Bu çalýþmada kliniðimizdeki; ektopik gebelik olgularýnýn risk faktörlerini, semptomlarýný, tedavi seçeneklerini ve sonuçlarýný retrospektif olarak analiz etmeyi amaçladýk. Ocak 2007-Þubat 2011 yýllarý arasýnda kliniðimizde ektopik gebelik tanýsý konulan ve tedavisi yapýlan 273 olgu analiz edildi. Tüm olgular risk faktörleri, tanýsal yöntemler ve tedavi seçeneklerine göre deðerlendirildi. Hastalarýmýzýn yaþ ortalamasý 31.47±6.06’dýr. Hastalarýn gravida ve parite ortalamalarý sýrasýyla 2.07±1.55 ve 1.61±1.18’dir. Risk faktörleri sýklýk sýrasýna göre abdominopelvik cerrahi öyküsü (% 29.3), pelvik inflamatuvar hastalýk öyküsü (% 25.3), rahim içi araç öyküsü (% 16.8), geçirilmiþ ektopik gebelik öyküsü (% 4) idi. Hastalarýn kliniðimize en sýk baþvuru yakýnmasý karýn aðrýsýydý (% 87,5). Olgularýn % 71.4’ünde cerrahi, % 11’inde medikal tedavi (Metotreksat), % 17.6’sýnda bekleme tedavisi yapýlmýþtýr. Risk faktörlerini modifiye etme olanaðý kýsýtlý olduðundan ektopik gebeliði önlemek zordur. Erken taný morbidite-mortalitenin önlenmesinde önemlidir ve konservatif tedavi yaklaþýmlarýna olanak tanýr.

The aim of this study is to retrospectively analyze risk factors, symptoms, treatment choices and results in cases of ectopic pregnancy in our clinic. Between January 2007-February 2011, 273 cases who were diagnosed and treated as ectopic pregnancy in our clinic were analyzed. All cases were evaluated according to their risk factors, diagnostic procedures and treatment choices. The mean age of the patients was 31.47±6.06 years. The mean gravida and parity were 2.07±1.55 ve 1.61±1.18, respectively. The risk factors in the order of frequencies were previous abdomino-pelvic surgery (29.3 %), pelvic inflammatory disease (25.3 %), use of intrauterine device (16.8 %) and ectopic pregnancies (4 %). The most common complaint on admission was abdominal pain (87.5 %). As a treatment option, surgery, medical therapy (methotrexate) and expectant management were applied on 71.4, 11and 17.6 % of the patients, respectively. Ectopic pregnancy is difficult to prevent because risk factors are poorly modified. Early diagnosis is important for the prevention of morbidity-mortality and enables conservative management approaches.

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GÝRÝÞ ve AMAÇ: Distal üreter taþlarýnýn tedavisinde Þok Dalga Litotripsi (SWL) ile semirigid ureterorenoskopik Litotripsinin etkinliðini ve tedavilerden hasta memnuniyetini karþýlaþtýrýlmaktý.
YÖNTEM ve GEREÇLER: Ocak 2007-Kasým 2011 tarihleri arasýnda distal üreter taþý nedeniyle tedavi edilen toplam 186 hasta retrospektif olarak deðerlendirildi. Hastalar tedavi þekline göre iki gruba ayrýldý. SLK Storz Medical Modulith cihazý ile SWL uygulanan 90 hasta (birinci grup) ile 9.5 Fr Storz üreterorenoskop ve ELMED pnömotik litotripsi cihazý ile semirigid ureterorenoskopi (URS) uygulanan 96 hasta retrospektif olarak karþýlaþtýrýldý. Hasta ve taþ karakteristikleri, tedavi parametreleri, klinik sonuçlar ve hasta memnuniyeti her iki grupta da belirlendi. Klinik baþarý, komplikasyon oranlarý ve hasta memnuniyetleri açýsýndan her iki grup postoperatif birinci ay karþýlaþtýrýldý.
BULGULAR: Her iki grup arasýnda yaþ, cinsiyet, taþ boyutu, toplam taþ sayýsý açýsýndan anlamlý fark yoktu (p>0.05). URS grubunda ortalama taþ çapý 9.3 mm (7-20 mm) iken SWL grubunda ortalama taþ çapý 8.6 mm (7-18 mm) idi (p>0.05). Birinci ayýn sonunda taþsýzlýk oranlarý sýrasýyla SWL’de % 93.3, URS’de % 94.7 olarak saptandý (p>0.05). Operasyon sonrasý komplikasyon oranlarý SWL grubunda % 2.1 ve URS grubunda % 4.3 olarak tespit edildi (p>0.05). Hasta memnuniyet oraný açýsýndan her iki grup arasýnda istatistiksel olarak fark bulunmadý (p>0.05).
TARTIÞMA ve SONUÇ: Üreter taþlarýnýn tedavisinde URS ve SWL tedavileri güvenli ve efektif olarak kullanýlabilir.

INTRODUCTION: To compare the efficacy and patient satisfactions of semirigid ureterorenoscopic lithotripsy and shock wave lithotripsy (SWL) in the treatment of distal ureteral stones.
METHODS: A total of 186 patients, who were treated for distal ureteral stone from January 2007 to November 2011, were evaluated retrospectively. Patients were divided into two groups according to the treatment modality. Ninety patients who underwent SWL with SLK Storz Medical Modulith device (first group), and 96 patients who underwent URS with Storz 9.5F ureterorenoscope and ELMED pneumotic lithotripsy device were compared retrospectively. Patient and stone characteristics, treatment parameters, clinical outcomes and patient satisfaction were assessed for both groups at post-operatively 1 month.
RESULTS: There were no significant differences between two groups in age, gender, stone size and total stone number (p>0,05). The stone size in URS group was 9.3 mm (7-20 mm), whereas it was 8.6 mm (7-18 mm) in SWL group (p>0,05). The stone-free rates at post-operatively 1 month were found to be % 93.3 in SWL group and % 94,7 in URS group (p>0,05). Post-operative complication rates were found to be % 2,1 in SWL group and % 5.2 in URS group (p>0,05). There was no significant difference in patient satisfaction between two groups (p>0.05).
DISCUSSION AND CONCLUSION: URS and SWL can be applied safely and effectively in the treatment of distal ureteral stones.

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Akut immun trombositopenik purpura trombositopeni, spontan purpura, ekimoz, peteþi ve mukozal kanamalar ile karakterizedir. Trombositopeninin diðer nedenlerinin dýþlanmasý ile taný konur. Ciddi organ kanamalrý ve kronikleþme riskinden dolayý önemli bir hastalýktýr.
ÝTP tanýsý almýþ 151 hasta retrospektif olarak deðerlendirildi. Hastalarýn erkek/kýz oraný 1/1.06 ve ortalama yaþ 5.1±3.4/yýl. Hastalarýn % 75 akut, % 25 kronik ÝTP tanýsý aldý. Yaþ gruplarýna göre kronikleþme oranýna bakýldýðýnda 2-10 yaþ grubundaki kronikleþen hasta oraný diðer gruplara yüksekti (p=0.01). Baþvuru semptomu en sýk cilt bulgularý olarak akut ve kronik grupta benzer ancak baþlangýç yakýnmalarý sinsi olanlarýn ise % 64.6’sý kronikleþmiþti. Mevsim ve cinsiyetin akut-kronik ÝTP olmayý etkilemediði saptandý (<0.05). Akut olgularýn % 68.4’ünde geçirilmiþ enfeksiyon varken, % 1 hastada seropozitiflik mevcuttu. Hiçbir olguda kemik iliði bulgularý ÝTP tanýsýný deðiþtirmedi. Ýlk tedavisi steroid ve parsiyel remisyon hastalarýnýn kronikleþme oraný ve akut ÝTP grubunun steroide yanýtlý olma oraný yüksekti (p=0.001 ve p<0.05).
Ekonomik ve etkili tedavi seçimleri ÝTP ‘ye baðlý morbidite ve mortaliteyi önleyecektir.

Acute immune (idiopathic) thrombocytopenic purpura is characterized by thrombocytopenia, spontaneous formation of purpura, petechiae, ecchymoses and mucosal bleedings.It is also a disease which can be diagnosed with exclusion of other causes of thrombocytopenia. However, the disease is important with respect to severe organ bleedings and risk of becoming chronic.
A total of 151 patients diagnosed as ITP, were evaluated. Male/female ratio was 1/1.06. The mean age of the patients was between 5.1±3.4, years. Seventy-five patients were diagnosed as acute ITP and 25 % of them as chronic ITP. Predilection to chronicity was higher in the 2-10 year- age group relative to other groups (p=0.01). The most frequent presenting symptom was skin findings in both the acute and the chronic group, and 64.6 % of the cases with insidious onset had become chronic. It was determined that season and gender had no effect on chronicity of ITP (<0.05). In 68.4 % of the acute cases had history of infection and seropositivity was demonstrated in 1 percent. Bone marrow aspiration findings did not alter the diagnosis in any patient. The rate of chronicity in the patients whose initial treatment was steroids, and those demonstrating remission was increased, and in the acute ITP group responsiveness to steroids was comparatively higher ((p=0.001 and p<0,05).
The preference of economical and effective treatment methods will prevent morbidity and mortality of ITP.

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GÝRÝÞ ve AMAÇ: Hastanemize doðuma gelen gebelerin doðum öncesi ve sonrasý hemoglobin-hematokrit seviyelerini, doðum þekline göre hemoglobin-hematokrit seviyelerinin düþüþlerini ve hastanemizde gebelik öncesi ve sonrasý anemi insidansýný deðerlendirmek.
YÖNTEM ve GEREÇLER: 01.01.2011-31.12.2011 arasýnda, 1137 epizyotomi ile normal doðum ve 944 sezaryen ile doðum yapan toplam 2081 gebe retrospektif analiz edildi. Gebeler, 18-40 yaþ arasýnda, sistemik hastalýðý bulunmayan, gebelik süresince demir ve/veya multi-vitamin preperatý kullandýðýný belirten ve 37.-42. gebelik haftasýnda 2000-4000 g arasýnda doðum aðýrlýðýnda bebek dünyaya getiren þeklinde standardize edildi. Forseps/vakum ile operatif doðum yapan, doðum sonrasý vajinal deþür ya da kollum tamiri yapýlan, uterin atoni geliþen; plasenta previa, dekolman plasenta, preeklampsi, hellp sendromu, uzamýþ travay, çoðul gebelik, in utero mort fetüs gibi kan kaybýný arttýrabilecek ve taný konulmuþ hematolojik bozukluðu olan olgular çalýþma dýþý býrakýldý. Doðumdaki kan kaybýný belirlemek için doðum öncesi ve doðumdan 24 saat sonraki hemoglobin-hematokrit seviyeleri deðerlendirildi.
BULGULAR: Hastanemize baþvuran gebelerde doðum öncesi anemi insidansý % 19.7; doðum sonrasý epizyotomi ile normal doðum yapanlarýn anemi oraný % 27.9; sezaryen ile doðum yapanlarda %47.5’ti. Normal doðum yapan gebelerin postpartum hemoglobin-hematokrit deðerleri, sezaryen ile doðum yapan gebelerden anlamlý derecede yüksekti, sezaryen ile doðum yapanlarda hemoglobin-hemotokrit düzeylerinde görülen düþüþ istatistiksel olarak ileri düzeyde anlamlýydý (p<0,01).
TARTIÞMA ve SONUÇ: Bu hastane bazlý yayýnýmýz dýþýnda, ülke populasyonunu temsil edecek geniþ ölçekli ve coðrafi bölge farklýlýklarýný ortaya koyacak daha küçük ölçekli anemi prevalansý çalýþmalarýna gereksinim vardýr. Bu çalýþmalarda anemi prevalansýný etkileyen etiyolojik faktörler ve demografik özellikler ayrýntýlý þekilde ortaya konulmalýdýr.

INTRODUCTION: To assess prenatal and postnatal haemoglobin-haematocrit levels of pregnants, the decrease of haemoglobin-haematocrit levels according to the type of delivery and prenatal-postnatal anemia incidence in our hospital.
METHODS: 1137 pregnants who gave birth by normal spontaneous deliveries with episiotomy and 944 delivered by cesarean section (CS), between 01.01.2011-31.12.2011, were retrospectively analyzed. Pregnants were standardized as aged between 18-40 years old, without any sistemic disease who reportedly used iron and/or multi-vitamin drugs during pregnancy and had given birth to babies weighing between 2000-4000 g, between 37.-42. gestational ages. We excluded cases with diagnosed haematologic disorders which could increase blood loss including operative vaginal delivery with forceps/vacuum, postnatal repair of vaginal/collum rupture, and developing uterine atony, and indications for CS like placenta previa, placental detachment, preeclampsia, HELLP syndrome, prolonged labor, multiple pregnancies, and fetal death in utero. For the determination of blood loss during labour, haemoglobin-haematocrit levels were evaluated before and 24 hours after birth.
RESULTS: Among pregnant women who consulted to our hospital,prenatal incidence of anemia was 19,7 %, while its postnatal incidence was 27,9 % in women who gave birth by normal spontaneous deliveries with episiotomies and was 47,5 % in those who delivered by CS. Postnatal haemoglobin-haematocrit levels of pregnants who dgave birth by vajinal ruote with the aid of episiotomy were significantly higher than in pregnants who underwent CS. Besides decreases in haemoglobin-haematocrit levels in pregnants delivered by CS were highly significant (p<0,01).
DISCUSSION AND CONCLUSION: Except our hospital-based report, anemia prevalence studies representing the nation population in large scales and revealing the differences among geographic regions in smaller scales are needed. In these studies etiologic and demographic factors affecting anemia prevalence should be presented in detail.

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GÝRÝÞ ve AMAÇ: Ektopik gebelik en sýk tuba uterinaya (% 97) yerleþim gösterir. Etiyolojideki en sýk etken pelvik inflamatuar hastalýk iken, geçirilmiþ tubal cerrahi en önemli risk faktörüdür. Bu çalýþma ile kliniðimizdeki ektopik gebeliklerin medikal ve cerrahi tedavi sonuçlarýný inceledik.
YÖNTEM ve GEREÇLER: Baðcýlar EAH Kadýn Hastalýklarý ve Doðum Kliniði’ne 1 Ocak 2011 ile 31 Aralýk 2011 tarihleri arasýnda baþvuran 73 ektopik gebelik olgusunu retrospektif olarak inceledik. Olgularda pelvik inflamatuvar hastalýk, ektopik gebelik, rahim içi araç (RÝA) ve geçirilmiþ tubal cerrahi öyküsü araþtýrýldý. Hemodinamik olarak stabil ve Beta HCG deðeri 5000’den düþük olan olgulara tek doz Metotreksat (50 mg/m2 IM) yapýlmýþtýr. Fetal kardiyak aktivitesi olan olgularda ve/veya Beta HCG deðeri 5000’den yüksek olan olgularda ise cerrahi tedavi(laparotomi, laparoskopi) planlanmýþtýr. Tedavi sonrasý Beta HCG deðeri 5’in altýna düþene kadar olgular takip edilmiþtir.
BULGULAR: Yetmiþ olguda (% 95.8) ektopik odak tubal, 3 olguda ise kornual yerleþimliydi (% 4.2). En sýk baþvuru yakýnmasý kasýk aðrýsýydý (% 82.1). Olgularýn öyküsünde geçirilmiþ abdomino-pelvik cerrahi (% 10.9), ektopik gebelik (% 9,5), RÝA (% 9,5) ve pelvik enfeksiyon (% 6.8) vardý. Otuz dokuz olguya cerrahi tedavi yapýlmýþtýr (24 laparotomi, 15 laparoskopi). Cerrahi yapýlan olgular salpenjektomi ile tedavi edilirken, kornual gebelik olgularýnda salpenjektomi ve kornual rezeksiyon birlikte uygulanmýþtýr. Otuz dört olguya tek doz metotreksat uygulanmýþ ancak 6 olguda hemodinaminin bozulmasý nedeniyle cerrahiye gereksinim duyulmuþtur. Tek doz metotreksat ile % 82.3 oranýnda tedavi saðlanýrken, doz tekrarý yapýlmamýþtýr.
TARTIÞMA ve SONUÇ: Cerrahi yapýlan tüm olgularda etkin tedavi saðlanmýþtýr. Medikal tedavide de baþarý oraný yüksektir. Ektopik olgularýnda erken taný konmasý durumunda özellikle çocuk istemi olanlarda medikal tedavi de iyi bir seçenek olarak görünmektedir.

INTRODUCTION: Ectopic pregnancy is mostly settles in a fallopian tube (97 %). The most common cause of ectopic pregnancy is the pelvic inflammatory disease, while tubal surgery is the most important risk factor for ectopic pregnancy. In this study we analyzed medical and surgical results of ectopic pregnancies in our clinic.
METHODS: We retrospectively analyzed 73 cases of ectopic pregnancy hospitalized in the out-patient clinics of Obstetrics and Gynecology Baðcýlar Training and Research Hospital between 1 January - 31 December 2011. Previous pelvic inflammatory disease, ectopic pregnancy, IUD, tubal surgery were investigated. Single dose methotrexate (50 mg/m2 IM) was injected to hemodynamically stable cases, and cases with β-hücreG values below 500=IU. Surgical treatment (laparotomy, laparoscopy) was planned for cases with fetal cardiac activity and/or those with higher β-hCG levels (>5000). Patients were followed after the treatment until β-hCG levels dropped below 5 IU.
RESULTS: In 70 cases (95.8 %) ectopic pregnancy was located in tubes and in 3 cases (4.2 %) in the cornual area. The most common presenting complaint was groin pain (82.1 %). Previous abdominopelvic surgery (10.9 %), ectopic pregnancy (9.5 %), IUD (9.5 %), and pelvic infections (6.8 %) was learnt from their anamneses. Thirty-nine cases underwent surgical interventions (24 laparotomies, and 15 laparoscopies). Cases with a history of surgery was treated with salpingectomy, while for cases with cornual pregnancies salpingectomy was combined with cornual resection. Single dose methotrexate was injected into 34 cases but in 6 of them whose hemodynamic status deteriorated, needed surgery afterwards. Single dose methotrexate was succesful in 82.3 % of the patients and none of them needed repetitive doses of methotrexate.
DISCUSSION AND CONCLUSION: Effective treatment is achieved by surgery in all patients. The success rate was high in the medical treatment too. In cases with ectopic pregnancy, provided that early diagnosis is made, medical treatment seems to be a good option in women who desire to have a child.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzda trokanterik bölge kýrýklarýnýn tedavisinde ikinci nesil proksimal femur çivisi PFN ile üçüncü nesil proksimal femur çivisi PFNA arasýnda klinik ve radyolojik karþýlaþtýrma yapmayý amaçladýk.
YÖNTEM ve GEREÇLER: Aralýk 2006-Aralýk 2012 tarihleri arasýnda Acýbadem Kadýköy hastanesine baþvuran 182 trokanterik bölge kýrýklý hastadan 50’si PFN ve 46’sý PFNA çivisi ile tedavi edilerek en az 1 yýl takibini sürdürdüðümüz 69’u kadýn 25’i erkek 94 hasta çalýþmaya alýndý. Ortalama yaþ 76.3 (26-94), ortalama takip süresi 22.4 (12-72) ay idi. Olgularýn ameliyat süresi, skopi kullaným süresi, mobilizasyon süresi, tam yük verme süresi, kýrýk iyileþme süresi, bir yýl sonra Harris kalça skoru, bir yýl sonra grafi ölçümünde femur proksimalinde olan kýsalma ve ameliyat sýrasý veya sonrasýnda yaþanan komplikasyonlar açýsýndan karþýlaþtýrdýk.
BULGULAR: Elde ettiðimiz sonuçlar sýrasýyla PFN ve PFNA için; ortalama ameliyat süresi 73.4 ve 72.1 dk., ortalama skopi kullaným süresi 63.7 ve 64.5 sn, ortalama mobilizasyon süresi 2.5 ve 2.2 gün, ortalama tam yük verme süresi 9.0 ve 8.5 hafta, ortalama kýrýk iyileþme süresi 10.1 ve 10.2 hafta, birinci yýlda ortalama Harris kalça skoru 81.5 ve 80.5, bir yýl sonra grafi ölçümünde femur proksimalinde kýsalma görülen olgu sayýsý 14 ve 12, bu olgularda ölçülen ortalama kýsalýk miktarlarý 3.3 ve 3.1 mm bulundu. PFN grubunda 1 olguda distal çivi ucu seviyesinde femur kýrýðý, 2 olguda uzun süren kasýk aðrýsý, 1 olguda hematom, 4 olguda implant rahatsýzlýðý ve 1 olguda Z efekti ve cut out görüldü. Cut out olgusunun implantlarý çýkarýldý, diðer olgularda konservatif tedavi uygulandý. PFNA grubunda 1 olguda distal çivi ucu seviyesinde femur kýrýðý, 1 olguda lateral korteks kýrýðý, 1 olguda uzun süren kasýk aðrýsý, 2 olguda hematom, 3 olguda implant rahatsýzlýðý görüldü. Ýmplant rahatsýzlýðý olan olgulardan 2’sinin implantlarý çýkarýldý, diðer olgular konservatif tedavi edildi. Hiçbir olguda derin enfeksiyon veya nonunion görülmedi. Olgularýn tamamýnda kýrýk kaynamasý saðlandý.
TARTIÞMA ve SONUÇ: Bizim deðerlendirmemize göre trokanterik bölge kýrýklarý hem PFN hem de PFNA ile etkili ve baþarýlý biçimde tedavi edilebilmektedir. PFN çivisinin dezavantajý olarak bilinen Z efekti bizim bir olgumuzda karþýmýza çýkmýþtýr. Trokanterik kýrýk tedavisinde baþarýda implant seçimi kadar implant yerleþiminin iyi olmasý ve ameliyat tekniðinin iyi uygulanmasýnýn rolü büyüktür.

INTRODUCTION: The aim of our study is to comparison of radiological and clinic results of second generation PFN and third generation PFNA nails in pertrocanteric femur fractures.
METHODS: The study was done between December 2006 and December 2012. 182 pertrocanteric femur fractures were included to the study. 50 PFN and 46 PFNA nails minimum one year followed-up were included, there were total 94 patients (69 female and 25 male). Mean age was 76.3 (26-94), mean follow-up was 22.4 (12-72) month. Operation time, fluoroscopy time, mobilization time, the time of full weight bearing, fracture healing, Harris Hip score after the first year, the shortening of proximal femur at the end of one year, per-or postoperative complications were all compared between groups.
RESULTS: Here are the results of PFN and PFNA respectively: mean operation time: 73.4 and 72.1 minutes; mean fluoroscopy time: 63.7 and 64.5 seconds; mean mobilization time: 2.5 and 2.2 days; mean full weight bearing time: 9 and 8.5 weeks; mean healing of fracture: 10.1 and 10.2 weeks; mean Harris Hip Score: 81.5 and 80.5; number of subjects shortening of proximal femur at the end of the first year: 14 and 12; mean shortening: 3.3 and 3.1mm. In PFN group there were one iatrogenic distal femur fracture, 2 groin pain, one hematoma, 4 implant irritation and one Z-effect and cut-out. The implant was extracted in cut-out case and the others were treated conservatively. In PFNA group, there were one iatrogenic distal femur fracture, one lateral cortex fracture, one groin pain, 2 hematoma, 3 implat irritation. Ýmplants were extracted in two implant irritations and others were treated conservatively. There were no deep infections and nonunion. All fractures healed.
DISCUSSION AND CONCLUSION: According to us, in pertrocanteric femur fractures PFN and PFNA nails treatments are successful and effective. The Z effect known as PFN’s disadvantage was seen only in one case. In trochanteric femur fractures, the implant selection, implantation and surgical techniques are important for a successful results.

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Moyamoya hastalýðý (MMH), çocuk ve eriþkinlerde ender görülen kronik seyirli serebrovasküler hastalýktýr. MMH, iskemik inme, intrakraniyal kanama, baþ aðrýsý, konvulsiyon ve geçici iskemik ataklara neden olur. MMH için, anestezi indüksiyonu ve idamesinde daha iyi sonuç verecek özel bir anestezi tekniði veya ilaç iliþkisi bulunmamaktadýr. Çeþitli teknik ve tedaviler avantaj ve dezavantajlarý ile birlikte uygulanýr. Ýnhalasyon ajaný veya intravenöz ilaçlar ile indüksiyon saðlanabilir. Anestezi uygulamasý sýrasýnda amaç, beyindeki oksijen sunumu ve kullanýmý arasýnda denge saðlamaktýr. Serebral hemoraji ve iskemiyi önlemek için, hipokapni ve hipotansiyon gibi faktörlerden sakýnýlmalýdýr.
Bu olgu sunumunda, 15 aylýk moyamoya hastalýðý nedeniyle 2 kez miyosinangiozis ameliyatý yapýlan çocuk hastada anestezi uygulamasýný tartýþmayý amaçladýk.

Moyamoya disease (MMD) is a rare chronic cerebrovascular disease seen both in children and adults. The disease causes ischemic stroke, intracranial hemorrhage, headache, seizures, and transient ischemia attach in children and adults. There is no evidence associating the use of a particular anesthesia technique or drug with better outcome after induction or maintenance of anesthesia in MMD patients. A variety of techniques and medications are used, each with advantages and disadvantages. Induction may be achieved with inhalation or intravenous techniques. The goal for anesthesia is to maintain the balance between the oxygen supply and demand in the brain. The factors like hypocapnie, hypotension should be avoided to prevent cerebral ischemia and cerebral hemorogy.
In this case report, we discussed anesthetic management of a 15 mount female patient with MMD who presented for two times myosynangyosis.

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Sistinüri, sistin ve dibazik amino asitlerin (sistin, lizin, arjinin, ornitinin) böbrekler ve gastrointestinal sistemden taþýnmasýndaki defekt sonucu ortaya çýkan kalýtsal bir bozukluktur. Bu hastalýðýn baþlýca klinik bulgusu üriner sistemde rekürren sistin taþlarýnýn oluþmasýdýr. Sistin taþlarý genellikle yaþamýn ikinci ve üçüncü dekatýnda ortaya çýkarken infantil dönemde ender olarak görülmektedir. Anüri gibi atipik böbrek taþý semptomlarý infantil dönemde ortaya çýkabilir. Ýnfantil dönemde akut anüriye neden olan bilateral sistin taþý oldukça enderdir. Olgumuz, litaratürde anüri ile baþvuran sistin taþlarý ile sarýlmýþ bilateral DJ stenli infanta bilateral pyelolitotomi yapýlan ilk olgudur. Hastamýzda DJ stentler çýkarýlmýþtýr ve taþsýzlýk baþarý ile saðlanmýþtýr.

Cystinuria is a hereditary disorder of cystine and dibasic amino acids (lysine, arginine, ornithine) transport across the luminal membrane of renal tubules and intestine, resulting in recurrent nephrolithiasis. Predominant clinical finding of this disease is the occurrence of recurrent cystine stones. Cystine stones frequently occur in the second or third decade of life with an occasional occurrence in infancy. Atypical symptoms of renal stones as anuria can become apparent in infancy. Bilateral cystine stones causing acute anuria in infants are extremely rare. We report the first case of bilateral pyelolitotomy performed for cystine stone and impacted bilateral double-J (DJ) stents in an infant presenting with anuria. In our patients DJ stents were removed, and a stone-free state was successfully achieved.

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Dil tremoru esansiyel tremoru olan hastalarda görülebildiði gibi izole olduðunda beyin sapý tümörleri, Wilson Hastalýðý, hipertiroidizm ve multipl skleroz gibi hastalýklara veya ilaç kullanýmýna baðlý olarak da ortaya çýkabilir. Ayýrýcý tanýda dilde görülen diðer hareket bozukluklarý (fasikülasyon, miyokimi, diskinezi) düþünülerek hastalar ayrýntýlý olarak araþtýrýlmaktadýr. Tedavide propranolol, primidon ve klonazepam tercih edilmekte olup, çoðu zaman yüksek dozlarda etkinlik saðlanabilmektedir. Bu olgu sunumunda dilinde titreme, yeme ve konuþma güçlüðü çeken ve yakýnmalarý düþük doz propranololle düzelen izole dil tremoru tanýsý koyduðumuz bir hastayý sunmaktayýz.

Tongue tremor can be seen in patients with essential tremor, but when it is isolated, it can be due to tumors of the brain stem, Wilson’s disease, multiple sclerosis, hyperthyroidism or side effect of a drug. Other movement disorders of the tongue diseases (fasciculation, myokimia, dyskinesia) should be considered in the differential diagnosis and the patients should be investigated in detail. Propranolol, primidone, and clonazepam are preferred in therapy and most of the time response to therapy can only be achieved at higher doses. In this case, we are presenting a patient diagnosed as isolated tongue tremor, who had complaints of tongue tremor, eating and speech difficulties whose complaints resolved with low-dose propranolol.

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