical testing should be evaluated regarding uterine prolapse.

Abstract | Full Text PDF

Çalýþmada yoðun bakým ünitesinde (YBÜ) noninvaziv mekanik ventilasyon (NIV) uygulanan hastalarýn ilk ve son gecelerinde uygulama sýrasýnda maskelerini açma sýklýðý ve nedenleri araþtýrýldý. Ýleriye dönük kohort, gözlemsel çalýþmada 2009 yýlýnda bir eðitim araþtýrma hastanesi seviye III YBÜ’nde NIV uygulanan 258 hasta çalýþmaya alýndý. Hastalarýn solunum yetmezliði nedenleri, giriþ APACHE II ve arter kan gazý deðerleri kaydedildi. Yatýþýn ilk ve son gecesi NIV maskesinin açýlma sayýsý ve nedenleri: uyumsuzluk, su içmek, sekresyon çýkarmak, dinlenmek olarak gruplandý. Bu sýrada entübe edilen hastalar NIV baþarýsýzlýðý olarak alýndý. Hastalarýn medyan yaþlarý 65 (24-89) idi. Tanýlarýn 179’unu (% 69.4) KOAH tanýlý hastalar oluþturuyordu. Arter kan gazý incelemesinde pH: 7.33±0.09, APACHE II deðerleri 16.8±5.3 idi. Hastalarýn büyük birçoðunun maskelerini su içmek için açtýrdýðý, NIV baþarýsý saðlanan hastalarda maske açma sayýsýnýn daha az olmadýðý, ilk ve son geceler arasýnda da maske açma sayýlarý bakýmýndan istatistiksel bir fark olmadýðý saptandý. Sonuç olarak, NIV maskesinin hasta isteði ile sýk açýlmasý her zaman NIV uyumsuzluðu olarak yorumlanmamalý, doðru ve etkin takip ile aralýklý maske açýlmasýnýn yararý olabileceði akýldan çýkarýlmamalýdýr.

The causes and frequency of taking off masks during noninvasive ventilation (NIV) at first and last night of patient stay in the intensive care unit (ICU) were evaluated. The study was prospective, observational cohort study including 258 patients (176 males, 68.2 %) with NIV application at a training hospital within the year 2009. Causes of acute respiratory failure (ARF), ICU severity score (APACHEII), initial arterial blood gas measurements (ABGs), frequency and reasons of taking off mask during NIV at first and last night were recorded. Reasons of taking off mask were classified as: noncompliancy, for drinking water, rest and inadvertent sputum spill. Intubated patients were accepted as NIV failure. The median age was 65 (24-89) years, diagnosis of the cases: COPD 179 (69.4 %), mean initial ICU APACHE II score: 16.8±5.3, for ABG mean pH: 7.33±0.09. Majority of the patients interrupted NIV to drink water at night. Although statistically not significant, NIV successful patients had higher numbers of mask applications by nurses during night in ICU. It should be noted that with proper and effective follow-up, and intermittent taking-off the mask may be useful in NIV treatment.

Abstract | Full Text PDF

Bu prospektif çalýþmada, VAP geliþimi ile ilgili faktörlerin belirlenmesi ve VAP’ýn etyoloji ve insidansýnýn deðerlendirilmesi amaçlanmýþtýr. Kasým 2007 ile Haziran 2008 tarihleri arasýnda 48 saatten daha uzun sure mekenik ventilator ihtiyacý olan 148 hasta deðerlendirilmiþtir. Mekanik ventilator kullaným oraný 0,87 ve VAP hýzý 1000 ventilatör gününde 22,88 di. Trakeal aspiratlardan en sýk izole edilen üç mikroorganizma Pseudomonas aeruginosa (n=19), Acinetobacter species (n=11) ve Staphylococcus aureus (n=10) tu. Deðerlendirilen 21 risk faktöründen 7’si baðýmsýz olarak VAP ile iliþkiliydi (p<0.05): þok, koma (p<0.0006), baþvurudan en az bir ay önce antibiyotik kullanmýþ olmak (p<0.04), nazogastrik tüp varlýðý (p<0.01), bronkoskopi, trakeotomi gibi invaziv prosedürler (p<0.0001), reentübasyon (p<0.017), 5 günden uzun süreli entübasyon (p<0.0001), sigara kullanýmý (p<0.014). Yoðun Bakým Ünitesi (YBÜ) klinisyenleri VAP riskini azaltmak için VAP’a sebep olabilecek risk faktörlerinin farkýnda olmalý, hasta bakýmý kiþiselleþtirilmeli, bronkoskopi, reentübasyon gibi prosedürler dikkatle yapýlmalý ve takip edilmelidir. Bunlarýn yanýsýra, potansiyel mikroorganizmalar ve antibiyotik dirençleri hakkýndaki bilgiler ampirik tedavide kýlavuz olacaktýr.

In this prospective study, we aimed to identify the factors associated with the development of ventilator- associated pneumonia (VAP) and examine the etiology, and incidence of VAP. Between November 2007 and June 2008, 148 patients who required mechanical ventilation for longer than 48 hours were evaluated. VAP was observed in 54 patients (36 %). Mechanical ventilator and VAP utilization rates were 0.87 and 22.88 in 1000 ventilator days, respectively. The most common three microorganisms cultured from tracheal aspirates were Pseudomonas aeruginosa (n=19), Acinetobacter species (n=11) and Staphylococcus aureus (n=10). Of the 21 risk factors evaluated, 7 factors identified were independently associated with VAP (p<0.05): shock, coma (p<0.0006), antibiotic usage for at least 1 month prior to admission (p<0.04), nasogastric tube insertion (p<0.01), invasive procedures such as bronchoscopy, tracheotomy (p<0.0001), reintubation (p<0.017), intubation more than 5 days (p<0.0001), and smoking (p<0.014). Intensive Care Unit (ICU) clinicians should be aware of the risk factors for VAP to minimize the risk of VAP. Also patient care should be individualized, and procedures like bronchoscopy, and reintubation must be performed and followed up cautiously. Besides these, data about the potential microorganisms and resistance of antibiotics to them will guide the empirical therapy.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Endometrium kanseri çoðunlukla menopoz sonrasý kadýnlarda teþhis edilmektedir. Olgularýn % 90’ýndan fazlasý, 50 yaþ üzeri kadýnlarda görülmekte ve hastalýk 65 yaþ üzeri kadýnlarda en yüksek insidansa ulaþmaktadýr. Karþý konulmayan östrojenler hipotezi olarak da adlandýrýlan yüksek seviyelerde uzun süreli östrojen maruziyetinin progesteron varlýðýyla dengelenememesi durumu endometrium kanserinin etiolojisinde en yaygýn kabul edilen hipotezdir. Verilerin 2009 FIGO evrelemesine uygun olarak deðerlendirilmesine dayanan çalýþmamýzda olgularýmýzýn yaþ, gravida, parite, tümör boyutu, evresi ve patoloji sonucu gibi özellikleri tekrar gözden geçirildi ve sunuldu.
YÖNTEM ve GEREÇLER: Hastanemizde Haziran 2003-Ekim 2003 tarihleri arasýnda endometrium kanseri nedeniyle opere edilen 123 olgu çalýþmaya dâhil edildi. Olgular yaþ, gravida, parite, preoperatif ca 125 deðeri, tümör boyutu, myometrial invazyon derinliði, lenfovasküler invazyon, lenf bezi tümör metastazý, periton sitolojisinde atipik hücre varlýðý ve patoloji sonuçlarý açýsýndan retrospektif olarak deðerlendirildi.
BULGULAR: Çalýþma grubumuzda ortalama yaþ 59.7±8.1 olarak belirlendi. Probe ve operasyon materyallerinin histopatolojik inceleme sonuçlarýna göre sýrasýyla 111 (% 90.2) ve 119 (% 96.7) hastada endometrioid tip adenokarsinom saptandý (% 90.2). Lenfovasküler tutulum 23 olguda saptandý (% 18.7). Bilateral pelvik lenf nodu örneklemesi yapýlan 123 hastanýn 8’inde metastaz saptandý (% 6.5). Lenfovasküler tutulum olan hastalarýn ortalama CA 125 deðeri 36.6 IU/ml (maksimum 192 IU/ml), diðer hastalarýn ortalama CA 125 deðeri 16 IU/ml (maksimum 98 IU/ml) olarak saptandý (p<0.05). Çalýþma grubumuzda 60 yaþ altý 60 hasta, 60 yaþ ve üstü 63 hasta mevcuttu. Olgular histolojik grade açýsýnda incelediðimizde, 70 olgu (% 56.9) grade 1 olarak deðerlendirildi. Bu hastalarýn % 60’ý 60 yaþ altýndaydý. Histolojik grade 2 olan hastalarýn % 63.4’ü, histolojik grade 3 olan hastalarýn % 75’i 60 yaþ ve üstündeydi (p<0.05).
TARTIÞMA ve SONUÇ: Çalýþmamýzda preopretif ca125 deðeri ile lenfovasküler tutulum ve paraaortik lenf nodu metastazý arasýnda anlamlý korelasyon tespit edildi. Altmýþ yaþ altý ve üstü olgular karþýlaþtýrýldýðýnda 60 yaþ üstünde tümörün histolojik derecesinin anlamlý olarak arttýðý saptandý.

INTRODUCTION: Endometrial cancer is mostly diagnosed in postmenapausal women. More than 90 % of the cases were the women older than 50 years and the disease reaches its highest incidence in women older than 60 years. The most commonly accepted hypothesis about the etiology of endometrial cancer is the long-term exposure to high levels of estrogen without enough opposed progesteron level, which can be called as unopposed estrogen hypothesis. In our study, in which data were assessed according to 2009 FIGO staging; the features like age, gravida, parity, tumor size, stage and pathologic result of the cases were reviewed and presented.
METHODS: 123 cases who were operated for endometrial cancer between June and October 2003 at our hospital were incorporated in our study. Cases were assessed retrospectively in terms of age, gravida, parity, preoperative CA 125 level, tumor size, depth of myometrial invasion, lymphovascular invasion, metastatic lymphoid tissue, atypic cell in peritoneal cytology and histopathological results.
RESULTS: Mean age was determined as 59.7±8.1 years. According to the results of the histopathological analysis of probe and surgical specimens, endometrioid type of endometrial cancer was detected in 111 (90.2 %) and 119 cases (96.7 %) respectively. Lymphovascular involvement was seen in 23 cases (18.7 %). In 123 cases to whom bilateral pelvic lymph node sampling was applied, metastases were found in 8 cases (6.5 %). Mean CA 125 level of the patients who had lymphovascular involvement was 36.6 IU/ml (maximum 192 IU/ml), whereas mean CA 125 level of the rest of the patients was 16 IU/ml (maximum 98 IU/ml) (p<0.05). In our study group, 60 patients were younger than 60 years and 63 patients were ≥ 60 years of age. When cases were analysed with regard to histologic grade, 70 cases were evaluated as grade 1 (56.9 %). 60 % of these patients were younger than 60 years. 64.3 % of the patients whose histologic grade was determined as grade 2 and 75 % of those with grade 3 were ≥ 60 years of age (p<0.05).
DISCUSSION AND CONCLUSION: In our study, significant correlations were detected between preoperative CA 125 levels with lymphovascular involvement and paraaortic lymph node metastasis.When the cases younger and older than 60 years were compared, tumors with higher histologic grades were found in cases older than 60 years of age.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Üniversite yaþamý önemli deðiþikliklerin yaþandýðý adölesan döneme denk gelir ve ruhsal hastalýk yönünden riskin yüksek olduðu bir dönemdir. Bu araþtýrma Amasya Saðlýk Yüksekokulu öðrencilerinin genel saðlýk düzeylerini bazý deðiþkenler açýsýndan deðerlendirmek amacýyla gerçekleþtirilmiþtir.
YÖNTEM ve GEREÇLER: Tanýmlayýcý nitelikteki araþtýrmanýn evrenini Amasya Saðlýk Yüksekokulu'nda öðrenim gören 330 öðrenci oluþtururken, örneklemi gönüllülük esas alýnarak, araþtýrmaya katýlmak isteyen 295 öðrenci oluþturmuþtur. Araþtýrma verileri “Kiþisel Bilgi Formu” ve Goldberg (1972) tarafýndan geliþtirilen 12 maddelik Genel Saðlýk Anketi-12 (GSA-12) kullanýlarak toplanmýþtýr. Veriler SPSS 16.0 istatistik programýnda deðerlendirilmiþ, verilerin analizinde; frekans, Kruskal -Wallis H (KW), Mann-Whitney U (U) testleri kullanýlmýþtýr. Ýstatistiki analizlerde anlamlýlýk düzeyi p<0.05 olarak seçilmiþtir.
BULGULAR: Araþtýrmada Amasya Saðlýk Yüksekokulu öðrencilerinin genel saðlýk düzeyi risk açýsýndan düþük risk olarak (GSA-12 puan ortalamalarý X: 1.93) saptanmýþtýr.
TARTIÞMA ve SONUÇ: Araþtýrmada GSA-12 puan ortalamalarý ile babanýn eðitim düzeyi, gelir düzeyi, ailesi ve arkadaþlarý ile iliþki düzeyi, akademik baþarý algýsý, intihar düþüncesi taþýmasý ile istatistiksel anlamlý iliþki saptanýrken, bölümü, sýnýf düzeyi, yaþadýðý yer, kardeþ sayýsý, gibi deðiþkenler açýsýndan istatistiksel anlamlý bir iliþki saptanmamýþtýr.

INTRODUCTION: The period of significant changes in the universty life and the period of adolescence coincide. The risk of mental illness is higher in this period. This study was conducted to assess Amasya Health School Students’ general health state in terms of same variables.
METHODS: It was a descriptive study and all the 330 students of the Amasya University were included in the study. This study was based on a voluntary basis and 295 students made up the sample of the study. Personal information questionnaire and General Health Questionnaire (GHQ-12) improved by David Goldberg were used in the study.
RESULTS: The data were evaluated using SPSS 16.0 statistical program. Kruskal Wallis (KW), Mann Whitney U (U), frequency tests were used for the analysis of data. The significance level was chosen as p<0.05 at statistical analysisto be performed to determine general health state of the students in Amasya University and the study outcomes showed that their general health status were at low risk.
DISCUSSION AND CONCLUSION: A statistically significant correlation existed between students ’GHQ-12 mean scores and their fathers’ educational status, their families’ income levels, level of relationship with their families and friends, perception of academic achievement, their suicidal ideation. However a statistically significant correlation was not detected among variables such as their study of interest, class level, living place, the number of siblings.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Kömür madeninde çalýþan ve progresif masif fibrosis (PMF) geliþen hastalarda taný aþamasýndaki bronkoskopik bulgularý deðerlendirmek için bu çalýþmayý planladýk.
YÖNTEM ve GEREÇLER: 2003-2006 yýlarý arasýnda kömür madeninde çalýþma öyküsü olan 22 hastanýn klinik, radyolojik ve bronkoskopik bulgularý deðerlendirildi.
BULGULAR: Hastalarýn hepsi erkek yaþlarý 43 ve 82 arasýnda ve ortalamasý 66,4±9,37 idi. On beþi (% 68,2) sigara kulanýyordu. Kömür tozu maruziyet süreleri ortalama 21,5±9 yýldý (2-34). Hastalarýn 6’sýnda (% 27,3) klinik yakýnma yoktu. Aðýrlýklý olarak klinik yakýnma nefes darlýðý, öksürük ve balgam idi. Hastalarýn radyolojik bulgularýna bakýldýðýnda tamamýnda PMF (n: 22, % 100), % 95,4’ünde fibrotik deðiþim (n: 21), % 90’ýnda retikülonodüler görünüm (n: 20), % 77,2’sinde kalsifiye hiler lenfadenopati (n: 17), % 77,2’sinde mikronodül (n: 17), % 72,7’sinde interstisyel görünüm (n: 16), % 72,7’sinde plevral kalýnlaþma (n: 16), % 68,1’inde nodül (n: 15), % 40,9’unda bül ve amfizematöz alanlar (n: 9), % 27,2’sinde plevral kalsifikasyon, % 18,1’inde ise alveoler opasite (n: 4) bulundu. Bronkoskopik bulgularda % 77,2’sinde bronþial stenoz, % 72,7’sinde bronþta antrakoid nedbe, % 63,6’sýnda bronþial mukozada solukluk, % 63,6’sýnda antrakotik plak, % 50’sinde diffüz bronþial inflamasyon, % 40,9’unda ana karena ve lob ayrým karenasýnda geniþleme, % 31,8’inde trakea ve ana bronþlarda deformite, % 13,6’sýnda siyah-gri balgam, % 4,5’inde bronþial mukozada atrofi bulundu.
TARTIÞMA ve SONUÇ: Madenlerde çalýþma öyküsü olan ve özellikle PMF olan hastalarda taný aþamasýnda bronkoskopide indirekt tümör bulgularý olabileceði akýlda tutulmalýdýr.

INTRODUCTION: The aim of the study is to evaluate fiberoptic bronchoscopic signs especially in mine workers with progressive massif fibrosis (PMF) during diagnostic work-up.
METHODS: We evaluated clinical examination, radiological and bronchoscopic data of 22 patients who had worked in coal mines between 2003 and 2006.
RESULTS: Medical files of 22 male patients aged between 43 and 83 with a mean age of 66.4±9.37 years were investigated. Fifteen (68.2 %) were smokers. Duration of coal mine exposure was 21.5±9 years. Six (27.3 %) patients were asymptomatic and the others had mainly coughs, expectoration of sputum and dyspnea. The radiological signs were as follows: PMF (n: 22; 100 %), fibrotic pattern (n: 21; 95.4 %), reticular nodules (n: 20; 90 %), micronodules (n: 17; 77.2 %), calsificated hilus node (n: 17; 77.2 %), interstitial pattern (n: 16; 72.7 %), pleural thickening (n: 16; 72.7 %), macro nodules (n: 15; 68.1 %), bullae and emphysematous areas (n: 9; 40.9 %), pleural calsifications (n: 6; 27.2 %), and alveolar opacities (n: 4; 18.1 %). The bronchoscopic signs were bronchial stenosis (77.2 %), scar antracotic deformity of bronchi (72.7 %), diffuse atrophy and pale bronchial mucosa (63.6 %), antracotic plaques (63.6 %), diffuse bronchial inflammatory appearance (50 %), enlarged main and/or lobe carina (40.9 %), black-gray sputum (13.6 %), and bronchial mucosa atrophy (4.5 %).
DISCUSSION AND CONCLUSION: You should keep in mind that during diagnostic work-up of mine workers with PMF, indirect tumor signs can be detected during broncoshoscopic procedures.

Abstract | Full Text PDF

Sarkoidoz, sýklýkla akciðerleri tutan ve önemli morbiditeye neden olan multisistem granülomatöz bir hastalýktýr. Bu hastalýk nörolojik bir hastalýk olarak kendini gösterebileceði gibi uveitis, körlük, son dönem pulmoner fibrosis, pulmoner hipertansiyon, disritmiler, kardiyomyopati, hiperkalsemi ve renal yetmezlik bulgularý ile de karþýmýza çýkabilir. Bununla birlikte, hiperkalsemiye sekonder sistemik hipertansiyon çok nadirdir.
Biz de baþ aðrýsý ve bulantý þikayetleriyle hastanemiz acil servisine baþvuran 29 yaþýndaki erkek hastanýn yapýlan deðerlendirmelerinde arteriyel kan basýncý 220/110 mmHg ve kalsiyum 17.4 mg/dl ile splenektomi sonrasý patoloji raporunda sarkoidoz saptanan olguyu sunacaðýz.

Sarcoidosis, which occurs often with the lung involvement and causes significant morbidity, is a multisystem granulomatous disease. This disease manifests itself with signs, and symptoms of neurological disease such as uveitis, blindness or end-stage pulmonary fibrosis, pulmonary hypertension, dysrhythmias, cardiomyopathy, hypercalcemia and renal insufficiency. However, systemic hypertension secondary to hypercalcemia is very rare.
We present a 29-year old male patient admitted to the emergency service with complaints of headache and nausea. His arterial blood pressure and calcium level were 220/110 mmHg, and 17.4 mg/dl, respectively, and histopathological evaluation after splenectomy confirmed the diagnosis of sarcoidosis.

Abstract | Full Text PDF

Kornual (interstisyel) dýþ gebelik, çoðunlukla klinisyen için tanýsý ve tedavisi zor olan, ektopik gebeliðin ender görülen, morbiditesi ve mortalitesi çok daha yüksek olan bir formudur. Biz de, bu doðrultuda, yaklaþýk 3 aydýr düþmeyen β-hCG deðerleri nedeniyle hastanemize defalarca baþvuran kadýn hastayý yayýnladýk. Hasta, muayene ve deðerlendirme sonrasý kornual gebelik þüphesiyle ilk baþvurusundan 3 ay sonra operasyona alýndý. Perioperatif taný, preoperatif tanýyý doðruladý. Sað kornual rezeksiyon + sað salpingooferektomi + sol tüp baðlanmasý yapýldý. Böylece; görece erken, doðru ön taný ve ardýndan cerrahi tedavi sonrasý, hasta herhangi bir yerde ve herhangi bir zamanda beklenmedik bir þekilde geliþebilecek uterin rüptür ve belki de ölümden kurtarýlmýþ oldu.

Cornual (interstitial) ectopic pregnancy is a rare type of ectopic pregnancy, with a high rates of morbidity and mortality, which is frequently hard to be diagnosed and treated. So; we reported a female patient presented to our hospital with persistently higher levels of β-hCG for 3 months. The patient, with the suspicion of cornual ectopic pregnancy, was operated following examination and evaluation 3 months after her first presentation. Perioperative diagnosis verified preoperative diagnosis. A right cornual resection + right salpingo-ovariectomy + left tubal ligation was performed. Thus, relatively early, and accurate initial diagnosis and consequent surgical treatment saved the patient from uterine rupture and maybe death which might occur unexpectedly at any time, and anywhere.

Abstract | Full Text PDF

Pulmoner alveoler mikrolitiyazis, etiyolojisi ve patogenezi bilinmeyen ender bir hastalýktýr. Bu makalede arka-ön akciðer grafisi ve bilgisayarlý tomografi ile bu hastalýktan þüphelenilen ve açýk akciðer biyopsisi ile taný konulan iki olguyu sunduk. Birinci olgu pulmoner alveoler mikrolitiyazis ile eþzamanlý plevral tüberküloza sahipti. Ýkinci olguda, tanýdan 30 yýl sonraki baþvurusunda solunum yetmezliði saptandý.

Pulmonary alveolar microlithiasis is a rare disease with unknown etiology and pathogenesis. Herein, we report two cases of pulmonary alveoler microlithiasis who were suspected to have the disease on chest x-ray and computed tomography. Later the suspect diagnosis was confirmed by open lung biopsy. The first case had a diagnosis of the synchronous occurrence of pleural tuberculosis. In the second case, respiratory failure was diagnosed 30 years after the initial diagnosis.

Abstract | Full Text PDF

Epstein-Barr virüs (EBV), sýklýkla ateþ, boðaz aðrýsý, lenfadenopati ve periferik kanda atipik lenfomonositoz ile karakterli infeksiyöz mononükleoz tablosuna neden olmaktadýr. EBV enfeksiyonlarýnda karaciðer tutulumuna baðlý olgularýn % 80-90’ýnda serum aminotranferaz deðerlerinde genellikle ýlýmlý yükseklikler görülebilir. Alkalen fosfataz ve bilirübin yükseklikleri ile karakterize kolestatik hepatit ise ender görülen bir durumdur. Bu olgu sunumunda karaciðer fonksiyon testleri, alkalen fosfataz, gama glutamil transpeptidaz ve bilirübin düzeylerinde yükseklik bulunan ve akut kolestatik hepatit etkeni olarak EBV saptanan 31 yaþýnda bir erkek hasta sunulmuþtur.

Epstein-Barr virus (EBV) causes infectious mononucleosis characterized by fever, sore throat, and lymphadenopathy. Although hepatic involvement is usually mild in 80 to 90 % of the cases with infectious mononucleous, cholestatic liver disease characterized predominantly by elevation of serum alkaline phosphatase and bilirübin is rarely seen. Herein, we report a 31-year-old men with cholestatic hepatitis, presenting with elevated liver function tests, alkaline phosphatase, gamma transpeptidase and bilirubin.

Abstract | Full Text PDF

Yüksek enerjili travma olgularýnda çoklu kemik-eklem patolojilerine sýk rastlanýlmasýna raðmen, ayný taraflý çoklu yaralanmalara daha az rastlanýlmaktadýr ve acil serviste gözden kaçabilmektedir. Hastanýn kýrýk paterni yüksekten düþme sýrasýnda açýk el üzerine aksiyel yüklenme ve dirsek valgusu sonucu distal radius kýrýðý ve dirsek çýkýðý, daha sonra omuz üzerine düþme sonucu proksimal humerus kýrýðý olduðunu tahmin ettik. Çok ender görülen bu ayný taraflý çoklu travma olgusýnýn olabileceðini ve gözden kaçmamasý amacý ile yayýnlamayý düþündük.

After high-energy traumas it is common to see multiple bone-joint pathologies but it is uncommon to see these pathologies ipsilaterally and these cases can be overlooked in the emergency departments. We thought that after a fall on the open hand; because of the axial loading and elbow valgus stress, patient suffered from distal radius fracture and elbow dislocation and afterwards as the patient fell over the shoulder, this caused proximal humeral fracture. Although ipsilateral multiple trauma case is very rare, it can still happen and should not be overlooked.

Abstract | Full Text PDF

Abstract | Full Text PDF