Cerrahi iþlem sonrasý geliþen yara yeri enfeksiyonlarý, günümüzde hala belirgin morbidite ve mortaliteye yol açmakta, ayný zamanda saðlýk sistemi için ekonomik yük oluþturmaktadýr. Bu sebeplerden dolayý, yara yeri enfeksiyonunun önlenmesi önem arz etmektedir. Bu çalýþmada, tam kan sayýmý parametrelerinin histerektomi sonrasý yara yeri enfeksiyonu geliþimi ile iliþkisi araþtýrýldý. 2009-2013 arasý abdominal histerektomi yapýlan 270 hasta, retrospektif olarak deðerlendirildi. Postoperatif yara yeri enfeksiyonu geliþen hastalar ile herhangi bir enfeksiyöz komplikasyon geliþmeyen hastalar karþýlaþtýrýldý. Her iki grup arasýnda hasta yaþ, komorbidite, preoperatif hemoglobin ve albümin seviyeleri, immünsupresif kullanýmý ve sigara içen oraný açýsýndan fark izlenmedi. Yara yeri enfeksiyonu geliþen olgularda, preoperatif nötrofil seviyeleri ve nötrofil-lenfosit oraný anlamlý olarak yüksek, preoperatif lenfosit seviyesi ise anlamlý olarak düþük bulundu. Trombosit seviyeleri iki grup arasýnda benzerdi. Çalýþmanýn sonucuna dayanarak, preoperatif yüksek nötrofil seviyesi ve yüksek nötrofil-lenfosit oranýnýn ve düþük lenfosit seviyesinin, histerektomi sonrasý yara yeri enfeksiyonu geliþimini öngörmede kullanýlmasý önerilebilir.

Surgical site infections (SSI) represent a significant burden concerning morbidity, mortality and additional cost to health system. For these reasons, the prevention of SSI is important. In this study, the potential relationship betweenpreoperative blood count parameters and SSI after hysterectomy was investigated. A total of 270 patients who underwent abdominal hysterectomy between 2009 and 2013 were retrospectively analyzed. Patients with postoperative superficial SSI were compared to those without postoperative infectious complication. Patients’ age, BMI, comorbidity, preoperative serum hemoglobin and albumin levels, use of an immunsupressive medication and rate of current smoker were similar between groups. Patients with SSI had significantly elevated levels of neutrophil, neutrophil/lymphocyte ratio and decreased levels of lymphocyte compared to those without SSI. Serum platelet level did not differ between groups. Standing these data, one may suggest using preoperative high neutrophil and NLR levels and low lymphocyte levels as predictors of SSI after hysterectomy.

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Yaþlýlarda kalça kýrýklarý, önemli mortalite nedenlerinden biridir. Çeþitli komorbid faktörler bu sonuca katkýda bulunur. Son derece önemli bir komorbid faktör olan son-dönem böbrek yetmezliði (SDBY), ciddi komplikasyonlara neden olur. Bununla birlikte, diðer komorbid hastalýklarýn mevcudiyeti göz önünde bulundurulduðunda SDBY'nin tek baþýna mortaliteye etkisi halen netlik kazanmamýþtýr ve bu çalýþmada bu iliþkinin deðerlendirilmesi amaçlanmýþtýr. Kalça kýrýðý tanýsý ile kliniðimize baþvurup parsiyel kalça artroplastisi ile tedavi edilmiþ olan 65 yaþ ve üstü hastalar retrospektif olarak deðerlendirildi. Tüm hastalarla temasa geçildi. Ölüm meydana gelmiþ ise tarihi kaydedildi. Hastalar kýrýk oluþumundan önce taný koyulmuþ SDBY'si olan (Grup1, n=37) ve olmayan (Grup2, n=281) olmak üzere 2 grupta deðerlendirildi. Her iki gruptaki hastalar ortalama yaþ, cinsiyet, kardiyak ejeksiyon fraksiyonu (EF), toplam hastanede kalýþ süresi, hastaneye yatýþtan ameliyata kadar geçen süre, ameliyat süresi, çimento kullanýmý ve mortalite parametreleri açýsýndan karþýlaþtýrýldý. Ayrýca komorbid hastalýklar kategorize edilerek kardiyak, pulmoner, nörolojik komorbid hastalýklar ve diabetes mellitus (DM) gruplarýna ayrýldý. Her iki grup ek hastalýk kategorileri açýsýndan karþýlaþtýrýldý. Yaþ ortalamasý (p=0.782), cinsiyet (p=0.659), EF (p=0.285), çimento kullanýmý (p=0.971) ve ameliyat süresi (p=0.758) açýsýndan gruplar arasýndan anlamlý fark yoktu. Gruplar arasýnda toplam hastaneye yatýþ süresi (p<0.001), ameliyat olana dek geçen süre (p<0.001) ve mortalite (p=0.009) açýsýndan anlamlý fark tespit edildi. Komorbid faktörlere göre gruplarýn karþýlaþtýrýlmasý sonucunda kardiyak (p=0.570), pulmoner (p = 0.875) ve nörolojik (p=0.895) açýdan fark yoktu. DM açýsýndan gruplar arasýndaki fark bulundu (p=0.043). SDBY ile birlikte DM varlýðý, yaþlý hastalarda kalça kýrýklarýnýn mortalitesini diðer komorbiditelerden baðýmsýz olarak artýrmaktadýr. Bu hastalarýn hastanede kalýþ süresi ve cerrahi hazýrlýk süresi daha uzun olmaktadýr.

Hip fractures are associated with increased mortality. The relationship between mortality of hip fractures and end-stage renal disease was not well elucidated in the elderly population. The aim of this study was to determine the association between hip fracture mortality and end-stage renal disease. An evaluation was made of the data of patients with diagnosis of hip fracture. Current status of survival or date of death was determined. Patients were examined in 2 groups. Group 1: 37 patients who has end-stage renal disease and Group 2: 281 patients who do not have. Both groups were retrospectively compared on the age, female/male ratio, cardiac ejection fraction, bone cement usage, total hospitalization time, time from initial trauma to surgery for surgical preparation and mortality. There were additional co morbid diseases except renal disease. They were grouped as cardiac / pulmonary / neurologic and diabetes mellitus both study groups were compared on these co morbid disease groups. There were no significant differences in respect of age (p=0.782), female: male ratio (p=0.659), ejection fraction (p=0.285), bone cement usage (p=0.971), duration of surgery (p=0,758), cardiac co morbidity (p=0.570), pulmonary co morbidity (p=0.875), neurologic co morbidity (p=0.895) between two groups. A statistically significant relationship was found between the groups in respect of total hospitalization period (p<0.001), time from trauma to surgery (p<0.001), mortality (p=0.009) and diabetes mellitus (p=0.043) between two groups. End-stage renal disease with diabetes mellitus increases mortality of hip fractures in the elderly. These patients have a longer period of total hospitalization and surgical preparation time.

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Amputasyon revizyon cerrahisi ile ilgili risk faktörlerinin ortaya konmasý, etiyoloji ve seviyelerinin yaþ gruplarý ile iliþkisinin deðerlendirilmesidir. Çalýþmamýzda Ocak 2012 ve Kasým 2017 tarihleri arasýnda kliniðimizde yapýlan 410 (275 erkek, 135 kadýn) hastanýn 532 amputasyonu, 7 farklý yaþ grubunda retrospektif olarak incelendi. Olgularýn cinsiyet, etiyoloji, amputasyon seviyesi ve seviye yükseltme amacýyla yapýlan revizyon ameliyatlarýnýn yaþ gruplarý ile iliþkisi deðerlendirildi. Toplamda 532 amputasyonun %20,2’si revizyon ameliyatlarýdýr. Amputasyon nedenleri %57,3 diyabet, %20,2 periferik vaskuler hastalýk, %16,4 travma ve %5,4 olguda ise diðer nedenler idi. Etiyolojide diyabet anlamlý oranda fazlaydý (p<0.001). Kýrk yaþ ve üstü, vasküler yetmezliðe baðlý amputasyonlar ve 40 yaþ altý travmatik amputasyonlar anlamlý olarak fazla bulundu. Travmatik amputasyonlar %7,1 trafik kazasý, %1 ateþli silah yaralanmasý, %8,3 olguda iþ kazasý sonucuydu. Alt ekstremite amputasyonlarý üst ekstremiteden fazlaydý. En sýk diz altý seviyesinde amputasyon %38,3 yapýldýðý görüldü. Üst ekstremite amputasyonlarý arasýnda en sýk el-parmak amputasyonlarý %3,7 idi. Revizyon oranlarý; diyabet için %73,5, PAH için %22,9 ve travmatik sebepler için %3,6 olarak bulunmuþtur. Revizyon amputasyonu ile en fazla iliþki faktörlerlerin; 56 yaþ< ve diyabet olduðu görüldü. Amputasyon en sýk vaskuler yetmezliðe baðlý olarak alt ekstremitede ve ileri yaþta yapýlmaktadýr. Bu hasta grubu revizyon amputasyonu için de yüksek risk taþýmaktadýr. Ameliyat öncesi ayrýntýlý deðerlendirme ile seviye tayini ve özellikle diyabetiklerde medikal tedavi etkinliðinin arttýrýlmasý amputasyon sayý ve revizyonlarýnýn azalmasýna yol açacaktýr.

The aim of the study was the determination of the risk factors related with the revision of amputations and the evaluation of the etiologies with the relation among age groups and the amputation levels. Five hundred and thirty-two amputations in 410 patients (275 male, 135 female) which were performed between January 2012 and November 2017 were retrospectively evaluated in 7 separate age groups. The relation of the age groups with the sex, etiology, the level of the amputation, necessity of revision was evaluated. The revisions in which the level of the amputation have been increased have accounted for 20,2% of 532 amputations. The indication for amputation was diabetes in 57,3%; peripheral vascular disease (PVD) in 20,2%; trauma in 16,4% and other reasons in 5,4%. The indication due to diabetes was significantly more than the other indications (p<0.001). Diabetes and peripheral vascular disease were predominant after the 4th decade and trauma was predominant before the 4th decade. Traffic accidents have accounted for 7,1%, gunshots for 1% and labour accidents have accounted for 8,3% of traumatic amputations. The amputations were performed more in the lower limb. Below knee amputations were performed the most (38,3%). Hand digit amputations were performed the most in the upper extremity (3,7%). The revision rates were as following; 73,5% in diabetes, 22,9% for PVD and 3,6% in trauma. The factors which were most related with the revisions were 56 years age< and diabetes. Amputations are most commonly performed due to vascular insufficiency in the elderly. This patient group also carries the high risk for revision amputations. The accurate determination of the amputation level with detailed preoperative evaluation and the efficacy of medical treatment especially in the diabetics may decrease the number of the amputation and revision amputation cases.

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Amaç: Son beþ yýl içerisinde acil operasyona alýnan genel cerrahi hastalarý için seçilen anestezi tekniðinin retrospektif olarak deðerlendirilmesidir.
Gereç ve yöntem: Ocak 2011 - Aralýk 2015 tarihleri arasýnda Ondokuz Mayýs Üniversitesi Týp Fakültesi ameliyathanesinde acil operasyona alýnan genel cerrahi hastalarýnýn anestezi kayýtlarý retrospektif olarak incelendi.
Bulgular: Toplam 762 hastanýn verileri tarandý. Hastalarýn yaþ ortalamasý 55 yýl idi. Hastalarýn 712’sine (%93,4) genel anestezi uygulandý. Toplam 5 (% 0,7) hastada entübasyon güçlüðü ile karþýlaþýldý. Ýndüksiyon ajaný olarak genelde propofol, anestezi idamesinde sevofluran veya desfluran, kas gevþetici olarak rokuronyum, intraoperatif analjezi amacý ile remifentanil tercih edildi. Geri döndürücü ajan olarak ise çoðunlukla neostigmin+atropin (%60,4) kombinasyonu tercih edildi. Postoperatif dönemde analjezi amacýyla opioid ajanlar kullanýldý.
Sonuç: Ameliyathanemizde son beþ yýl içerisinde genel cerrahi tarafýndan acil cerrahiye alýnan hastalara bakýldýðýnda, açýkça görüldüki çoðunluðuna genel anestezi uygulandý. Ýndüksiyon ajaný olarak propofol, kas gevþetici olarak rokuronyum tercih edildi. Anestezi idamesinde inhalasyon ajanlarý ve opioidler uygulandý. Geri döndürücü ajan olarak ta asetilkolinesteraz inhibitörleri kullanýldý. Ayrýca hastanemizde postoperatif analjezi yönetiminde multimodal yaklaþýmýn dikkate alýndýðý bir protokol oluþturulmasý hedefi belirlendi.
Anahtar sözcükler: acil operasyon, genel cerrahi, anestezi yönetimi

Objective: The aim of the study is to evaluate retrospectively the anaesthesia techniques chosen for the patients in the department of general surgery who undergone emergency surgery in the last five years.
Materials and Methods: In between January 2011 and December 2015, anaesthesia records for the patients in the General Surgery department received emergency surgical operation in the Faculty of Medicine of Ondokuz Mayýs University have been evaluated retrospectively.
Results: The data of 762 patients were searched thoroughly. The mean age was 55. General anaesthesia was performed on 712 (93.4%) patients. Endotracheal intubation difficulties occured in 5 (0.5%) patients. Propofol as an induction agent, Sevofluran or Desfluran as an anaesthesia maintenance agent, rocuronium as a muscle relaxant agent and remifentanil as an intra-operative analgesic agent were chosen. Neostigmine+atropine combination (60.4%) was chosen as a recovery agent. During post-operative period, opioid agents were used for analgesic purposes.
Conclusion: In our operation theatre, following the patients who undergone emergency surgical operation in the last five years, it was clear that general anaesthesia was performed on most of the patients. And Propofol as an induction agent, Rocuronium as muscle relaxant agent were chosen. Inhalation agents and opioids were given to the patients in order to maintain anesthesia. Acetylcholine esterase inhibitors as recovery agents were used. At our hospital, as for postoperative analgesia method, a protocol in which multi-model approach was taken into account was aimed at.

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Aim: The aim of this study was to see correlation between anxiety levels and heart rate variability (HRV) indices in adolescents with type1 diabetes mellitus (T1 DM).
Methods: Sixty four subjects were recruited for this study which included 33 patients with diagnosed T1 DM and 31 controls. All the anthropometric measurements such as height, weight, BMI and biochemical parameters were recorded. Subjects were invited to the autonomic function testing laboratory (AFT lab), in the department of Physiology, for HRV analysis and anxiety level determination using a simple questionnaire called Hamilton’s scale of anxiety (HAMA). Statistical tests like unpaired T test, Fischer’s exact test and Pearson’s correlation coefficient was employed where ever necessary.
Results: Anxiety levels were negatively correlated with percentage of Normal-Normal interval pNN 50 (r= -0.380,p< 0.05), Standard deviation of normal-normal interval SDNN(r= -0.349, p<0.05), root mean square of the squared deviation RMSSD(r= -0.384, p< 0.05), very low frequency VLF(r= -0.586, p< 0.01), low frequency LF(r= -0.048, p< 0.01), high frequency HF( r= -0.351,p < 0.05), total power (r= -0.468, p< 0.01). Anxiety level was positively correlated with LF/HF ratio (r= 0.349, p< 0.05). There was no correlation between anxiety levels and biochemical parameters such as fasting blood glucose and glycated hemoglobin (HbA1c).
Conclusion: Since HRV is a marker of parasympathetic activity, a negative correlation of anxiety levels with HRV parameters indicates reduced parasympathetic activity in patients with T1 DM. A positive correlation between anxiety levels and sympathovagal balance (LF/HF ratio) appears to be because of reduced parasympathetic activity which is attributed to reduced HF. It may be concluded that in this preliminary study anxiety appears to play an important role in reducing HRV in patients with T1 DM.

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Deep neck infections remain a significant cause of morbidity, although their prevalence has been diminshed with modern antimicrobal therapy. The retrospective study shows that our experience in the treatment of serious cases of deep neck infections (phlegmons) and to inditify the predictors of a possibly poor outcome. This retrospective study comprised 44 patients with neck phlegmons, who were treated at the ENT Clinic, during 2000-2016. The study included the etiology, predisposing factors, causative microbiological organisms, and the clinical outcomes associated with the mortality. In the analised period, 44 patients with deep neck infections (phlegmons) were noted. The average age of the patients was 45.9 years (from 14-81), there were 26 males (59%). The patients were on average, in the hospital for 22.5 days (from 3-80 days). Staphillococus aureus was the most common isolated bacteria. Death was noted in 10 patients (22.7%). Conclusion: Diagnose made in the right time, aggresive surgical curing with using the aimed antibacterial therapy was the key to sucess in the treatment of the patients with deep neck infections. The predictors of poor prognosis in our patients were a association of conditions: tonsillar disease, diabetes mellitus, mediastinitis, age above 65 years.

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Son dönem böbrek yetmezliði hastalarýnda malnutrisyon-inflamasyon ve aðrý komponenti yaþam kalitesini etkileyen en önemli faktörlerdendir. Biz bu çalýþmada hemodiyaliz hastalarýnda malnutrisyon-inflamasyon ve aðrý algýsý arasýndaki iliþkiye baktýk. Kronik böbrek yetmezliði hastalarýnda tedaviye ve hastalýklarýna uyum bozukluðu sýklýkla mevcuttur. Bu hastalarda hasta uyumunu arttýrarak tedavi ve yaþam kalitesini arttýrabileceðimizi düþünüyoruz. 44 hemodiyaliz hastasýnda, malnutrisyon-inflamasyon skoru (MIS) ile aðrý algýsý, MIS ile CRP, aðrý ile CRP arasýnda pozitif korelasyon, aðrý ile albumin arasýnda negatif bir korelasyon tespit ettik. Sonuçta daha önce yapýlan çalýþmalarla uyumlu olarak malnutrisyon ile inflamasyon arasýnda bir iliþki olduðunu gösterdik. Ýlaveten bu hastalarda aðrý algýlarýnýn inflamasyon ve malnutrisyonu olmayan HD hastalarýna göre daha fazla olduðunu ve malnutrisyon ve inflamasyonun tedavi edilmesi ile birlikte hastalarda uyum problemlerinin azalacaðýný,mortalite oranlarýnýn düþeceðini, aðrý eþiklerinin yükseleceðini ve yaþam kalitesinin artacaðýný umuyoruz.

Malnutrition-inflammation and pain in end-stage renal failure patients are the most important factors affecting quality of life. In this study we looked at the relationship between malnutrition-inflammation and pain perception in hemodialysis patients. Adherence to treatment and illnesses is often present in patients with chronic renal failure. We think that in these patients we can improve treatment quality and quality of life by increasing patient compliance. In 44 patients with hemodialysis, we found a positive correlation between pain and perception of pain with malnutrition-inflammation score (MIS), CRP with MIS, pain, and a negative correlation between pain and albumin. In conclusion, we showed that there is a relationship between malnutrition and inflammation, consistent with previous studies. In addition, we believe that the pain perception in these patients is greater than in HD patients without inflammation and malnutrition, so with the treatment of malnutrition and inflammation, the compliance problems will decrease in patients. We hope that in these patients mortality will decrease, pain thresholds will rise, and quality of life will increase.

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Daha önceki çalýþmalarda düþük doz ve uzun süreli kortikosteroid tedavisinin akut solunum sýkýntýsý sendromlu (ARDS) hastalarda iyi klinik sonlanýmlar ile iliþkili olduðu gösterilmiþtir. Ancak, bu hastalarda ARDS tiplerine göre kortikosteroidlerin etkinliðini inceleyen bir çalýþma bulunmamaktadýr. Çalýþmamýzýn amacý; konvansiyonel tedavilere ek olarak kortikosteroid tedavisi uygulanan pulmoner ve ekstrapulmoner kaynaklý ARDS hastalarýnýn, klinik parametreleri ve hastane içi sonlanýmlarýný karþýlaþtýrmaktýr. Ocak 2008 – Aralýk 2012 tarihleri arasýnda yoðun bakým ünitesinde takip edilen, ARDS tanýsý alan ve düþük doz-uzun süreli metilprednizolon tedavisi uygulanan 22 hastanýn verileri geriye dönük olarak incelendi. Hastalar, pulmoner kaynaklý ARDS (14 hasta), ve ekstrapulmoner kaynaklý ARDS (8 hasta) olarak iki ana guruba ayrýldý ve karþýlaþtýrmalar yapýldý. Tüm hastalara konvansiyonel tedavilere ek olarak metilprednizolon tedavisi uygulandý. Pulmoner ARDS ve ekstrapulmoner ARDS guruplarý arasýnda yaþ, cinsiyet, aðýrlýk, yoðun bakýmda kalýþ süresi, ARDS geliþen gün ve mekanik ventilatörde (MV) kalma süresi açýsýndan anlamlý bir farklýlýk tespit edilmedi. Ancak, ekstrapulmoner kaynaklý ARDS gurubunda MV’den ayrýlma oraný ve hastane içi saðkalým oraný anlamlý olarak daha az idi. Çok deðiþkenli analizde, ekstrapulmoner kaynaklý ARDS hastane içi ölümün baðýmsýz öngördürücüsü olarak tespit edildi. Sonuç olarak, önceki çalýþmalarda metilprednizolon tedavisi uygulanan ARDS hastalarýnda saðkalým oranýnýn artmýþ olduðu gösterilmiþ olmasýna raðmen, çalýþmamýzda extrapulmoner kaynaklý olgularda saðkalým oranýnýn pulmoner kaynaklý olgulara oranla daha düþük olduðu gözlendi. Bu nedenle, ekstrapulmoner kaynaklý ARDS olgularýnda kortikosteroidlerin faydasýný göstermek için daha kapsamlý çalýþmalara ihtiyaç olduðu sonucuna varýldý.

Previous studies have shown that low-dose and long-term corticosteroid therapy is associated with good clinical outcomes in patients with acute respiratory distress syndrome (ARDS). However, there is no study investigating the efficacy of corticosteroids according to ARDS types. The aim of our study is to compare the clinical parameters and in-hospital outcomes of pulmonary and extrapulmonary ARDS patients who treated with corticosteroids in addition to conventional treatments. Between January 2008 and December 2012, the data of 22 patients, who were followed in intensive care unit, were diagnosed with ARDS and underwent low-dose and long-term methylprednisolone treatment, were retrospectively investigated. Patients were divided into two groups as pulmonary ARDS (14 patients) and extrapulmonary ARDS (8 patients). There was no significant difference between pulmonary ARDS and extrapulmonary ARDS groups in terms of age, gender, weight, length of stay in intensive care unit, day ARDS development, and duration of mechanical ventilation (MV). However, the weaning from MV and in hospital survival rate was significantly lower in extrapulmonary ARDS group. In multivariate analysis, extrapulmonary ARDS was detected as an independent predictor of in-hospital mortality. In conclusion, although previous studies have shown an increased survival rate in ARDS patients who received methylprednisolone therapy, it was found that survival rate was lower in extrapulmonary origin ARDS compared to pulmonary origin ARDS in our study. Therefore, it is concluded that more detailed studies are required to demonstrate the benefit of corticosteroids in extrapulmonary ARDS cases.

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Erkeklerde en sýk görülen solid tümör olan prostat kanserinin taramasýnda günümüzde halen en sýk belirteç olarak prostat spesifik antijen (PSA) kullanýlmaktadýr. PSA, prostata spesifik olmasýna raðmen prostat kanseri için spesifitesi düþüktür ve yanlýþ negatiflik oraný yüksektir. PSA bazlý taramalar ile hastalýða özgü mortalite son yýllarda azalmýþ ancak bu bazý hastalarýn fazladan taný almasýna, gereksiz biyopsilere ve tedaviye maruz kalmasýna sebep olmuþtur. Bu gibi sorunlarý giderilmesi amacýyla son yýllarda prostat kanserine spesifik ve erken taný olanaðý sunabilen biyomarkerler geliþtirilmiþtir. Bu derlemede prostat kanseri taný ve taramasý için kullanýmda olan biyomarkerlar ve görüntüleme yöntemleri güncel literatür eþliðinde deðerlendirilecektir.

Prostate-specific antigen (PSA) is the most commonly used marker in the screening of prostate cancer which is the most common solid tumor in men. Although PSA is specific for prostate, its specificity for prostate cancer is low and its false negative rate is high. With PSA-based screening, disease-specific mortality has declined in recent years, but this has led some patients to receive overdiagnosis, unnecessary biopsies and unnecessary treatment. In recent years, new biomarkers have been developed that can provide specific and early diagnosis of prostate cancer to resolve these problems. In this review, the biomarkers and imaging methods used for the diagnosis and screening of prostate cancer will be evaluated in the light of current literature.

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Sistemik lupus eritematozus(SLE), antinükleer antikor(ANA) gibi çeþitli antikorlar ile iliþkili olduðu bilinen otoimmun bir hastalýktýr. SLE hastalarýnýn çoðunda ANA pozitif olarak bulunmaktadýr. Aslýnda ANA pozitifliði SLE'nin taný kriterlerinden biridir. Fakat, SLE hastalarýnýn çok az bir kýsmý ANA negatifliði gösterebilir. Masif ödemi ve 10 gr/gün proteinürisi olan 70 yaþýndaki kadýn hastayý yayýnladýk. Hastanýn SLE serum antikorlarýnýn hepsi negatifti ve böbrek biyopsisi lupus nefriti sýnýf 5 olduðunu gösterdi. Bu olgu, birden fazla nedenden dolayý SLE'nin alýþýlmadýk bir þeklidir: hasta yaþlý bir kadýn olup izole lupus nefriti ve ANA negatifliðini de içeren negatif seroloji ile beraberdi.

Systemic lupus erythematosus (SLE) is an autoimmune disease known to be associated with various kinds of autoantibodies such as Antinuclear antibodies (ANA). ANA is found to be positive in most of the SLE patients. In fact, ANA positivity in serum is defined as one of the diagnostic criteria of SLE. However, a minority of SLE patients may present with ANA negativity. We report a 70-year-old female who presented with massive edema and 10-gram/day proteinuria. Her serum antibodies for SLE were all negative and the renal biopsy showed a class V lupus nephritis. This case was unusual of SLE due to multiple reasons: the patient was an elderly woman, with isolated lupus nephritis and negative serology including ANA negativity.

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Çalýþmamýzda nadir görülen Zenker divertikülü tanýsý alan ve tedavide eksternal yaklaþýmla krikofarengeal miyotomi ve divertikülektomi yapýlan olguyu sunuyoruz. Zenker divertikülü, özofagus üst sfinkterindeki spazma baðlý yükselen basýnç nedeniyle, inferiyor konstrüktör kas ile krikofarengeus kasý arasýndaki zayýf noktadan farenks mukoza ve submukozasýnýn dýþarýya herniasyonuyla oluþur. Genellikle 7. ve 8. dekatlarda ve erkeklerde daha sýk görülür. Hastalar sýklýkla disfaji, odinofaji, regürjitasyon, halitozis ve kronik öksürük þikayetleri ile baþvururlar. Günümüzde Zenker divertikülü tedavisi büyük oranda belirlenmiþ, ancak kesinlik kazanmamýþtýr. Tedavideki amaç divertikülü rezervuar olmaktan kurtararak, lümende düzgün bir akým oluþturmaktýr. Günümüzde operasyon ve hastanede kalýþ sürelerinin ve komplikasyon oranlarýnýn daha az olmasý nedeniyle endoskopik yaklaþým sýklýkla tercih edilmektedir. Bunun yanýnda baþarý oranlarýnýn daha fazla olduðunu, endoskopi yapýlamayacak ve büyük divertikülü olan hastalarda eksternal yaklaþýmýn uygulanmasý gerektiðini savunanlar da vardýr. Tedavinin belirlenmesinde doktorun tercihi, hastanýn beklentisi, genel þartlar ve imkanlar dikkate alýnmalýdýr.

In this article, we present a rare case which was diagnosed with Zenker's diverticulum and that treated with external approach by performing cricopharyngeal myotomy and diverticulectomy. Zenker’s diverticulum occurs by herniation of the pharynx mucosa and submucosa from the weakened area between the cricopharyngeus and the inferior constructor muscles, because of the increased pressure created by the spasm of the upper esophageal sphincter. It is usually seen in 7-8th decades of life and more common among men. Patients usually present with complaints of dysphagia, odynophagia, regurgitation, halitosis, and chronic cough. Currently, Zenker’s diverticulum therapy has been generally defined, however it has not exactly determined. The purpose of the treatment is to create a uniform flow in the lumen by preventing the diverticulum storage function. Today, endoscopic approach is frequently preferred for low complication rates and operation times and short hospital stay. However, there are also advocates that external approach should be applied for large diverticulum and in patients who can not undergo endoscopy and that the success of the external approach is greater. In determining the treatment, the preference of the doctor, the patient's expectation, general conditions and possibilities should be considered.

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Streptekok Enfeksiyonu ile iliþkili pediatric otoimmun nöropsikiyatrik bozukluk (PANDAS) streptekok enfeksiyonu sonrasý alevlenen obsesif kompulsif bozukluk ve/veya tik bozukluðudur. Güncel biriken bilgiler PANDAS’ýn bazý varyasyonlarý olduðunu söylemektedir; infantile baþlangýçlý tip, yetiþkin baþlangýçlý tip, myoklonik tip ve distonik tip. Bu yazýda, 17 yaþýnda olup antidepresan ve antipsikotik ile uzun sure tedavi edildikten sonra geç baþlangýçlý PANDAS distonik tip tanýsý konulan bir vakayý sunacaðýz.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is defined as exacerbation of obsessive-compulsive disorder and/or tic disorder after streptococcal infections. New accumulating evidence suggests that PANDAS have some variants such as infantile-onset type, adult onset type, myoclonic type, and dystonic type. In this report, we present a case of 17 years old who was treated with antidepressant and antipsychotic medicine for a long time until the diagnose of late onset PANDAS dystonic variant was established.

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Kondrosarkom göðüs duvarýnýn en sýk görülen malign tümörüdür ve tedavide göðüs duvarý rezeksiyon ve rekonstrüksiyonu en sýk uygulanan cerrahi yöntemdir.
78 yaþýnda erkek olgu sað yan aðrýsý þikâyetiyle kliniðimize baþvurdu. Fizik muayenede göðüs sað anterolaterinde 3 x 3 cm ebatlarýnda kitle tespit edildi. Posteroanterior akciðer grafisinde sað kostodiyafragmatik sinüs bölgesinde opasite görüldü. Toraks tomografisinde sað 5. kostayý destrükte eden yumuþak doku kitlesi mevcuttu. Genel anestezi altýnda sað anterolateral torakotomi yapýldý. Ekspansil kemik kitlesi palpe edildi ve 4, 5 ve 6. kaburgalar çevrede 4 cm. lik cerrahi marjin býrakýlarak rezeke edildi. Oluþan defektin kapatýlmasýnda prolene mesh ve pektus barý birlikte kullanýldý. Histopatolojik inceleme ile kondrosarkom tanýsý konulan olgu 1 yýllýk takibin sonunda asemptomatiktir.
Göðüs duvarý tümörlerinin rezeksiyonu sonrasý oluþan defektlerin rekonstrüksiyonunda konjenital göðüs duvarý deformitelerinde kullanýlan pektus barlarý; temin edilmesinde zorluk çekilmeyen bir malzeme olmasý, kolay kullanýmý ve doku uyumu nedenleriyle uygun olgularda tercih edilebilecek prostetik materyallerdir.

Chondrosarcoma is the most frequently seen malign tumor of the thoracic wall and resection and reconstruction of the thoracic wall is the most widely used surgical method for its treatment.
A 78-year-old male patient consulted our clinic with a right side pain complaint. In his physical examination, a mass 3 x 3 cm in size was found in his right anterolateral thorax. His posteroanterior chest x-ray showed opacity in right costodiaphragmatic sinus. There was a soft tissue mass destructing the right 5th rib in his thoracic computed tomography. The patient underwent right anterolateral thoracotomy under general anesthesia. The expansile bone mass was palpated and the mass was resected together with the 4th, 5th and 6th ribs leaving a 4-cm surgical margin around it. The resulting defect was repaired using prolene meshes in combination with pectus bar. The patient who was diagnosed with chondrosarcoma upon the histopathological examination was still asymptomatic at the end of his 1-year follow-up.
The pectus bars used in congenital chest wall deformities is a appropriate prosthetic material that may be preferred in selected cases for reconstruction of the defects which occurred the resection of chest wall tumors for the reason of easy to provide, easy to use and have good tissue compatibility.

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