Ayak bileðinin Weber B kýrýklarýnda fibula distalinde eklem seviyesinde oblik kýrýk olur. Deplase Weber B tipi kýrýklarýn tedavide önerilen tedavi seçeneklerinden biri posterolateral antiglide plaðýdýr. Posterolateral plaklamanýn kýrýðýn stabilizasyonunda mekanik olarak daha güçlü destek saðladýðý kabul edilmektedir. Stabilizasyonu artýrmak için önerilen yöntemlerden bir baþkasý da kilitli plaklamadýr. Özellikle osteoporotik kemiklerde tercih edilmesi önerilen kilitli plaklarýn güçlü kemik tutunumu saðlayarak stabilizasyonu artýrdýðý bildirilmektedir. Posterolateral kilitli plak hem yerleþtiriliþ yeri hem de kilitli olmasý nedeniyle Weber B tipi kýrýklarda avantajlý görünmektedir.
Çalýþmamýza Weber B tipi kýrýðý olup onarýmýnda posterolateral kilitli anatomik plak uyguladýðýmýz, 11’i osteoporozun sýk görüldüðü 50 yaþ ve üzeri olmak üzere toplam 28 hasta dahil edildi. Ortalama yaþ 43.9 (17-83), ortalama takip süresi 11.6 (6-21) aydý. Hastalar 3 ve 6. ayda AOFAS ayak bileði ve arka ayak skalasýna göre deðerlendirildi ve ayak bileði hareket açýklýklarý kaydedildi. AOFAS skoru ortalamalarý 3. ayda 89.1, 6. ayda 94.3 bulundu. Dorsofleksiyon ve plantar fleksiyon açýlarýnýn saðlam tarafla olan fark ortalamalarý 3. ayda 4.9 ve 5.6, 6. ayda 2.2 ve 1.3 derece bulundu.
Çalýþmamýzdan elde ettiðimiz sonuçlara göre çözümü zor osteoporotik kýrýklar da dahil Weber B tipi ayak bileði kýrýklarýnýn kilitli anatomik plak ile posterolateralden fiksasyonu etkili bir yöntemdir.

Weber type B is oblique fracture of distal fibula at the level of ankle. In Weber type B, one of the treatment choices is posterolateral antiglide plate. Posterolateral plating is more mechanically powerful then the others. The other treatment choice is locking plate. The locking plates are useful in osteoporotic bones and hold the bone more powerful. Posterolateral locking plates have advantages in Weber type B fractures, because implantation place of bone and the locking technique increase the attachment power.
28 Weber type B fractures were included to the study. 11 of them were over 50 ages in which osteoporosis seen more. Mean age was 43.9 (17-83), mean follow-up time was 11.6 (6-21) month. At the third and sixth months AOFAS ankle scores and range of motion of ankle were obtained. Mean AOFAS scores of third and sixth months were 89.1 and 94.3 respectively. The mean dorsoflexion and plantar flexion differences at third and sixth month were 4.9; 5.6 and 2.2; 1.3 respectively.
In our study, the treatment of Weber type B ankle fractures including the osteporotic fractures with posterolateral anatomic locking plates is an effective technique.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzda propofol ve remifentanil bazlý total intravenöz anestezi ve epidural analjezi uygulanan jinekolojik kanser ameliyatlarýnda intraoperatif ve postoperatif aðrý kontrolünde adjuvan ajan olarak kullandýðýmýz magnezyum sülfatýn intraoperatif anestezik gereksinimi ve postoperatif analjezi üzerine etkisini araþtýrdýk.
YÖNTEM ve GEREÇLER: Hastalar iki gruba ayrýldý. Magnezyum grubuna (n=16) 30 mg/kg baþlangýç dozunu takiben 10 mg/kg/saat magnezyum sülfat 20 saat süreyle uygulandý. Kontrol grubuna (n=15) eþdeðer volümde % 0. 9 NaCl uygulandý. Postoperatif dönemde analjezi hasta kontrollü epidural analjezi yöntemiyle saðlandý. Magnezyum uygulamasýndan önce, 90. dk. ve 24. saatte alýnan kan örneklerinde Mg ölçümleri yapýldý.
BULGULAR: Ýki grup arasýnda intraoperatif dönemdeki propofol ve remifentanil gereksinimi; postoperatif 30. dk., 6., 12. ve 24. saatteki kalp atým hýzý, ortalama arter kan basýncý, solunum sayýsý, “verbal numeric rating scale” deðerleri, sedasyon skoru, 24. saatteki sunum ve istek sayýlarý açýsýndan anlamlý fark saptanmadý.
TARTIÞMA ve SONUÇ: Jinekolojik kanser operasyonlarýnda intraoperatif ve postoperatif aðrý tedavisinde adjuvan ajan olarak kullandýðýmýz magnezyum sülfatýn uygula

INTRODUCTION: We tested magnesium infusion for intraoperative anaesthetic requirement and postoperative analgesia during and after gynecologic oncology surgery.
METHODS: In a randomized, single blinded study, patients were assigned to two groups. The magnesium group (n=16) received an initial dose of 30 mg/kg followed by 10 mg/kg/h over 20 h. The control group (n=15) received placebo. Blood samples were obtained before magnesium administration, 90 minutes and 24 hours following initial magnesium administration. Plasma Mg were investigated.
RESULTS: There were no significant change between two groups in intraoperative propofol and remifentanil requirements. There were no significant change between two groups in sedation score, pain score, heart rate, mean arterial blood pressure, respiratory rate, delivery and demand on PCA device during postoperative 24 h period.
DISCUSSION AND CONCLUSION: IV administration of Mg sulfate in our dose, had no effect on postoperative pain and intraoperative propofol and remifentanil consumption.

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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 mekanik 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 utilizationrate was 0.87, and VAP rate in 1000 ventilator days was 22.88. The most common three microorganisms cultured from tracheal aspirates were Pseudomonas aeruginosa (n=19), Acinetobacter spp.(n=11), and Staphylococcus aureus (n=10). Of the 21 risk factors evaluated, 7 factors identified were independently associated with VAP (p<0.05) such as 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 lasting for 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, patient care should be individualized, and procedures like bronchoscopy, reintubation must be performed and followed up cautiously. Besides these, data about the potential microorganisms and those resistant to antibiotics will guide the empirical therapy.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, bimanuel pelvik muayene, ultrasonografik inceleme yöntemleri kullanýlarak preoperatif myoma uteri tanýsý konulup opere edilen olgularda, postoperatif histopatolojik tanýdaki doðruluk oranlarýnýn karþýlaþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Pelvik muayene, ultrason (USG) incelemeleri sonucunda uterin leiomyom ön tanýsý ile cerrahi tedavi uygulanan 402 olgunun týbbi kayýtlarý retrospektif olarak incelendi. Ayýrýcý tanýda ileri görüntüleme teknikleri kullanýlan ve patoloji sonuçlarý malign olgular çalýþmaya dâhil edilmedi. Üçyüzdoksanaltý olgunun postoperatif histopatolojik tanýlarý kaydedildi. Postoperatif histopatolojik inceleme ile doðrulanan leiomyom tanýsý alan olgu sayýsý hesaplandý, eþzamanlý diðer patolojiler incelendi. Hastalarýn demografik özellikleri, preoperatif endometriyal örnekleme sonuçlarý kaydedildi.
BULGULAR: Olgularýn yaþ ortalamasý 45.7±7.3 yýl idi. Histopatolojik inceleme olgularýnda, % 91.4’ünde leiomyom tanýsý kesinleþtirilmiþtir. Ancak, bunlarýn % 1.3’ü sellüler leiomyom, % 0.5’i yüksek mitotik aktiviteli myom, % 0.5’i atipik leiomyom tanýsý almýþtýr. Yalnýzca leiomyom tanýsý alan olgu yüzdesi % 89.1 idi. Leiomyom saptanmayan 43 olgunun 3’ünde servikal kronik inflamasyon dýþýnda patoloji saptanmamýþtýr. Kýrk olgunun 12’sinde, kendisi cerrahi endikasyon taþýyan, leiomyomu taklit eden patolojiler (endometriyal stromal sarkom, nörilemmom, adenomatoid tümör, endometriyoma) olduðu görüldü. Sekiz olguda ise kompleks atipili hiperplazi nedeni ile operasyon yapýldýðý görüldü. Kalan 20 olguda ise neden olduklarý belirti ve bulguya göre, cerrahi tedavi gerekliliði tartýþmalý patolojiler (adenomiyozis, atipisiz endometriyal hiperplazi, endometriyal polip, granülomatöz endometrit) mevcut idi.
TARTIÞMA ve SONUÇ: Preoperatif tanýda doðru algoritmik deðerlendirme ve uygulamalar ile seçilmiþ leiomyom ön tanýsý ile opere edilen olgularda yüksek oranda leiomyoma tanýsýna ulaþýlabilse de adenomyozisin klinik ve ultrasonografik olarak benzer bulgulara sahip olmasý ve sarkomlarýn kesin tanýsýnýn histopatolojik olarak konulabilmesi nedeni ile % 100 doðruluk oranlarýna ulaþabilmek olasý görünmemektedir.

INTRODUCTION: The aim of this study was to compare the accuracy rates of the postoperative histopathological diagnosis with the preoperative diagnose in patients were operated for presumed leiomyoma uteri using the methods of bimanual pelvic examination and ultrasonographic imagine.
METHODS: The medical records of 402 cases, who were underwent surgical treatment with the prediagnosis of uterine leiomyoma based on the pelvic examination and ultrasonographic evaluation, were retrospectively reviewed. The patients, in whom the advanced image techniques were used for differential diagnosis, were not included in the study. The type of surgery and the postoperative histopathological diagnoses were recorded for 396 patients. The number of cases, in whom confirmed the diagnosis of leiomyoma by postoperative histopathological examination, were calculated and the other pathologies were analyzed. Patients demographics findings and the results of preoperative endometrial sampling was recorded.
RESULTS: The mean age of the patients were 45.7±7.3 years. As a result of histopathological examination, leiomyoma diagnosis was confirmed in 91.4 % of the cases. But, in this cases 1.3 % of cellular leiomyoma, 0.5 % of the high mitotic activity, fibroids, 0.5 % were diagnosed as atypical leiomyoma. Only 89.1 % was the percentage of patients who were diagnosed as leiomyoma. There was no pathology other than cervical chronic inflammation in 3 cases out of 43 without leiomyoma. In 12 patients out of 40, pathologies with surgical indications, presenting as a mass, mimicking leiomyoma (endometrial stromal sarcoma, nörilemmom, adenomatoid tumor, endometrioma) were observed. In the remaining 20 cases, pathologies with disputable necessity for surgery (adenomyosis, endometrial hyperplasia without atypia, endometrial polyp, granulomatous endometritis) are present.
DISCUSSION AND CONCLUSION: In the patients, who were selected in the preoperative diagnostic process with the algorithmic assessments and applications and operated for presumed leiomyoma uteri, the correct diagnosis rate can be reached but because of adenomyosis have similar findings with leiomyoma uteri and definitive histopathological diagnosis for sarcomas is not possible without operation, not possible to achieve 100 % accuracy rate.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada Psödoeksfoliasyon Sendromlu (PES) katarakt olgularýnýn demografik özelliklerinin, olgularda görülen katarakt tiplerinin ve katarakt cerrahisinde (fakoemülsifikasyon) karþýlaþýlan komplikasyonlarýn araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþmaya Göztepe Eðitim ve Araþtýrma Hastanesi Göz Hastalýklarý Kliniði’nde Ocak 2007 ve Ocak 2009 tarihleri arasýnda katarakt cerrahisi uygulanmýþ 112 psödoeksfoliasyonlu göz, kontrol grubu olarak 970 psödoeksfoliasyonsuz göz toplam 1082 göz retrospektif olarak alýndý. Hastalarýn yaþý, cinsiyeti, her iki gözünün ön segment ve fundus bulgularý, psödoeksfoliatif materyal varlýðý, preoperatif-postoperatif 1. gün göz içi basýnçlarý (GÝB) ve ameliyat notlarý deðerlendirildi.
BULGULAR: PES’li katarakt olgularýnýn 67’si (% 59.8) erkek ve 45’i (% 40.2) kadýn, kontrol grubunun 525’i (% 54.1) erkek ve 445’i (% 45.9) kadýndý. PES’li katarakt olgularýnýn ortalama yaþý 75.91±9.11, kontrol grubunun ise ortalama yaþý 70.94±9.73 olarak tespit edildi. Her iki grupta en sýk görülen katarakt tipi mikst kataraktý. PES’li grupta matür katarakt oraný yüksekken; kontrol grubunda posterior subkapsüler katarakt oraný daha yüksek saptandý. PES’li katarakt grubunda ön kamera göz içi lens konulmasý oraný kontrol grubuna göre yüksekti. Ýntraoperatif komplikasyonlar yönünden incelendiðinde; PES’li grupta vitre kaybý, zonul dializi kontrol grubuna göre anlamlý yüksek bulunurken, arka kapsül açýlmasý yönünden gruplara göre istatistiksel olarak anlamlý farklýlýk bulunmadý. Kontrol grubunda 2 hastada lens drop geliþti. PES’li grupta lens drop görülmedi. Her iki gruptada postoperatif GÝB’leri preoperatif GÝB’lerine göre anlamlý düþük tespit edildi.
TARTIÞMA ve SONUÇ: PES’li katarakt olgularýna uygulanan katarakt cerrahisinde oluþmasý olasýlýkla komplikasyonlar ile karþýlaþýlmamasý için cerrahinin her aþamasýnda azami dikkat gösterilmeli ve bu komplikasyonlarýn yönetiminde bilgi sahibi olunmalýdýr.

INTRODUCTION: The purpose of this study is to investigate the demographic characteristics, cataract types and complications encountered in cataract surgery (phacoemulsification) among cataract patients with pseudoexfoliation syndrome (PES).
METHODS: This study retrospectively examined a total of 1082 eyes undergoing cataract surgery between January 2007 and January 2009 of which 112 had pseudoexfoliation and 970 were in the control group, without pseudoexfoliation. The study assessed patient age, gender, anterior segment and fundus findings in both eyes, presence of pseudoexfoliative material, preoperative and postoperative 1st day intraocular pressure (IOP) and surgery notes.
RESULTS: 67 (59.8 %) cataract cases with PES were male whilst 45 (40.2 %) were female. On the other hand, 525 (54.1 %) of the control group were male and 445 (45.9 %) were female. Average age of cataract patients with PES was 75.91±9.11 and 70.94±9.73 for the control group. The average age of the PES group was found to be significantly higher. The most frequently encountered type of cataract seen in both groups was mixed cataract. Whilst the frequency of mature cataract was high in the PES group, the frequency of posterior subcapsular cataract was higher in the control group. The frequency of implanting anterior chamber intraocular lens in the cataract group with PES was higher compared to the control group.
DISCUSSION AND CONCLUSION: To avoid potential complications each stage of the cataract surgery on cataract cases with PES demands maximum attention with comprehensive knowledge on managing these complications.

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GÝRÝÞ ve AMAÇ: Benign endikasyonlarla yapýlan histerektomilerde, cerrahi yaklaþýmýn operatif ve postoperatif sonuçlar üzerine etkisini araþtýrmak ve histerektomi yaklaþýmlarýný bu sonuçlar eþliðinde deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmamýzda Ocak 2011-Aralýk 2011 tarihleri arasýnda kliniðimizde histerektomi yapýlan 312 olgu retrospektif olarak incelendi. Olgular abdominal total, abdominal subtotal, vajinal ve laparoskopik histerektomi olarak gruplandýrýldý. Komplikasyonlar mesane, üreter, baðýrsak yaralanmasý ve yara yeri infeksiyonu olarak sýnýflandýrýldý. Olgularýn demografik bulgularý ve preoperatif tromboz proflaksisi, salpingoooferektomi uygulanmasý, postoperatif hematokrit deðerleri ve eritrosit transfüzyonu, hospitalizasyon süresi kaydedildi.
BULGULAR: Çalýþmaya alýnan 312 olgunun 222’sine abdominal total histerektomi (% 71.2), 54’üne vajinal histerektomi (% 17.3), 24’üne abdominal subtotal histerektomi (% 7.7) ve 12 olguya laparoskopik histerektomi (% 3.8) yapýlmýþtýr. Vajinal histerektomilerde en sýk endikasyon desensus uteri (% 93) olarak saptandý. Abdominal total histerektomide % 63, abdominal subtotal histerektomide % 79 ve laparoskopik histerektomilerde % 68 olgunun histerektomi endikasyonunu myoma uteri oluþturuyordu. Vajinal histerektomiler post menapozal dönemdeki kadýnlara, abdominal total histerektomi, abdominal subtotal histerektomi ve laparoskopik histerektomi perimenapozal dönemdeki kadýnlara uygulanmýþtý. Salpingoooferektomi oraný abdominal total, subtotal ve laparoskopik histerektomilerde sýrasýyla % 84 (n: 187), % 54 (n: 13) ve % 67 (n: 8) olarak bulundu. Vajinal histerektomilerde bu oran % 6 (n: 3) olup, diðer gruplardan istatistiksel açýdan anlamlý olarak daha az bulundu. Eritrosit transfüzyon ihtiyacý, hematokrit deðerlerinde düþüþ, yatýþ süreleri, preoperatif tromboz proflaksisi ve diðer postoperatif komplikasyon oranlarý, gruplar arasýnda anlamlý farklýlýk göstermedi. Vajinal histerektomi grubunda ortalama yaþ (57 yýl±12), gravida (5±3) ve parite (4±2) deðerleri, diðer gruplara kýyasla istatistiksel açýdan anlamlý olarak daha yüksek bulundu (p<0.5).
TARTIÞMA ve SONUÇ: Histerektomi yapýlýþ yollarýnýn postoperatif sonuçlarýný karþýlaþtýran çalýþmalarda vaginal yoldan yapýlan histerektomilerde daha az komplikasyon veyatýþ süresi bildirilmektedir.Ancak, bizim çalýþmamýzda gruplar arasýnda anlamlý bir farklýlýk bulunmadý. Bu sonucun olgu sayýsýnýn azlýðýndan kaynaklandýðý ve daha geniþ hasta popülasyonunda parametrelerin deðerlendirilmesi gerektiði görüþündeyiz.

INTRODUCTION: To evaluate operative and postoperative outcomes of hysterectomies for benign condition.
METHODS: A retrospective analysis of 312 hysterectomies between january 2011-december 2011. All cases were grouped as abdominal total, abdominal subtotal, vajinal and laparoscopic hysterectomies. Complications were classifed, such as bladder, ureter, intestine injuries and wound infections. For all patients, demographic findings, preoperative thrombose prophylaxis, salpingo oopherectomy application, postoperative hematocrite values, eritrocyte transfusions, hospitalization and other complications were registered.
RESULTS: In 312 cases, hysterectomies were performed with four main approaches: 222 abdominal total hysterectomies (% 71,2), 54 vaginal hysterectomies (% 17.3),24 abdominal subtotal hysterectomies (% 7.7) and 12 laparoscopic histerectomies (% 3.8). Most common indication for vaginal hysterecromy was determined as desensus uteri (% 93). % 63 of total abdominal histerectomies, % 79 of abdominal subtotal hysterectomies, % 68 of laparoscopic histerectomies were performed for myoma uteri indication. Although vaginal hysterectoies were at post menapozal period, abdominal total, abdominal subtotal and laparoscopic hysterectomies were at peri menapozal period. Compared with other type of hysterectomies, vaginal hysterectomies had significantly higher average of age and gravida. Salpingo oopherectomy rate is % 84 (n: 187) in abdominal total hysterectomies, % 54 (n: 13) in abdominal subtotal hysterectomies, and % 67 (n: 8) in laparoscopic histerectomies. In vaginal hysterectomies this ratio is % 6 (n: 3) and significantly less than the other groups. There was no evidence of a difference in the rates of eritrocyte transfusion, decrease in hematocrite value, hospitalization time, perioperative trombose prophylaxis and other post operative complications.
DISCUSSION AND CONCLUSION: According to the reviews vaginal hysterecctomies has less complications and hospitalization time. But we didn’t find any difference between the groups. For us the reason of that is minority of cases and more analysis in extended patient populations are needed.

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GÝRÝÞ ve AMAÇ: Hyaluronik asit, bað dokunun yapýsýný oluþturan temel yapýlardandýr. Hyaluronoglucosaminidase-1 (HYAL-1), hyaluronik asiti yýkan bir endoglikozidazdýr. Çalýþmanýn amacý, HYAL-1 ekspresyonunun yüzeyel mesane tümörü tanýsý alan hastalarda progresyon ve rekürrens üzerine olan etkisini incelemektir.
YÖNTEM ve GEREÇLER: Kliniðimizde mesane tümörü tanýsýyla TUR-BT yapýlan ve düzenli takipleri olan 63 hastanýn verileri retrospektif olarak incelendi. Hastalarýn ilk TUR-BT sonrasý elde edilen patolojik spesimenleri HYAL-1 antikoru ile manuel yöntemle immunohistokimyasal olarak boyandý. Hastalar boya tutma skoruna göre negatif, düþük, orta ve yüksek olmak üzere dört gruba kategorize edildi. Tüm spesimenler ayný patolog tarafýndan deðerlendirildi. HYAL-1 skorlarýna göre rekürrens ve progresyon durumlarý deðerlendirildi.
BULGULAR: Nüks geliþen 20 hastanýn patolojik incelemesinde, spesimenlerin orta ve yüksek derecede boyanma oranlarý nüks geliþmeyen hastalara daha yüksekti (% 55 vs % 14, p=0.005). Benzer þekilde progresyon geliþen 6 hastada, spesimenlerin orta ve yüksek derecede boyanma oranlarý progresyon geliþmeyen hastalara göre anlamlý derecede daha yüksekti (% 83.30 vb. % 21, p=0.004). Nüks ve progresyonu etkileyen grade, tümör boyutu, tümör evresi, tümör morfolojisi, EORTC skoru, re-TUR durumu ve HYAL-1 skoru gibi faktörlerin mutivariate cox regresyon incelemesinde; HYAL-1 skoru nüksü ve progresyonu öngörmede en önemli parametreler olarak bulundu.
TARTIÞMA ve SONUÇ: HYAL-1 ekspresyonu, yüzeyel mesane kanserlerinde rekürrens ve progresyonu öngörmektedir. Son dönemlerdeki literatürle uyumlu olan bulgumuz yüzeyel mesane kanseri takibinde risk gruplarýnýn belirlenmesinde kullanýþlý bir parametre olabilir.

INTRODUCTION: Hyaluronic acid is a one of major component of connective tissue. Hyaluronoglucosaminidase-1 (HYAL-1) is an endoglucosidase that dissolves hyaluronic acid. The main aim of the study is to evaluate the effect of HYAL-1 expression on progression and recurrence rates in patients with superficial bladder tumor.
METHODS: 63 patients, who underwent TUR-BT for bladder tumor and had available data, were analyzed retrospectively. Specimens of first TUR-BT were strained with HYAL-1 anticore immunohistochemically using manuel method. Patients were divided to four groups according their straining scale as negative, low, intermediate and high. All specimens were analyzed by the same pathologist. Progression and recurrence rates in the groups were evaluated according the HYAL-1 scores.
RESULTS: In evaluation of the pathological specimens of 20 patients who had recurrence, intermediate and high straining rates were higher than patients without recurrence (55 % VS 14 %, P=0.005). Similarly, in 6 patients who had progression, intermediate and high straining rates were higher than patients without progression (83.30 % vs 21 %, p=0.004). In multivariate cox analyses of factors that effects progression and recurence rates such as grade, tumor size, stage, tumor morfology, EORTC score, re-TUR and HYAL-1 score; HYAL-1 score were observed the most significant factor for determining recurrence and progression.
DISCUSSION AND CONCLUSION: HYAL-1 expression could predict recurrence and progression in patients with superficial bladder tumor and be used as a parameter to evaluate the risk groups on follow up of this patients.

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Epilepsi; çocukluk ve ergenlik çaðýnda en sýk, eriþkinlerde ise serebrovasküler hastalýklarýndan sonra ikinci sýklýkta görülen nörolojik bir hastalýktýr. Bu yaygýn prevalansýna raðmen, özellikle psikojenik nöbetlerden ayýrt etme noktasýnda epilepsinin kesin tanýsýnýn konulmasý sýrasýnda çeþitli zorluklarla karþýlaþýlmaktadýr. Psikojenik non-epileptik nöbetler (PNES), en sýk karþýlaþýlan ve epileptik nöbetlerden ayýrt edilmesi en zor durumlardan biridir. Özellikle, üçüncü basamak saðlýk kurumlarýndaki epilepsi birimlerine farmakolojik tedaviye dirençli nöbet tanýsýyla baþvuran hastalarýn % 17-30’unu bu hasta grubu oluþturmaktadýr. Doðru taný konmadýðýnda PNES hastalarý, doðru tedavinin gecikmesi, uzun süre antiepileptik ilaçlarýn maddi yükü ve yan etki olasýlýklarý gibi ciddi ve çok yönlü sýkýntýlarla karþý karþýya kalmaktadýr. Bu hem hastalar için hem de konuyla ilgili bütün saðlýk birimleri çalýþanlarý için hem iþ gücü, zaman ve ekonomik kayba hem de psikolojik etkilenmeye neden olmaktadýr. Bundan dolayý, bu makalede epileptik ve non-epileptik nöbetlerin genel özellikleri sunularak bu iki nöbetin ayýrýcý tanýsýnda kullanýlabilecek elektrofizyolojik, biyokimyasal ve psikolojik test yöntemleri güncel literatür ýþýðýnda tartýþýlmýþtýr.

Epilepsy is the most common neurological disorder in adolescence and also the second common disease after the cerebrovascular problems in adults. In spite of its high prevalance; there are lots of difficulties on definitive diagnosis of epilepsy; especially on differential diagnosis with psychogenic seizures. Psychogenic non epileptic seizures (PNES) are one of the most common and the most difficult diseases to differentially diagnose from epileptic seizures. Particularly; 17-30 % of patients consulted epilepsy units in tertiary health institutions with complaint of seizures resistant to pharmacological therapy, are in this group. When the PNES patients are misdiagnosed; they are exposed to serious and versatile problems such as detention of the correct treatment, financial burden and possible side effects of antiepileptic drugs. This problems cause psychological effects and also loss of labor, time and money in both patients and sanitarians. Therefore; in this paper, we introduced general properties of epileptic and non epileptic seizures and also discussed the electrophysiologic, biochemical and psychologic analyse methods for the differential diagnosis of these diseases by evaluating actual literature.

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Noonan sendromu, boy kýsalýðý, ensede düþük saç çizgisi, yele boyun, kubitus valgus, göðüs duvarý deformiteleri ve konjenital kalp defektleri ile karakterize ender bir genetik hastalýktýr. Bu nedenle, toplumda daha sýk olan Turner sendromu ile karýþtýrýlýr. Burada konjenital anomali nedeni ile kliniðimize gönderilen bir aylýk kýz olgu sunulmuþtur.

Noonan syndrome is a rare disorder, characterized by such as short stature, low posterior hairline, a webbed neck, cubitus valgus, thoracic wall deformities, and congenital heart defects. It may be confused with Turner’s syndrome which is more frequent in the population. We describe here a 1-month old girl, who was referred to our clinic with congenital anomaly.

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Menkes hastalýðý X’e baðlý resesif geçiþli, ender olarak görülen nörodejeneratif bir hastalýktýr. Klinik bulgular bakýr emilimi ve taþýnmasýndaki bozukluk ve bakýr baðýmlý enzimlerin aktivitelerindeki bozukluktan ortaya çýkmaktadýr. Bu makalede hipotoni ve nöbet öyküsü ile tetkik edilirken saç bulgularý sayesinde Menkes hastalýðý tanýsý alan olgu, hastalýðýn ender görülmesi ve tanýda saç bulgularýnýn önemini vurgulamak amacýyla sunuldu.

Menkes disease is a rare neurodegenerative disorder which is inherited X-linked recessive. Clinical findings occurs due to defect in cooper absorption and transport and disorders of copper-dependent enzyme activities. The patient who was being examined with a history of seizures and hypotoni, then he was diagnosed with Menkes disease by the hair findings. We present this case to emphasize that Menkes disease is a rare entity and to draw attention to the typical hair findings to support the diagnosis.

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Kromozom 10’un uzun kolunun distal trizomisi iyi tanýmlanmýþtýr fakat nadir bir sendromdur. Büyüme geriliði, geliþme geriliði ve karakteristik yüz görünümü sendromda iyi tasvir edilmiþtir. Olgu mikrosefali, karakteristik dismorfik yüz görünümü, ekstremite anomalisi ile iyi karakterize fenotipe sahip idi. Olgudaki trizomi 10q25-->q terminal bölgesinde oluþmuþtu.

Partial trisomy of the long arm of chromosome 10 is a well-defined but rare syndrome. Growth retardation, developmental delay and characteristic dysmorphic features are well described in the syndrome. The case had the well characterized phenotype of microcephaly, characteristic dysmorphic facies and limb anomalies. Trisomy in the case involved the 10q25-->qter region.

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Amaç: Adneksiyal kitleler gebelik sýrasýnda sýk gözlenmez. Genellikle öncesinde teþhis edilmiþ kist ve tümör zemininde over torsiyonu olur. Gebeliðin ileri dönemlerinde normal ovaryel zeminde torsiyon geliþmesi nadirdir.
Olgu sunumu: Burada herhangi bir predispozan faktör olmadan 9 haftalýk gebede geliþen adneksiyel torsiyon olgusunu sunuyoruz. Hasta acil servise hafif altabdominal aðrý ve bulantý þikayeti ile baþvurdu. Klinik durumunun ultrason bulgularýnýn kötüleþmesi sonrasýnda,hastaya sað salpingo-overektomi uygulandý.
Sonuç: Gebeliðin ileri dönemlerinde alt abdominal aðrýnýn ayrýcý tanýsýnda adneksiyel torsiyon akla getirilmelidir.

Introduction: Adnexal torsion is an uncommon case during pregnancy. Torsion usually occurs in ovaries with previously diagnosed cysts and tumors. It is rare for a previously normal ovary to undergo torsion in advanced gestation.
Case presentation: Here, we report a case of adnexal torsion during the 9th week of pregnancy without any predisposing factors. The patient was admitted to emergency department with mild lower abdominal pain and nausea. With the worsening of clinical and ultrasonographic signs, a right salpingo-oophorectomy was performed.
Conclusion: Adnexal torsion, though rare, should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation.

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