Amaç
Operasyon tekniklerindeki ve implant teknolojisindeki ilerlemelere raðmen, tibia plato kýrýklarýnýn hem tedavi öncesi planlamasý hem de tedavi sonrasýndaki takibi konusunda halen görüþ birliði bulunmamaktadýr. Bu çalýþmanýn amacý, Ankara Numune Eðitim ve Araþtýrma Hastanesi ortopedi kliniðinde tedavi edilen bikondiler tibia plato kýrýklý hastalarýn klinik ve radyolojik olarak fonksiyonel sonuçlarýnýn deðerlendirilmesidir.
Materyal ve Metod
Retrospektif olarak belirlenen 24 hastanýn ortalama takip süresi 33,1 ay olarak belirlendi. Hastalar tek plak veya çift plak uygulananlar olarak iki gruba ayrýldý. Ýki grubun demografik özellikleri, kýrýk oluþum mekanizmalarý ve kýrýk tipleri belirlendi. Fonksiyonel sonuçlar, Rasmussen klinik ve radyolojik skorlama sistemleri kullanýlarak tespit edildi.
Bulgular
Gruplar arasýnda fonksiyonel ve radyolojik olarak fark olmadýðý bulundu (p>0,05). Rasmussen klinik skorlarý ile radyolojik skorlarý arasýnda istatistiksel olarak uyum tespit edildi (p=0,001). Her iki cerrahi teknik de bikondiler tibia plato kýrýklarýnda uygun seçenek olarak kullanýlabilir. Ancak çift plak uygulanan hastalarda yumuþak doku enfeksiyonu daha fazla görülmüþken, sadece lateral plak uygulanan hastalarda da eklem yüzeyinde çökmenin daha fazla görülmesi cerrahi tercihleri etkileyebilir.
Sonuç
Beklenilen fonksiyonel sonuçlarýn elde edilebilmesi için, detaylý klinik ve radyolojik analiz ile preoperatif planlama, uygun cerrahi tekniðin belirlenmesinde büyük önem taþýmaktadýr.

Aim
Despite advances in operation techniques and implant technology, there is still no consensus on both pre-operative planning and post-operative follow-up of tibial plateau fractures. The aim of this study is to evaluate the clinical and radiological functional results of bicondylar tibia plateau fractured patients treated in Ankara Numune Training and Research Hospital Orthopedic Clinic.
Material and Method
The mean follow-up duration of 24 retrospectively determined patients was 33.1 months. Patients were divided into two groups as patients with single or double plate. The demographic characteristics of the two groups, fracture mechanisms and fracture types were determined. Functional outcomes were determined by using Rasmussen clinical and radiological scoring systems.
Results
There was no functional or radiological difference between the two groups (p>0,05). Rasmussen clinical scores and radiological scores were found statistically compatible (p=0,001). Both surgical techniques can be used as an option in bicondylar tibia plateau fractures. However, in patients with double plate, soft tissue infection was seen more frequently, whereas in patients who only have lateral plate, the presence of more collapse on the joint surface may affect surgical preferences.

Conclusion
Detailed clinical and radiological analysis and preoperative planning are crucial in determining the appropriate surgical technique so that the expected functional results can be obtained.

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Amaç: Zehirlenme ciddi bir saðlýk sorunu olarak önemini korumakta, alýnan maddeye veya hastaneye baþvuru süresine baðlý olarak ciddi sonuçlar doðurabilmektedir. Zehirlenme nedeniyle acil servislere baþvuran hastalarýn bir kýsmý, yoðun bakým dahil yatarak tedavi görmektedir. Bu çalýþmada acil servise baþvuran ve yatarak tedavi gören çocuk zehirlenmelerinde, olgularýn demografik özellikleri, zehirlenme nedenleri, yatýþ süresi ve hastalýk seyrine ait bilgilerin deðerlendirilmesi amaçlandý.
Hastalar ve Yöntem: 2008-2016 tarihleri arasýnda Erzurum Bölge Eðitim ve Araþtýrma Hastanesine baþvuran ve yatarak tedavi gören 0-18 yaþ zehirlenme olgularýna ait týbbi kayýtlar retrospektif olarak deðerlendirildi.
Bulgular: Çalýþma kapsamýnda 642 olgu deðerlendirildi. Olgularýn %61,8'i (n=397) kýz, %38,2'i ise (n=245) erkek olup, ortalama yaþ (mean± sd) 8,1±6,6 idi. Olgularýn zehirlenme nedenleri sýrasýyla; %57,9’ü (n=372) ilaçlar, %11,5’i (n=74) pestisitler, %8,6’i (n=55) temizlik maddeleri,%3,3’ü (n=21) yabani bitki olup %18,7 (n=120) olgunun sebebi bilinmiyordu. Olgularýn hastanede ortalama yatýþ süresi 3 gün olup, %9’u (n=58) yoðun bakýmda yatarak tedavi görmüþtü. Olgularýn %21’inde (n=135) bir psikopatoloji saptanmýþ olup, bunlardan %85,9’unda (n=116) majör depresif bozukluk tespit edilmiþtir.
Sonuç: Bulgularýmýza göre yatarak tedavi gören çocuk zehirlenmelerinin önemli kýsmýný 5 yaþ altýnda kazara meydana gelen zehirlenmeler oluþturmaktadýr. 13 yaþ üstü çocuklarda ise öz kýyýma baðlý zehirlenmeler ve psikopatolojiler ön plandadýr. Ýlaçlar, zehirlenme etkeni olarak ilk sýradadýr. Olgularýn yaklaþýk beþte biri için yoðun bakýmda tedaviye ihtiyaç duyulmaktadýr.

Objective: Intoxication remains a serious health problem and can have serious consequences, depending on the substance received or the time elapsing to presentation to hospital. Some patients presenting to emergency departments due to intoxication are hospitalized for treatment, including intensive care. The purpose of this study was to evaluate demographic characteristics, causes of intoxication, and information concerning length of hospitalization and course of disease in cases of childhood poisoning presenting to the emergency department.
Patients and Methods: Medical records of patients with intoxication aged 0-18 years preenting to the Erzurum Regional Training and Research Hospital and receiving inpatient treatment in 2008-2016 were evaluated retrospectively.
Results: 642 cases were evaluated within the scope of the study. The mean age of the cases was 8.1±6.6 years (mean± SD); 61.8% (n=397) of patients were female and 38.2% were male (n=245). Causes of intoxication were drugs in 57.9% (n=372) of cases, pesticides in 11.5% (n=74), cleaning products in 8.6% (n=55), and wild plants in 3.3% (n=21), while the cause was unknown in 18.7% (n=120). The mean length of hospitalization was 3 days, and 9% (n=58) of patients received inpatient treatment in the intensive care unit. Pathology was determined in 21% (n=135) of cases, major depressive disorder being identified in 85.9% (n=116) of these.
Conclusions: According to our findings, the most important part of childhood poisoning is poisonings that accidentally occur under 5 years of age. In children over 13 years of age, poisonings and psychopathologies are associated with self-healing. Drugs are the first to be effective in poisoning. Treatment for intensive care is needed for approximately one fifth of children of the population.

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Bu prospektif çalýþmayla, timpanoplasti uygulanan 90 hastada postoperatif bulantý ve kusma üzerine deksametazon ve düþük doz propofol infüzyonunun etkileri araþtýrýldý. Ameliyat bitiminden 15 dakika önce deksametazon grubuna (Grup D) 8 mg deksametazon ve kontrol grubuna (Grup C) 2 ml salin yapýlýrken; propofol grubuna (Grup P), anestezi indüksiyonu sonrasýnda ameliyat boyunca 20mcg/kg/dk propofol intravenöz infüzyonu yapýlmýþtýr. Postoperatif ilk 24 saat boyunca bulantý-kusma ve antiemetik gereksinimlerinin insidans ve þiddeti kaydedildi. 0-2 saatlik periyotta, Grup P'de 23 (% 76.7) hastada, Grup D'de 17 (%56.7) ve GrupC'de 8 hastada (%26.7) postoperatif bulantý ve kusma görülmedi. Gruplar arasýnda postoperatif bulantý ve kusma için sözel tanýmlayýcý ölçek deðerleri açýsýndan 0-2 ve 2-8 saatlik süreler arasýnda farklar gözlemlendi (sýrasýyla p<0.01 ve p=0.004). 2-8 saatlik postoperatif bulantý ve kusma insidansý Grup P'de % 10.0 (n = 3), Grup D'de % 36.7 (n = 11) ve Grup C'de % 53.3 (n = 16) idi; bu fark Grup P lehine istatistiksel olarak anlamlýydý (p = 0.032). 0-24 saatte tedaviye raðmen kusma sayýsý grup C'ye kýyasla Grup P ve Grup D'de (sýrasýyla n = 4,% 13.3 ve n = 5,% 16.7) daha düþüktü (n = 14, 46.7 %) (P = 0.005). Antiemetik kullanýmý, Grup C'de Grup D ve P'ye göre daha yüksekti (p = 0.001).Ýntraoperatif düþük doz propofol infüzyonu, postoperatif bulantý ve kusma insidansýný ve þiddetini azaltmada ayný zamanda timpanoplastiden sonra bir antiemetik kullaným ihtiyacýný azaltmada deksametazon kadar etkilidir.

This prospective study investigated the effects of dexamethasone and low-dose propofol infusion on postoperative nausea and vomiting in 90 patients undergoing tympanoplasty. The dexamethasone group (Group D) received 8 mg dexamethasone and the control group (Group C) 2 ml saline 15 min before the end of surgery, while the propofol group (Group P); received 20 mcg/kg/min ýntravenous propofol infusion throughout surgery following anaesthesia induction. Incidences and severity of nausea-vomiting and antiemetic requirements were recorded throughout the first 24h postoperatively. Between hours 0 and 2, no postoperative nausea and vomiting was observed in 23 (76.7%) patients in Group P, 17 (56.7%) in Group D and 8 (26.7%) in Group C. Differences were observed between the groups in hours 0-2 and 2-8 in terms of verbal descriptive scale values for postoperative nausea and vomiting (p<0.01 and p=0.004, respectively). Total incidences of postoperative nausea and vomiting at hours 2-8 h were 10.0% (n=3) in Group P, 36.7% (n=11) in Group D and 53.3% (n=16) in Group C, the difference being statistically significant in favour of Group P (p=0.032). At 0-24 h, the numbers of patients vomiting, despite treatment, were lower in groups P and D (n=4, 13.3% and n=5, 16.7%, respectively) compared to Group C (n=14, 46.7%)(p=0.005). Antiemetic use was higher in Group C than in groups D and P(p=0.001). Intraoperative low-dose propofol infusion is as effective as dexamethasone in reducing the incidence and severity of postoperative nausea and vomiting, as well as reducing post-tympanoplasty antiemetic requirements.

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Preconditioning in Cardiac Surgery
Cardioprotective management has increasingly become a standard of care for preservation of myocardial reserve during cardiac surgery. This study investigates the usefulness of inflammatory cytokines and PAPP-A levels in predicting the appropriate preconditioning method. Ninety ASA III patients scheduled for CABG surgery were included and allocated into three groups. Group 1 (n=30) received propofol (2–3 mg.kg-1.h-1) and fentanyl (3¬–5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. Group 2 (n=30) received propofol (5–6 mg.kg-1.h-1) and fentanyl (3–5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. Group 3 (n=30) received midazolam (0.04¬–0.06 mg.kg-1.h-1) and fentanyl (3–5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. TNF-α, PAPP-A and usCRP levels were measured one day preoperatively (S1), immediately prior to the cardiopulmonary bypass (S2), after completion of the cardiopulmonary bypass (S3) and 48 hours postoperatively (S4). In all groups, TNF-α increased at S2 and S3 and decreased at S4 (P<0.05), with the most prominent increase observed in Group 2. The highest increase in PAPP-A levels at S2 and S3 stages was observed in group 2 whereas the lowest decrease at S4 stage was observed in Group 1 and 3. In Group 1, usCRP levels showed a significant increase at S3 compared to S1 and S2 (p<0.05) and decreased to levels close to S1 and S2. PAPP-A can be used with usCRP and TNF-α to determine the optimal preconditioning method in the anaesthetic management of CABG surgery. Using these markers, we observed that midazolam-desflurane and low-dose propofol-desflurane were effective in anaesthetic preconditioning during CABG surgery

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Preterm eylemde trombosit indeksindeki deðiþiklikleri deðerlendirmek ve preterm eylemi tanýsý için bir öngörü deðeri taþýyýp taþýmadýðýný araþtýrmaktýr.
Retrospektif olarak 2013-2016 yýllarý arasýnda 140 preterm eylem ve 130 saðlýklý gebeði olan kadýnlar çalýþmaya alýndý. Toplam 270 gebenin demografik, obstetrik ve labaratuvar sonuçlarý (hemoglobin, hematokrit, beyaz küre, trombosit, trombosit yayýlým geniþliði, ortalama trombosit volümü) karþýlaþtýrýldý.
ortalama trombosit volümü (MPV) ve hemoglobin seviyeleri preterm eylem gurubunda önemli derecede düþük bulundu(sýrasýyla p<0.001,p=0.01). Trombosit yayýlým geniþliði (PDW) seviyeleri ise preterm eylem grubunda yüksek bulundu(p=0.05).Trombosit sayýsý arasýnda her iki grupta önemli bir fark görülmedi.
Gebeliðin oluþumu ve seyri için baþarýlý bir koagulasyon ve antikoagulasyon dengesi çok önemlidir. Bunun için PDW, MPV gibi bir çok belirteç çalýþýlmýþtýr. Ancak bilhassa son dönemde kan hücreleri subtip oranlarýnýn kronik düþük dereceli inflamasyon ile iliþkili hastalýklarda prognoz ve teþhis için ipuçlarý barýndýrabileceði düþünülmüþtür.Preterm eylemde MPV seviyelerinin düþük PDW seviyelerinin yüksek bulunmasý patalojide trombosit aktivasyonu ve inflamasyona baðlý olabileceðini düþündürmektedir.Artmýþ PDW seviyeleri obstetrisyeni preterm eylem riski konusunda uyarabilir.Mamafih preterm eylem tanýsýnda trombositlerin faydalý rolu için daha fazla çalýþmalara ihtiyaç vardýr.

To evaluate changes in platelet index in preterm labor and to investigate whether there is a predictive value for preterm labor.
Retrospectively, women with 140 preterm labor and 130 healthy pregnant women between 2013 and 2016 were included in the study. Demographic, obstetric and laboratory results (hemoglobin, hematocrit, white blood cell, platelet, platelet distribution width, mean platelet volume) of 270 pregnancies were compared.
Mean platelet volume (MPV) and hemoglobin levels were significantly lower in the preterm labor group (p <0.001, p = 0.01, respectively). Platelet distribution width (PDW) levels were higher in the preterm labor group (p = 0.05). There was no significant difference between platelet counts in both groups.
Successful coagulation and anticoagulation stabilization are very important for the formation and progression of the pregrancy. For this, many markers such as PDW, MPV have been studied. More recently, however, blood subtypes are thought to be able to provide clues for prognosis and diagnosis in chronic low-grade inflammation-related diseases. MPV levels in preterm labor suggest that high levels of low PDW levels may be due to pathologic thrombocyte activation and inflammation. Further PDW levels may alert the obstetrician to the risk of preterm labor. However, there is a need for further study for the beneficial role of platelets in the diagnosis of preterm labor.

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Vitamin D, deride ultraviyole ýþýðýn etkisiyle üretilen steroid yapýlý bir hormondur
Aktif vitamin D’nin hücresel büyüme, proliferasyon ve apoptozis, oksidatif stres, membran transportu, matriks hemostazý, hücre adezyonu, immun sistem fonksiyonu gibi hayati olaylarda rol oynadýðý düþünülmektedir.
Bazý çalýþmalarda inflamatuvar sisteme etkileri sonucunda vitamin D eksikliðinin ortalama trombosit hacminde (OTH) artýþa yol açtýðý iddia edilmiþtir. Yüksek OTH’ýn venöz tromboembolizm, hipertansiyon, koroner arter hastalýðý gibi damar hastalýklarý ile iliþkili olduðu yapýlan çalýþmalarda gösterilmiþtir. Bizim bilgilerimize göre þu ana kadar böbrek nakilli hastalarda vitamin D düzeyi ve OTH arasýndaki iliþkiye dair bir yayýn yoktur. Biz de çalýþmamýzda stabil böbrek nakilli hastalarda vitamin D düzeyi, OTH ve kardiyovasküler hastalýklar (KVH) arasýndaki iliþkiyi araþtýrmayý amaçladýk.
Kasým-Aralýk 2015 tarihleri arasýnda polikliniðe vuran 150 hastadan vitamin D düzeyi ölçülmüþ olan 92’si alýndý. Hasta bilgileri retrospektif olarak toplandý. Hastalar, vitamin D düzeyi <20 ng/mL olanlar grup I (n: 63), >20 ng/mL olanlar grup II (n: 29) olarak ikiye ayrýldý.
Bizim çalýþmamýzdaki hastalarýn %68.5’inde vitamin D eksikliði vardý. Bu oran daha önceki çalýþmalarda bulunan oran ile benzerdi. Korelasyon analizinde vitamin D düzeyi ve OTH ve KVH varlýðý arasýnda bir iliþki saptanamadý (p=0.60, p=0.19).
Vitamin D ve OTH üzerine büyük bir ilgi olsa da böbrek nakilli hastalarda vitamin D eksikliðinin inflamasyona yol açýp açmadýðý ve OTH’nin bir belirteç olarak kullanýlýp kullanýlamayacaðý netleþmemiþtir. Vitaminin D replasmaný yapýlýrken bu tedaviden beklenen olumlu etkilerin yaný sýra birikime baðlý zararlý etkilerinin olabileceði göz önünde bulundurulmalýdýr. Vitamin D eksikliði, OTH ile KVH arasýndaki iliþkinin belirlenmesi için daha geniþ randomize kontrollü çalýþmalara ihtiyaç vardýr.

Vitamin D plays a role in growing, proliferation, apoptosis and immune system. Vitamin D deficiency is supposed to affect mean platelet volume (MPV) by its impact on inflammatory system. Increased MPV was shown to be related to arterial and venous diseases. To our knowledge, there is no study about the relation between vitamin D and MPV in kidney transplant recipients (KTRs). The aim of this study is to determine the relation between vitamin D levels, MPV and cardiovascular disease (CVD) in KTRs.
Ninety two patients who admitted to our clinic between November- December 2015 were eligible for the study. Patient’s data examined retrospectively. Patients are grouped in two according to vitamin D levels: group I vitamin <20 ng/mL (n: 63) and group II vitamin D>20 ng/mL (n: 29). The relation between MPV, vitamin D and other parameters was evaluated.
In our study, 68.5% of the patients had vitamin D deficiency. In correlation analysis no relation was determined between vitamin D level and MPV (rs=0.16, p=0.60). MPV does not correlate with CVD (p=0.19)
There is great interest in vitamin D and MPV, it is unclear whether vitamin D deficiency causes inflammation and MPV can be used as a marker of vitamin D deficiency in KTRs. When vitamin D is replenished, it should be noted that there may be adverse effects due to accumulation, as well as the positive effects expected from this treatment. Further randomized controlled trials are needed to address the relationship between vitamin D deficiency, MPV and CVD.

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Erken gebelik haftasýnda alýnan servikovajinal smear testi (CVS) sonuçlarýnýn postpartum dönemde alýnan cvs sonuçlarý ile karþýlaþtýrýlýp yeterliliðinin sorgulanmasýný amaçladýk.
Çalýþmaya 2014 -2016 yýllarý arasýnda gebeliðin ilk trimestrýnda hastaneye baþvuran 179 hasta dahil edildi. Prospektif yapýlan çalýþmada gebelikte alýnan CVS sonuçlarý ile postpartum 8. haftadan sonra alýnan CVS sonuçlarý karþýlaþtýrýldý. Takibe alýnan hastalarýn 82’si vajinal doðum, 97’si sezaryen (C/S) ile doðurtuldu. Doðum þeklinin CVS sonuçlarý üzerindeki etkisi deðerlendirildi. Gebelikte ve postpartum dönemde alýnan CVS sonuçlarýnda displazi izlenmedi. Postpartum CVS sonuçlarýnda C/S ve vajinal doðum arasýnda fark görülmedi (p>0.05). Postpartum hiçbir hastada düþük ya da yüksek dereceli servikal displazi tespit edilmedi.
Gebelikte ve postpartum dönemde alýnan servikal yayma sonuçlarýný deðerlendirdiðimiz bu çalýþmada gebelik sürecinde alýnan CVS sonuçlarýnýn güvenilir olduðunu ve postpartum süreçteki CVS sonuçlarý ile benzerlik gösterdiðini saptadýk. Gebelik sürecinde alýnan CVS testinin rutin taramaya eklenmesinin, serviks kanseri tarama programýnda yakalanamayan hastalarýn saptanmasýna katkýsý olacaðýný düþünüyoruz.

In this prospectively designed study, we aimed to determine the accuracy of cervicovaginal smear tests obtained during pregnancy by comparison with postpartum test results. between 2014-2016, 179 pregnant women were included. Of 179 pregnant women 82 were delivered vaginally, 97 by C/S. CVS test results obtained during first trimestr of pregnancy and postpartum 8 weeks after delivery were compared.
No statistically significant difference was found between women delivered vaginally and those delivered by cesarean section with respect to age, parity and gravida. All cervicovaginal smear results were negative for inraepitelial lesions and malignancy. No significant difference was found between vaginal and C/S delivery group CVS results (p>0.05). In both groups there were no progression to low grade or high intraepitelial displasia.
In this study by comparing CVS results obtained during pregnancy and postpartum we concluded that CVS tests taken during pregnancy is reliable. CVS should be a part of prepartum routine examination. Obstericians should take the opportunity to catch patients who could not reach cervical cancer screening programme.

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Endometriozis, endometriyal gland ve stromanýn uterin kavite dýþýnda bulunmasýdýr. Reprodüktif çaðdaki kadýnlarýn %10-15 inde görülen hastalýðýn semptomlarý arasýnda; kronik pelvik aðrý, dismenore, disparoni ve infertilite yer almaktadýr. Her ne kadar endometriyozisin kesin tanýsý cerrahi olarak çýkarýlan dokunun histopatolojik incelemesi ile olsa da; invaziv yöntemlere dair hasta korkusu, cerrahi komplikasyon riskleri ya da cerrahi gözlem ile odaðýn gösterilememesi gibi olasý zorluklar nedeniyle non-invaziv testler ile hastalýðýn tanýsýný koyma çalýþmalarý önem kazanmýþtýr. Günümüzde endometriyozis tanýsý için klinik uygulamada rutin olarak kullanýlan non-invaziv bir test bulunmamaktadýr. Non invaziv taný test araçlarýndaki geliþmeler ve standardizasyon, erken taný (dolayýsý ile erken tedavi) ve hasta konforu açýsýndan önem arz etmektedir. Bu derlemede endometriyozis tanýsýnda kullanýlmasý mümkün olan non invaziv testler özetlenmiþ, spesifik serum belirteçleri, görüntüleme yöntemleri ve ötopik endometrial belirteçleri içeren bir dizi aday taný testi güncel bilgiler ýþýðýnda tartýþýlmýþtýr.

Endometriosis is defined as presence of endometrial glands and stroma out of the uterine cavity. Symptoms of the disease which affects 10–15% of women of reproductive age are chronic pelvic pain, dysmenorrhoea, dyspareunia and infertility. Although definitive diagnosis of endometriosis is made by histopathological examination of surgically removed tissue, non-invasive tests have become important for diagnosis because of possible difficulties of surgical diagnosis such as patient’s fear of invasive procedures, risks of surgical complication or failure to show the endometriotic lesions by surgical inspection. To date, there is no any non-invasive test for the diagnosis of endometriosis that is routinely used in clinical practice. Developments and standardization in non-invasive diagnostic test instruments are getting important in terms of early diagnosis ( and thus early treatment) and patient comfort. In this review we summarise the non-invasive methods which are currently used and discuss a number of candidate methods including specific serum tests, imaging modalities and eutopic endometrial markers for the non-invasive diagnosis of endometriosis have been discussed along with the relevant literature.

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Benign prostatic hyperplasia (BPH) is common in the elderly. The surgery of choice in those who failed medical treatment is transurethral resection of prostate (TURP). Haematuria post TURP can be distressing and difficult to manage. The physiological changes in the elderly have led to inability to withhold hypovolaemic states especially in inoperable candidate. Using endovascular modalities, this complication can be managed efficiently without endangering patients’ well-being. Herein, we present a case of a successful prostatic artery embolization in a patient with poor surgical fitness, which was complicated with bleeding post TURP.

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32 yaþýndaki erkek yürürken sol alt ekstremite ve sol diz seviyesinin altýnda ters bir pulsatil kitle aðrý ile baþvurdu. Manyetik rezonans anjiyografi incelemede popliteal arterin anevrizmal dilatasyonu bildirildi. Kesenin cerrahi rezeksiyonu ve revaskülarizasyonun ardýndan, histopatolojik inceleme ve mikrobiyolojik deðerlendirmesinde mantar hifleri tespit edildi. Potansiyel etyolojisi göz önüne alýndýðýnda, asemptomatik hastada detaylý bir kalp deðerlendirmesi gerçekleþtirildi. Ekokardiyografik deðerlendirmede ön mitral kapak üzerinde belirgin vejetasyon ve ileri mitral yetmezlik saptandý. Uygun antifungal tedavi ve baþarýlý cerrahi tedavi ile tam iyileþme saðlandý.

A 32-year-old male presented with pain in the left lower extremity while walking and a pulsatile mass on the backside below the left knee level. Aneurysmal dilatation was reported in the popliteal artery in the magnetic resonance angiographic examination. Following the surgical resection of the sac and revascularization, fungal fibers were detected in the histopathological examination and microbiological evaluation of the specimen. Considering the potential etiology, a detailed cardiac assessment was carried out in asymptomatic patient. It was found significant vegetation and severe mitral insufficiency on the mitral valve anterior leaflet in the echocardiographic evaluation. Appropriate antifungal treatment and successful surgical management were handled with a complete recovery.

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Non-Hodgkin lenfomalar arasýnda ekstranodal doðal katil/T-hücreli lenfoma nazal tip çok nadir görülür. Ekstranodal doðal katil/T-hücreli lenfoma nazal tip çoðunlukla nazal kavite, paranazal sinüsler, nazofarenks ve yüzün orta hat yapýlarýnda ortaya çýkar. Yüzün orta hat yapýlarý tutulduðunda hastalar genellikle burun týkanýklýðý, burun kanamasý, kötü kokulu burun akýntýsý, baþ aðrýsý ve yüzde þiþlik þikayetleriyle baþvururlar. Maligniteler nazal solunum epitelinin fonksiyonlarýnda bozukluk meydana getirerek, Klebsiyella Ozaenae gibi patojen mikroorganizmalarýn çoðalmasýna yatkýnlýk oluþturabilirler. Atrofik rinit veya Ozena mukozal atrofi ve altta yatan kemik dokuda destrüksiyonla giden bir hastalýktýr. Nazal kültürlerde Klebsiyella Ozaenae yaygýn olarak üretilir. Ozena ve ekstranodal doðal katil/T-hücreli lenfoma nazal tip hastalarda benzer þikayetler oluþturabilirler. Bu nedenle malignite varlýðýnýn kesin ekarte edilmesi gerekir. Bu sebeple nazal biyopsi sonucu malignite açýsýndan negatif olan vakalarda biyopsi tekrarý önemlidir. Bu çalýþmada Klebsiyella Ozaenae enfeksiyonu tarafýndan gizlenen ve ekstranodal doðal katil/T-hücreli lenfoma nazal tip tanýsý alan vaka sunulmuþtur.

Extranodal natural killer/T-cell lymphoma nasal type is extremely rare among Non-Hodgkin lymphomas. By a majority, extranodal natural killer T cell lymphoma nasal type arises in nasal cavity, paranasal sinuses, nasopharynx and midline structures of the face. When midline structures of the face are involved, patients generally admit with complaints such as nasal congestion, epistaxis, foul-smelling nasal discharge, headache, and swelling in face. Malignancies can cause impairment on functions of nasal respiratory epithelium and a predisposition for reproduction of pathogenic microorganisms such as Klebsiella Ozaenae. Atrophic rhinitis or Ozena is a disease characterized by mucosal atrophy and destruction in underlying bone tissue. In nasal cultures, Klebsiella Ozaenae is commonly reproduced. Extranodal natural killer T cell lymphoma nasal type and Ozena can be caused similar complaints in patients. For this reason the presence of malignancy should be excluded. Therefore in cases which nasal biopsy results are negative in terms of malignancy, repetition of biopsy is important. In this article, we present a rare case which diagnosed with extranodal natural killer T cell lymphoma nasal type that hidden by Klebsiella Ozaenae infection.

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Cinsel uyarý olmaksýzýn idiopatik spontan orgazm gerçekleþmesi nadir bir durumdur. Bu durumun, antidepresan veya antipsikotik tedavisi sýrasýnda bir çok farklý ilaçla ortaya çýkabileceði ifade edilmiþtir. Panik bozukluðu ve seksüel disfonksiyon arasýndaki iliþki ile ilgili tartýþmalý bulgular mevcuttur. Bazý çalýþmalar panik bozukluðu hastalarýnýn diðer anksiyete bozukluklarý olan hastalara kýyasla daha fazla orgazm sorunlarý yaþadýðýný bildirmiþtir. Bu olgu sunumunda, 34 yaþýnda kadýn hasta idiopatik spontan orgazmlar ve istenmeyen genital uyarýlar ile baþvurdu. Hasta günde 10-15 kez olan ve bir dakikada yaklaþýk 30 saniye süren spontan orgazmla sonuçlanan cinsel uyarýlma yaþadýðýný belirtti. Çarpýntý, nefes darlýðý, boðulma hissi, uyuþukluk ve ölümden korkma gibi birkaç semptom tarifledi. Medikal öyküsünde mani veya hipomani yoktu. Detaylý incelemede, fizik muayene, rutinler hormonal inceleme, elektroensefalografi (EEG), bilgisayarlý beyin tomografisi yapýldý. Tüm sonuçlar normal sýnýrlardaydý. Hastaya panik bozukluk tanýsý konuldu. Bu hastalýk spontan orgazmlarýn baþlamasýndan sonra ortaya çýkmýþtý. Paroksetin ile tedavi uygulandý ve dozu kademeli yükseltilerek bir ay sonra 30 mg/gün’e çýkýldý. Ek tedavi olarak alprazolam 0,5 mg günde iki kez tedavisi baþlandý. Kontrolde semptomlar ve önceki tedavi deðerlendirildikten sonra alprazolam tedavisi kesildi ve paroksetin 30mg/gün dozunda devam edildi. Paroksetin ve alprazolam tedavisiyle spontan orgazm ataklarý ortadan kayboldu. Seksüel semptomlar ve spontan orgazm durumlarý iki ayda yavaþ yavaþ giderildi. Bu olgu sunumu spontan orgazmlarýn varoluþ ve karakteristikleri hakkýnda cinsel týp alanýnda uzmanlaþmýþ kiþiler tarafýndan daha fazla bilgi edinilmesine gerek duyulduðunun üzerinde durmuþtur.

Idiopathic spontaneous orgasm without sexual arousal is a rare condition that has been described during antidepressive or antipsychotic treatment using several different drugs. The relationship between panic disorder and sexual dysfunction is controversial. Some studies have reported that patients with panic disorder have more orgasm problems compared to those with other anxiety disorders. In this case, a 34-year-old woman was admitted with idiopathic spontaneous orgasm and unwanted genital sensations. The patient expressed that she experienced sexual arousal culminating in spontaneous orgasm approximately 10–15 times/day and each episode lasted 30 s to 1 min. She reported several symptoms, such as palpitations, shortness of breath, smothering, numbness, and fear of dying. The patient did not have a medical history of mania or hypomania. An in-depth interview, physical examination, routine hormonal evaluation, electroencephalography, and brain computed tomography scan were performed. All results were within the normal range. She was diagnosed with panic disorder. The disease began after the spontaneous orgasms started. She was treated with paroxetine, and the dosage was increased gradually to 30 mg/day after 30 days. Additional treatment with 0.5 mg alprazolam twice daily for 30 days led to improvement. After considering her symptoms and prior treatment, we stopped the alprazolam and continued 30 mg/day paroxetine. The spontaneous orgasms and sexual symptoms resolved gradually after 2 months. This case report emphasizes the need to provide more information on characteristics of spontaneous orgasm by generalists who practice outside the field of sexual medicine.

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