Bu çalýþmamýzda servisimizde yatarak tetkik ve tedavi edilen 78 ampiyem olgusu (3 kadýn, 75 erkek) retrospektif olarak incelenmiþtir. Yaþ ortalamasý 42 olan olgularýmýzýn 43’ü (% 55) tüberküloz, 35 (% 45)’i ise parapnömonik orijinli olarak bulunmuþtur.

Non-tüberküloz ampiyemli 35 hastanýn 28’inde adi kültür ve antibiyogram yapýlabilmiþ ve en sýk saptanan aerob etkenler Gram (-) basiller ve S aureus olmuþtur. Bu olgularýmýzdan 24’ünde antibiyotik tedavisi yanýsýra kapalý sualtý drenajý uygulanmýþ, ankiste ampiyem olan 8 olgu ise antibiyotik tedavisi yanýsýra tekrarlanan torasentezler ile tedavi edilmiþtir.

Tüberküloz ampiyemli olgularda taný 17 olguda (% 39) balgamda, 6 (% 13) olguda hem balgam hem ampiyem mayiinde, 8 olguda (% 18) yalnýzca mayide ARB (+) bulunmasý ve 2 olguda plevra biyopsisi ve 2 olguda cerrahi materyalin histopatolojik tetkiki ile konulmuþtur. 18 olguda ise klinik radyolojik verilere göre tüberküloz tanýsý konulmuþtur. Tüm olgularda anti-tbc tedavi yanýsýra 7 olguda tekrarlanan torasentezler, 36 olguda ise kapalý sualtý drenajý uygulanmýþtýr. Bu olgularýn 9’unda ayrýca cerrahi müdahale uygulanmýþtýr.

Tüberküloz ampiyemli olgularda hastanede kalýþ süresi parapnömonik olgulara oranla anlamlý derecede yüksek bulunmuþ olup, takip süresince ölen 6 olgu dýþýnda týbbi-cerrahi tedavi ile sonuç alýnmýþtýr.

In this retrospective study, 78 patients (3 women, 75 men) who were treated in our clinic are discussed. The mean age is found to be 42.43 of the cases (55 %) ere due to tuberculosis, where 35 (45 %) were parapneumonic in orgin.

Culture and antibiogram studies were done in 28 of 35 nontuberculosis empyema patients. The most frequently identifical aerob agents were Gram (-) basils and Staphylococcus aureus. In patients. The most frequently identifical aerob agents were Gram (-) basils and staphylococcus aureus. In 24 of them antibiotherapy and closed underwater drainage was applied. 8 cases were treated with both recurrent thorasynthesis
and antibioteraphy.

In tuberculosis empyema cases AFB was identified in the sputum, both in the sputum and the empyema fluid, in the pleural fluid samples with respectively, in 17 (39 %), 6 (13 %) and 8 (18 %) cases. Pleural biopsy material in 2 cases and surgical samples in 2 other cases were analysied hystopathologically and diagnosed. Antituberculosis therapy was given to all the cases, thorasynthesis was done to 7 cases and closed underwater
drainage was applied to 36 cases. In 9 of these patients other surgical procedures were also applied.

The duration of total hospital stays were to be significantly longer in tuberculosis empyema patients compared to those of parapneumonic empyema cases. Except 6 cases who died during follow-up period, medical and surgical treatments resulted
in cure.

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Kalp yetersizliði; kalbin metabolize olan dokularýn ihtiyaçlarýný karþýlayacak düzeyde kan pompalayamamasý ve/veya bunu sadece ileri derecede artmýþ dolma basýncýnda yapabildiði kalp fonksiyon anormalliðinin neden olduðu fizyopatolojik durum olarak tanýmlanabilir. Diüretikler, kalp yetersizliði tedavisinde çok önemli rol oynarlar ve furosemid bu amaçla sýklýkla kullanýlan etkili bir diüretiktir.

Biz de, kalp yetersizliðinde furosemidin etkinliðini ve güvenirliðini incelemek üzere bu çalýþmayý planladýk. Çalýþmaya, Eylül 1999 ile Kasým 2000 tarihleri arasýnda Kliniðimize
baþvuran, konjestif kalp yetersizliði olan 38 eriþkin hasta (E/K=26/12) dahil edildi. 19 hastada (E/K=15/4) 20-80 mg/gün dozlarýnda furosemid kullanýldý.tüm hastalar, nokturnal hipokalemi açýsýndan gözlendi.

Heart failure may be defined as the pathophysiologic state in which an abnormality of cardiac function is responsible for the failure of the heart to pump blood at a rate commensurate with the reguirements of the metabolising tissues and/or can do so only from an abnormally elevated filling pressure. Diuretics play a very important role in the treatment of heart failure. Furosemide is an effective diuretic and is frequently used in congestive hearth failure.

Our aims is to show the safety and efficancy of furosemide therapy in hearth failure. 38 adult patients (M/F=26/12) with hearth failure who applied to our cilinic between September 1999-November 2000 were enrooled in the study. 19 patients (M/F=15/4) were prescribed to use furosemide in doses changing between 20-80 mg/day. All patients investigated for nocturnal hypocalemia.

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Ýnsizyonel herniler aþýrý büyüme eðilimindedir ve genelikle bu tip herniler obez insanlarda daha çoktur. Karýn duvarýndaki obesiteye baðlý sarkýklýk yara iyileþmesini olumsuz yönde etkilemektedir. Bu durum, herni nüksü için predispozan bir faktördür. Bu çalýþmada amacýmýz, insizyonel hernilerde kullanýlan polypropylene meshin abdominoplasti ile beraber kullanýlmasýnýn morbitide ve mortalite üzerine etkilerini araþtýrmaktýr.

Ocak 1997-2000 yýllarý arasýnda SSK Göztepe Eðitim Hastanesi 2. Cerrahi servisinde insizyonel herni nedeniyle müracaat eden hastalardan obez olanlar (BMI>35kg/m2) ve herni defekti 10 cm üstündekiler çalýþma kapsamýna alýndý. 1. Grup (n=35); abdominoplasti+prolen mesh onarým yapýlan ve 2. grup sadece prolen mesh ile onarým yapýlanlar olarak 2 gruba ayrýldý. Hastalar postoperatif komplikasyon ve hastanede yatýþ süreleri açýsýndan deðerlendirildi.

1. gruptaki hastalarýn yaþ ortalamasý 54.7, ikinci grubtaki hastalarýn yaþ ortalamasý 52.3 idi. Her iki gruptaki hastalarýn postoperatif komplikasyonlar açýsýndan anlamlý bir fark görülmedi. 1. gruptakilerin hastanede kalýþ sürelerinin uzadýðý görüldü (p<0.001).

Obez geniþ defektli insizyonel hernilelerde abdominoplasti ile birlikte prolen mesh onarýmý güvenli ve kozmetik açýdan daha iyi sonuç vermektedir.

Incisional hernieas have a tendency in growing to huge dimensions and these kind of hernias are seen especially in obese patients. In this study; the effects of the abdominoplasty and prolene mesh repair in the morbidity and mortality rates of incisional hernia repairs.

This study includes obese patients (BMI>35 kg/m2) with hernia defects larger than 10 cm that were operated in between january 1997-2000 in the 2nd surgical clinic at SSK Göztepe Educationaal Hospital. The patients were divided into two groups.

First group abdominoplasty+prolene mesh repair second group only prolene mesh repair (n=35). Both groups were evaluated with complicatios and hospital stay time.

The average age in group 1 was 54.7, in group 2 was 52.3. Both groups had no significant complication rates. The hospital stay time was longer in group 1 (p<0.001).
In obese patients with gross incisional hernias Abdominoplasty+ prolene mesh repair is a safe and cosmotically better procedure.

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Astým, tekrarlayan öksürük hýrýltý ve nefes darlýðý semptomlarý ile seyreden kronik bir havayolu hastalýðýdýr. Bu bildiride 636 astýmlý çocuk hastaya ait demografik özelliklerin ve etyolojik faktörlerin retrospektif olarak irdelenmesini amaçlanmýþtýr.

Çalýþmaya dahil edilen çocuklarýn yaþ ortalamasý 5.9±3.3 yýl, erkek/kýz oraný 1.5, hastalýk baþlangýç yaþý ortalamasý 2.5±2.5 yýldý. Hastalýða % 63 oranýnda allerjik rinit, % 38 oranýnda ise rekürran sinüzit eþlik etmekteydi. Atopi araþtýrmasý sonucu % 73 (n=208) olguda en az bir aeroallerjene pozitif deri testi yanýtý elde edildi. Bunlarýn içinde % 93 oranýnda ev tozu allerjisi (n=194) en ön sýrada yer almaktaydý. Otuz beþ hastada (% 17) ev tozu ile birlikte diðer alerjenlerden (mantar sporlarý, hayvan epitel ve tüyleri veya polenler) en az biri daha pozitifti. Mantar sporlarýna pozitif reaksiyon toplam 7 hastada (% 4), hayvan epitel ve tüylerine reaksiyon 11 hastada (% 5), polenlere pozitif reaksiyon ise 35 hastada (% 15) mevcuttu. Toplam 38 hastada (% 18) birden fazla allerjene pozitif reaksiyon saptandý. Atopik ve nonatopik astýmlýlarda ailede astým veya allerji mevcudiyeti açýsýndan fark yoktu (p=0.5).

Türkiye’nin bu bölgesinde yaþayan astýmlý çocuk hastalarýn demografik özelliklerinin ve etyolojik faktörlerinin dünyanýn diðer bölgelerinden bildirilmiþ verilerle uyumlu olduðu gözlenmektedir.

Asthma is disease characterized by recurrent cough, wheeze and dyspnea. In this study the demographic characteristics and etiological factors related with the disease is aimed to be discussed on a group of 636 asthmatic children, retrospectively.

The mean age for the patients was 5.9±3.3 years, the male/ female ratio was 1.5 and the age of disease onset was 2.5±2.5 years. Allergic rhinitis was diagnosed in 63 % of the patients and recurrent sinusitis was diagnosed in 38 % of the patients. Skin prick test was positive at least to one of the most common aeroallergens in 73 % (n=208) of the children. Sensitivity to at least one of the other allergens (animal dander, polens or yeast) was positive in 17 %. Positive reaction to yeast spors was detected in % 4, reaction to animal dander was positive 18 % and reaction to polens was positive in 15
%. No statistically significant difference was detected between atopic and nonatopic asthmatics with respect to having a positive family history of allergy or asthma (p=0.5).

The asthma demographics and the ethiologic factors in children living in this region of Turkey was found to be consistent with literature from other parts of the world.

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Kolorektal adenokarsinomlarda nöroendokrin diferansiyasyon varlýðýnýn prognostik rolünü belirlemek amacý ile 45 kolorektal adenokarsinom olgusuna ait H&E kesitler, bilinen prognostik faktörlerden tümör lokalizasyonu (rektum/kolon), müsin pozitivitesi (% 50 üzerinde müsin içerenler müsinöz, % 50’den daha az içerenler nonmüsinöz), tümör grade, stage (Astler-Coller), lenf nodu tutulumu pozitif lenf nodu olmayanlar L0, 1-3 pozitif olanlar L1, 4’den fazla pozitif olanlar L2 olarak deðerlendirildi. Nöroendokrin diferansiyasyonu deðerlendirmek için nöronspesifik enolase (NSE) ve Chromogranin A (CgA) tümörlü bloklara uygulandý. NSE için, N0: boyanma olmayanlar, N1: boyanma olanlar, CgA için, C0: boyanma olmayanlar, C1: 1-4 tümör hücresinde boyanma olanlar, C2: 4’ün üzerinde tümör hücresinde boyanma olanlar olarak deðerlendirildi. Olgularýn 11’inde (% 24.4) CgA ve 8’inde (% 17.8) NSE ile immünreaktivite izlenmiþtir. Sonuç olarak NSE immünreaktivitesinin sadece stage B2 ile iliþkili olduðunu (p<0.05, r=0.34), CgAile immünreaktivitesinin tüm faktörler ile iliþkisiz olduðunu saptadýk.

In order to define the prognostic value of neuroendocrine differentiation in colorectal adenocarcinomas, H&E sections of 45 colorectal adenocarcinoma cases are evaluated with the known prognostic factors such as tumour localization (rectum/ colon), mucin positivity (tumours with more than 50 % mucin positivity are considered as mucinous/tumours with less than 50 % mucin positivity are considered as nonmucinous),
tumour grade, tumour stage (Astler-Coller), involvement of lymph nodes tumours without lymph node involvement are L0, tumours with 1 to 3 lymph node involvement are
L1, tumours with more than 4 lymph node involvement are L2. In 11 cases CgA is positive (24.4 %) and in 8 cases NSE is positive (17.8 %). As a result, we detected that NSE correlated with only stageB2 (p<0.05, r=0.34), but CgA uncorrelated with whole prognostic factors.

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Homosistein; diyetle alýnan methioninin demetilasyonundan elde edilen toksik bir aminoasittir. Hiperhomosisteineminin, tromboemboli, kardiyovasküler ve serebrovasküler hastalýklar için bir risk faktörü olduðu ve tip 2 diabette normal topluma göre daha yüksek olduðu bildirilmiþtir.

Bu çalýþmada tip 2 diabetli 32 hasta ile 32 kiþilik saðlýklý kontrol grubunda plazma homosistein düzeyleri araþtýrýlmýþ, tip 2 diabetlilerde plazma homosistein düzeyi, kontrol grubuna göre çok ileri düzeyde anlamlý olarak yüksek bulunmuþtur (p<0.001).

Homocysteine is a toxic aminoacid formed by demetilation of methionine taken in normal diet. Hyperhomocysteinemia is a risk factor for cardiovascular and cerebrovascular diseases
and also thromboemboli. Hyperhomocysteinemia is more frequent in type 2 diabetes than normal population.

In this study, plasma levels of homocysteine were investigated in two groups; a patient-group formed out of 32 type 2 diabetic patients and a control group of 32 healthy volunteers. The plasma homocystein level was found significantly higher in type 2 diabetics than in control group (p<0.001).

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Ülkemizde süt çocukluðu döneminin en büyük mortalite ve morbitide nedenleri arasýnda akut ishaller önemli bir yer tutmaktadýr. Her yýl 1.5 milyon kiþinin ishale yakalandýðý ve
27.000 kiþinin ishalden öldüðü sanýlmaktadýr. Ýshalin etyolojisine yönelik çalýþmalar ne yazýk ki ülkemizde yeterince yapýlamaktadýr. Bu nedenlerle, çoðu kez ucuz yöntemlerle tedavi olanaðý olan akut viral gastroenteritlerinin tedavi masraflarý oldukça fazla olmaktadýr.

Ýshalin viral etkenlerinin en önde geleni olan rotavirüsün bölgemizdeki hastalarda görülme sýklýðýný araþtýrmak için Nisan 1996-Mart 1997 arasýndaki 1 yýllýk sürede SSK Bakýrköy Doðumevi Kadýn ve Çocuk Hastalýklarý Eðitim Hastanesi’ne akut ishalle gelen 758 olgu rotavirüs aglutinasyon testi ile incelendi. Rotavirüs aglütinasyon testi tüm olgularýn % 21.1’inde (Ocak ayýnda % 45.5 ve Temmuz ayýnda % 1.5’inde) pozitif bulundu. Hastalarýmýzýn yaþlarý 1-24 ay arasýnda deðiþiyordu. En sýk 7-12 aylýk çocuklarda rotavirüs pozitif bulundu. Rotavirüs pozitif ishalli vakalarýmýzýn yaklaþýk % 50’si deðiþik derece dehidrate idiler.

Sonuç olarak, süt çocukluðu akut ishallerinde özellikle kýþ aylarýnda mümkün olduðunca antibiyotikten kaçýnýlmalý, ciddi dehidratasyona varabilecek komplikasyonlar unutulmamalý, oral rehidratasyon sývý tedavisi ile beraber beslenmeye ara verilmemelidir. Bunlarýn yanýsýra ailelerin eðitimi ile süt çocukluðu ishallerinin mortalite ve morbitidesi en aza indirilebilir.

Acute gastroenteritis takes great place in mortality and morbidity reasons of infancy in our country. It is estimated that every year 1.5 millions of people get diarrhea and 27.000
people die because of that. Unfortunately, studies regarding to etiology of acute gastroenteritis hasn’t been carried out properly in our country. Because of that, in many cases the expenses of acute viral gastroenteritis, which can be treated with cheap methods, cost very expensive.

In order to search the frequency of rotavirus, which is the most important agent of viral gastroenteritis, on the patients of our region 758 patients coming to SSK Bakýrköy Doðumevi Kadýn ve Çocuk Hastalýklarý Eðitim Hastanesi for a year between the dates April 1996-March 1997 were examined with the test of rotavirus agglutination. Rotavirus agglutination test was found positive in 21.1 % of all cases (in january 45 %, in July 1.5 %). The ages of our patients varied between 1-24 months. Rotavirus was found positive as most frequent in 7-12 month children. 50 % of cases with positive rotavirus
diarrhae were dehydrated in different degrees.

As a result, in the cases of acute gastroenteritis in infancy in the winter months we must avoid antibiotics as much as possible, we shouldn’t ignore the complications which may result with serious dehydratations and together with rehydratation fluid treatment we shouldn’t interfere with feeding. Besides these, the mortality and morbidity of acute gastroenteritis of infancy can be decreased to the minimum with the education
of the families.

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Bu çalýþmanýn amacý kronik bel aðrýlý hastalarda bel okulunun etkinliðini deðerlendirmektir.

Bel okuluna alýnan 54 hasta bel okulu öncesi ve bel okulundan üç ay sonra (n=23); aðrý þiddeti (VAS), Schober testi (cm), parmak ucu yer mesafesi (cm), düz bacak kaldýrma testi (DBKT) gibi parametrelerle deðerlendirildi. Fonksiyonel yetersizlik modifiye oswestry Bel Aðrýsý Sorgulama Formu ile deðerlendirildi (OBASF). Tüm parametreler Wilcoxon matched testi ile bel okulu öncesi ve üç ay sonrasý deðerlendirildi. Bel okulunun tüm parametrelerde etkisiz olduðu saptandý (p>0.05). Bel okulunun baþarýsýzlýðýnýn nedeni yetersiz örnek sayýsý, programýn yürütülmesindeki yetersizlik ya da programýn kendisinin yetersizliði olabilir.

Geniþ hasta gruplarýnda kontrolü uygun programlarla, uzun süreli izleme ile yapýlan çalýþmalar daha kesin ve güvenilir sonuçlar verecektir.

The aim of this study was to evaluate the effectiveness of the back school in chronic low back pain.

54 patients admitted to our back school were evaluated at admission and 3 months later (n: 23) by the following parameters; intensity of pain (VAS), lomber Schober (cm), straight leg raising (SLR). Functional disability was assessed by the revised Oswestry pain questionnaire. All parameters were evaluated by Wilcoxon matched test at admission and at the end of third month. There were no significant effect of the back school on all parameters. The failure to detect any effect of low back pain programme may be due to inadequate sample size, inadequate implementation of the programme or a fundamental lack of efficacy of the programme.

We believe larger group studies with longer follow-up periods with an adequate of the programme will give more definite and reliable results.

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Çalýþmamýzda sezaryen anestezisinde kullanýlan tiyopental ve ketaminin postoperatif analjezik tüketimine etkisini araþtýrmayý amaçladýk.

Çalýþmaya, genel anesteziyle sezaryen uygulanacak 40 hasta dahil edildi.Hastalar preoperatif dönemde 100 mm VAS ve PCA hakkýnda bilgilendirildi. Grup T’ye (n=20) 5 mg/kg tiyopenton, grup K’ye (n=20) 1 mg/kg ketamin verilerek anestezi indüksiyonu yapýldý. Kas gevþemesi 0.6 mg/kg rokuronyumla saðlandý. Anestezi idamesi, bebek doðana kadar % 50 O2+% 50 N2O ile,bebek doðduktan sonra 0.001 mg/kg fentanil ve % 0.8 isoþuran ile sürdürüldü. Bebeðin 1. ve 5. Dakika APGAR skorlarý kaydedildi. Operasyon sonrasý nöromuskuler blok 0.5 mg atropin ve 1 mg prostigminle antagonize edildi. Postoperatif dönemde hastalarýn emirlere yanýt verme zamaný kaydedildi ve bunu takiben ellerine PCA aleti verildi. Tramadolün 50 mg’lýk yükleme dozunu izleyerek, PCA dozu 20 mg, kilitli kalma süresi 15 dk, 4 saatlik limit 200 mg olarak programlandý. Postoperatif 1, 2, 4, 24. saatlerde sedasyon ve VAS skoru, toplam tramadol tüketimi, solunum sayýsý, SAB, DAB, KAH ve varsa yan etkiler kaydedildi. Ýlk ek analjezik gereksinim zamaný not edildi. Hastalar, 24. saat takibinde, intraoperatif olaylarý hatýrlama ve rüya görme açýsýndan sorgulandý.

Grup K’de emirlere uyma zamaný istatistiksel açýdan anlamlý derecede kýsaydý (p<0.05). Yine Grup K’de, 4. ve 24. Saatlerde nabýz sayýsý ile sedasyon skorundaki artýþ anlamlýydý (p<0.05). Solunum sayýsý arasýnda ise ileri derecede anlamlý farklýlýk vardý (p<0.01). Grup T’de 1. saatteki VAS skoru anlamlý derecede yüksekti (p<0.05). Diðer parametrelerde istatistiksel açýdan anlamlý fark yoktu.

Analjezik etkisi olan ketaminin indüksiyonda kullanýmýnýn, tiyopentale göre daha iyi bir derlenme, postoperatif 1. saate kadar daha iyi bir analjezi ve ilk 24 saat boyunca daha iyi
bir sedasyon saðladýðý kanýsýna vardýk. Ancak indüksiyonda kullanýlan tiyopental veya ketaminin postoperatif analjezik gereksinimine etkisi olmadýðý görüþündeyiz.

The aim of this study is to investigate the effect of ketamine and thiopental used in sezaryan anaesthesia and postoperativ analgesic requirement. 40 patients who underwent cesarean section were enrolled into study. Patients were instructed on the use of a 100 -mm visuel analog skala (VAS) for the measurement of pain and patient-contrelled analgesia (PCA). Induction was achieved by thiopental 5 mg/kg in group T (n=20) and by ketamine 1 mg/kg in group K (n=20). Muscle relaxation was performed by rocuronium 0.6 mg/kg. Anaesthesia was maintained with 50 % nitrous oxide in oxygen till
the fetus was delivered. After delivery of fetus, fentanyl 0.001 mg/kg was given and isofluran 0.8 % was added. The time in which patients were able to respond commands was recorded in postoperative period. The PCA device was set to deliver a bolus of tramadol 50 mg, with lock-out interval of 15 min and 4 h maximal dose of 200 mg. Sedation score, VAS, cumulative consumption of tramadol, respiratory rate, systolic and diastolic arterial pressure, heart rate, side effects and the time to first PCA demand were recorded 1, 2, 4 and 24 h after surgery.

In group K, the time to respond commands was statistically lower than group T. Increases in respiratory rate, heart rate and sedation score at 4 and 24 h in group K were significantly more different than group T. Postoperative analgesic requirement between groups was not found statistically significant.

We concluded that compared with thiopental, using ketamine which has analgesic properties during induction period provided better emergence, analgesia till postoperative 1h and sedation during first 24h and that thiopental and ketamine used during induction period didn’t affect postoperative analgesic requirement.

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Tek baþýna anne sütü ile beslenme hayatýn ilk 4-6 ayýnda en uygun beslenme þeklidir. Anne sütü çocuklarýn büyüme ve geliþmeleri üzerinde olumlu etkilere sahiptir. Bu çalýþmanýn amacý, çocuklarýn anne sütü alma durumlarýný ve anne sütünün çocuklarýn büyüme ve geliþmeleri üzerine etkilerini deðerlendirmektir. Bu amaçla, 6 ay-5 yaþ arasý 134 bebek ve çocuk çalýþmaya dahil edildi. Araþtýrma grubunun anne sütü alma durumu, büyüme ve geliþmeleri deðerlendirildi. Ýlk besin olarak anne sütü alanlarýn oraný % 61.2 olarak tespit edildi. Tek baþýna anne sütü alma durumu ile anne yaþý, eðitim durumu, çalýþma durumu ve çocuk sýrasý arasýnda anlamlý iliþki bulunamadý. Ýlk emzirilme zamaný ile aðýrlýk ve boy arasýnda anlamlý ve pozitif iliþki olduðu tespit edildi. Boy ile emzirmenin devamý arasýnda da pozitif iliþki mevcuttu. Araþtýrma grubundaki çocuklara ilk verilen ek besinler yoðurt (% 35.1), meyve suyu (% 23.9), sebze çorbasý (% 17.2) ve muhallebi (% 7.5) idi ve ortalama anne sütü alma süresinin, ek gýdalara erken baþlanmasý durumunda anlamlý bir þekilde azaldýðý gözlendi.

Türkiye’de emzirme yaygýndýr, fakat büyük sorun bazý ailelerin ek gýdalara baþlamada aceleci olmasýdýr. Bu nedenle aileler eðitilmeli ve emzirme için teþvik edilmelidir.

Exclusive breastfeeding is the appropriate nutrition for infants during the first 4-6 months of life. Breast-feeding has positive effects on children’s growth and development. The
aim of this study was to evaluate the breastfeeding status of the infant and the children, and the effects of breastfeeding on children’s growth and development.134 infants and children between 6 months to 5 years of age were included. The breastfeeding status, growth and development of the study group were evaluated. The percentage of children who had taken the breast milk as the first food was 61.2 %. There was no significant correlation between solely breastfeeding and maternal age, education level, working status or number of children.

It’s found that bodyweight and height of the children were correlated with the time of first breastfeeding. Height was correlated with the duration of breastfeeding too. In the study
group, foods the first given to the study group were yoghurt (35.1 %), fruit juice (23.9 %), vegetables soup (17.2 %) and pudding (7.5 %). It is observed that the mean breast feeding time were diminished significantly when early beginning to complementary foods. Breast-feeding is common in Turkey but the biggest problem is that some families are beginning to give additional foods at early stages. So they should be educated and encouraged for the breastfeeding.

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Endemik guatr; Dünya populasyonunun % 12’sini kapsayan, ortak bir problemdir. Ýodinasyon çok etkilidir ve geçici olarak hipertirodizmde artýþa neden olsa da faydalarý risklerini üzerindedir. Bazý hastalarda, tiroid hormonu ile tedavi guatrýn büyüklüðünü stabilize etmede yada küçültmede faydalýdýr.

Tiroidektomi, mekanik ve kozmetik sebeplerle yada olasý veya ortaya konmuþ malignensilerde endikedir.

Bu çalýþmada, Türkiye’deki endemik guatr bölgesinde yaþayan, klinik, biyokimyasal, sintigrafik ve radyolojik deðerlendirmeler sonucu guatr teþhisi konan ve opere edilen 789 hasta preoperatif ve patolojik tanýlarý ve post operatif erken dönem komplikasyonlarý açýsýndan incelenmiþ ve literatür eþliðinde sunulmuþtur.

Endemic goiter is preventable and is common worldwide problem, since about 12 % of the world’s population has goiter. Iodination is costeffective and although it results in a
transient increase in hyperthyroidism, overall the benefits greatly outweigh the risks. Treatment with thyroid hormone is helpful in some patients in stabilizing or decreasing goiter size. Thyroidectomy is indicated for mechanical and cosmetic reasons or because of possible ordocumented malignancy.

In this study, we examined 789 patients who lives in the endemic goitre parts of Turkey and operated, after clinical, biochemistrical, syntigrafic, radilogical evaluation. 789 case
presented after the evaluation of the preoperative diagnosis, pathological diagnosis and post operative early complications and accompany of literature.

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Atrioventriküler (AV) bloðu bulunan normal sinüs fonksiyonlu hastalarda en fizyolojik pace modu VDD’dir. Bu modda AV senkronizasyon, atrial sensing kalitesine ve efor esnasýndaki P dalgasý amplitüdündeki deðiþikliklere veya P dalga tetiklemesinde deðiþikliklere neden olan günlük hayat aktivitelerine baðlýdýr. Ýlk önce standart çift bölmeli pacemaker’da gözlenen P dalga amplitüdündeki düþme single-lead VDD sistemlerinde de desteklenir gözükmektedir. Bu tip pacemaker’lerin istirahat halindeki güvenilirlikleri iyi dökümente edilmesine raðmen, egzersiz esnasýndaki davranýþlarý iyi belirlenememiþtir. Bu çaýþmanýn amacý, standardize efor esnasýnda atrial sensörün kalitesini ölçmekti. Atrial sensörün kalitesi senkronize AV olaylarýn yüzdesi olarak ifade edildi. Diðer bir amacý da ayný efor esnasýnda P dalga ampitüdündeki deðiþmelerin efor esnasýnda P dalga ampitüdündeki deðiþmelerin izlenmesiydi.

VDD is the most physiological pacing mode in patients with atrioventricular (AV) block. In this mode, AV syncbrony depends on the quality of atrial sensing and variations in P
wave amplitude during effort or during daily life activities that may alter the tracking of the P wave. This decrease in P wave amplitude, first observed with standard dual chamber pacemakers, appears to be confirmed with single-lead VDD systems. While the reliability of this type of pacemaker has been well documented at rest, behavior during exercise has been less fully characterized. The purpose of this study was to measure, during standardized effort, the quality of atrial sensing as expressed by the percentage of synchronized AV event, and to evaluate the evolution of P wave amplitude during that
same effort.

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Hypokalaemic paralysis is a life-threatening clinical syndrome characterised clinically by hipokalaemia and acute systemic weakness. It represents a heterogeneous group of
disorders, most of them are familial. Sporadic cases are associated with numerous disorders including renal disorders, barium poisoning, hyperthyroidism, certain endocrinopathies and gastrointestinal potassium losses. Initial therapy of the
patient with hypokalaemic paralysis includes potassium replacement and search for underlying aetiology (1). The recurrent attacks with normal plasma potassium levels
between attacks distinguish periodic paralysis from other causes (2). The presence of type 1 RTA should be considered in any patient with a normal anion gap metabolic acidosis and an inappropriate high urine pH (3). The complications to renal tubular acidosis including hypokalaemic muscle paralysis or chronic muscle weakness, nephrolitiasis, and osteomalacia can be avoided if the diagnosis of renal tubular acidosis
is made and corrective alkali therapy is maintained (4).

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Rubella is a common communicable disease of childhood characterised ordinarily by mild constitutional symptoms, a rash similar to that of mild rubeola or scarlet fever, and
enlargement and tenderness of the postoccipital, retroauricular, and posterior cervical lymph nodes. Here we report a case of rubella without rash and mimic to leukemia clinically.

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Horner syndrome develops by compression on inferior cervical or superior thoracic sympathetic ganglions usually due to malignancy. In our centre a case presenting symptoms of ptosis, myosis and enophthalmus was suspected of Horner syndrome and malignity after which was diagnosed as hydatic cyst by thoracotomy. This study is presented because pulmonary hydatid cyst is a rare cause of the syndrome.

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A 42 years old man was referred to our clinic for evalution of acute alteration in clinical status. His medical history included mitral and aortic valve operation due to rheumatic valvuler disease 7 years ago and inadequate treatment for brucellosis 7 months ago. Sistolic murmur at middle left border of sternum was heart and tachycardia was observed on physical examination. The patient was hospitalised. Administiration of
empric vancomycin and gentamycin combination therapy had been initiated to treat prostetic valve endocardity. After several days in the hospital the clinical status persisted.Vegetations on prostetic aortic valve were seen in transesophageal cardiac
echo and brucella tube agglutination test was positive at a titer 1/640. The patient was diagnosed as brucella endocarditis and was treated rifampicin and doxycline.

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Adrenal myelolipoma and diaphragmatic crus lipoma are rarely occurring benign tumours. In this case report we present a case who has a right adrenal gland myelolipoma and
left surrenal lipoma. This condition either adrenal myelolipoma or diaphragmatic crus lipoma occuring same patient should be extremely rare because of we not found in literature.

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Malign melanoma of the choroid is the most common primary intraocular tumor in adults. Presentation is most commonly during the sixth decade of life. The typical choroidaal malign melanoma is a brown elevated,dome shaped subretinal mass. The degree of pigmentation ranges from dark brown to totally amelanotic. Clinical evaluation of all posterior uveal melanomas should include an extensive history and complete ophtalmologic evaluation to definitively establish the diagnosis. The correct management of malign melanomas of the choroid is contraversial. The choice of appropriate therapy depends on three major factor; firstly visual acuity of involved eye size, secondly location, extent and apparent activity of the tumor and thirdly general heallth and age of the patient. We present the clinical findings and treatment in a 40 years old male patient.

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