Çöliyak hastalýðý, gliadin adý verilen gluten fraksiyonunun ince barsak mukozasý üzerindeki toksik etkisi sonucu geliþen malabsorbsiyon ile karakterize bir hastalýktýr. Çöliyak hastalýðý sýklýðýnýn insüline baðýmlý diabetes mellitusda arttýðý bildirilmektedir. Bu çalýþmada, çöliyak hastalýðý sýklýðýnýn insüline baðýmlý diabetlilerde artýp artmadýðý araþtýrýlmýþ, insüline baðýmlý diabetlilerde çöliyak hastalýðý sýklýðý açýsýndan anlamlý bir artýþ bulunmamýþtýr (p>0.05). Hasta sayýsý artýrýlarak yapýlacak yeni çalýþmalarla sonuçlar yeniden gözden geçirilmelidir.

Coeliac sprue is a disease of malabsorbtion developed by toxic effects of gliadin which is a gluten fraction, to the mucosa of small intestine. It has been reported that the incidens of
coeliac disease was higher among insulin-dependent diabetics. In this study, it has been investigated whether if the incidence of coeliac disease was higher or not among insulindependent diabetics, and no significant increase was found (p>0.05). New studies on the populations including more patients should be held in the future.

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Son yýllarda idyopatik hiperkalsiüri çocukluk çaðý üriner sistem problemleri arasýnda giderek önem kazanmaktadýr. Üriner taþ insidansýnýn yüksek olduðu ülkemizde ise hiperkalsiüri ile ilgili epidemiyolojik ve etyopatogeneze yönelik çalýþmalar yeterli deðildir. Biz, SSK Bakýrköy Doðumevi Kadýn ve Çocuk Hastanesi Eðitim Hastanesi’ne baþvuraran asemptomatik çocuklarý tarayarak hiperkasiürili çocuklarý tespit etmek ve hastanemiz bölgesinde yaþayan çocuklarda ortalama idrar Kalsiyum/kreatinin oranýný ve hiperkalsiüri sýklýðýný saptamayý amaçladýk. Çalýþmamýzda hiperkalsiüriye eþlik edebilen hematüri ve üriner infeksiyon da araþtýrýldý. Hiperkalsiürinin yaþla iliþkisini saptamak için yaþlarý 2-14 arasýnda deðiþen 90’ý erkek, 84’ü kýz olmak üzere toplam 174 çocuk incelendi. Çalýþmaya alýnan tüm çocuklarýn idrar kalsiyum/idrar kreatinine oraný ortalama 0.150±0.045 olarak bulundu. Bu çocuklarýn 7’sinde hiperkalsiüri tespit edildiðinden sýklýk % 4.02 olarak saptandý. Kýz ve erkek çocuklarýn deðerleri arasýnda anlamlý bir fark görülmedi. Yaþ gruplarýnýn ortalama Uca/Ucr oranlarý arasýnda anlamlý bir fark bulunamadý. Hiperkalsiüri saptanan çocuklarda üriner infeksiyon, hematüri ve ailerinde üriner taþ sýklýðý açýsýndan anlamlý bir fark bulundu. Çalýþmalarda elde ettiðimiz veriler ülkemizde hiperkalsiüriye daha fazla önem vermemiz gerektiðini vurgulamaktadýr.

In the recent years, idiopatic hypercalciuria has gained importance in the problems of childhood urinary system. In our country where urinary stone incidence is high the epidemiologic studies concerning hypercalciuria and etiopathogenetic studies are not enough. By examining asemptomatic children coming to the SSK Bakýrköy Doðumevi Kadýn ve Çocuk Hastanesi Eðitim Hastanesi, we aimed to find incidence of hypercalciuria and average urine calcium/creatinin rate of the children living around our hospital and to find the children with hypercalciuria. In our study, we also searched urinary infection and hematuria which may come out to hypercalciuria. In order to find to the relationship of hypercalciuria with age, we examined 174 children (90 boys, 84 girls) in the age of 2-14. We found the rate of urine Ca/Cr of all children in the study as 0.150±0.045 in avarage. As we found hypercalciuria in 7 of those children, the incidence was found as 4.02 %. We couldn’t find a considerable difference between boys and girls. We coulnd’t find a considerable difference between the average Uca/Ucr rates of age groups. In the children who had hypercalciuria a considerable differance was found regarding to urinary infection, hematuria and incidence of urolithiasis of the children’s families. The results
we received at the end of our study shows that we must give more importance to hypercalciuria in our country.

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Hastanemize son bir yýl içinde baþvuran 1164 akut gastroenterit olgusu deðerlendirildi. Toplam 485 (% 42) olguda etken tespit edildi ve bunlarýn 251(% 52)’inin rotavirus, 110 (% 22)’unun Giardia intestinalis, 91 (% 19)’inin bakteriyel, 31 (% 6)’inin Entamoeba histolitica kaynaklý olduðu görüldü. Bakteriyel ajanlardan en sýk olarak shigella infeksiyonu tespit edildi ve buna karþý en hassas antibiyotik olarak seftriakson, en dirençli olarak ise ampisillin saptandý. Bu sonuçlarla önceki yýllarda en sýk bakteriyel ajan olarak bilinen E coli’-nin yerini shigella infeksiyonunun aldýðý görüldü. Ülkemizde shigella suþlarý içinde en sýk S flexineri’nin etken olduðu bilinirken bu çalýþmada S sonnei’nin daha ön plana geçtiði gözlendi.

Akut gastroenterit olgularýnda antibiyotik kullanýmý seçilmiþ olgularla sýnýrlandýrýlmalý ve böylelikle direnç oluþumunun önüne geçilmeye çalýþýlmalýdýr. Her hasta için kliniðe, altta
yatan veya eþlik eden diðer hastalýklara göre tedavi kararý verilmesi ishal ile baþvuran hastalarda antimikrobiyal tedavinin planlanmasýnda temel özellikler olmalýdýr.

1164 acute gastroenteritis cases who presented to our pediatry outpatient clinic throughout a year were evaluated. The pathogens were identified in 485 (% 42) cases. There were 251(% 52) rotavirus cases, 110 (% 22) Giardiasis, 91 (% 19) bacterial pathogens and 31 (% 16) amebiasis cases. Shigella infection was the most frequent isolated bacterial pathogen. The most sensitive antimicrobial against Shigella species was
Ceftriakson and the lowest was ampicillin. In this study E. coli, once the most common bacterial pathogen before, came after Shigella infection. In the past years S flexineri was the most frequent species of them all. In this study S sonnei was found as the most frequent agent that was isolated. Appropriate uses of antibiotics in selected cases of diarrhea will prevent the emergence of resistant strains. The treatment should be personalized to every patient with diarrhea according to features of his own, clinical status and presence of another disease and to hospital conditions.

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Bu çalýþmada akciðer kanserli hastalarda el parmaklarýnda ve ayak parmaklarýnda çomak parmak varlýðýný deðerlendirmek, oranýný belirlemek, çomak parmak varlýðý ile akciðer kanseri tipleri, ek hastalýk varlýðý, yaþam stili (sigara, alkol) cinsiyet, yaþ gruplarý arasýnda bir iliþkinin olup olmadýðýný de-ðerlendirmek amaçlandý. Çalýþma Mayýs 2000-Haziran 2001 tarihleri arasýnda 158 hasta ile prospektif olarak yapýldý. Hastalar 26 ile 76 yaþlarý arasýnda, ortalama 58 yaþýnda idi. Hastalarýn 50’sinde (% 31.6) el parmaklarýnda çomak parmak, 32 hastada (% 20.3) ayak parmaklarýnda çomak parmak tesbit edildi. Yalnýzca 2 hastada ek hastalýk tesbit edildi. Çalýþmada elde çomak parmak varlýðý ile akciðer karsinomu tipi, cinsi-yet, yaþ gruplarý, yaþam stili, ek hastalýk varlýðý arasýnda iliþki bulunmadý. Yine ayak parmaklarýnda çomak parmak varlýðý ile cinsiyet, yaþ gruplarý, akciðer karsinomu tipi, yaþam stili, ek hastalýk varlýðý arasýnda iliþki bulunmadý.

In this study, clubbing in fingers and toes was evaluated in lung cancer patients. For this purpose, rate of clubbing, relation of clubbing with lung cancer histopathologic type, gender, age, life quality (alcohol, tobacco consumption), commorbid diseases were evaluated. During the period of May 2000-June 2001 dates, 158 cases were investigated prospectively. Age range of the patients were between 26-76 years, mean age was 58 years. 50 (31.6 %) patients had a clubbing in their fingers. 32 (20.3 %) patients had a clubbing in their toes. Only two patients had a commorbid diseases. In this study we did not find any relationship between finger clubbing and lung cancer histopathologic type, gender, age, life quality, commorbid disease. We also did not find any relationship between toe clubbing and lung cancer histopathologic type, gender, age, life quality, commorbid disease.

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Primer immün yetersizlik sendromlarý (PIDs) arasýnda en çok taný alan humoral immün yetersizliklerdir. Humoral immün yetersizlikte, B hücrelerinden antikor üretiminde sorun vardýr. Böylece kapsüllü mikroorganizmalarýn neden olduðu sinopulmoner enfeksiyonlar ile çeþitli intestinal enfeksiyonlar sýk görülür.

Bu çalýþmada, SSK Göztepe Eðitim Hastanesi Çocuk Kliniði’nde Ocak-1997, Eylül-2000 tarihleri arasýnda humoral immün yetersizlik tanýsý almýþ 25 hasta deðerlendirildi. Erkek/kýz oraný 2.5 idi. IgA eksikliði (% 44), IgG4 eksikliði (% 24), hiper IgE sendromu (&12), IgG2 eksikliði (% 8), Bruton Hastalýðý (% 8) ve sýk görülen deðiþken immün yetersizlik (% 4) saptandý. Serimizde tespit edilen mikroorganizmalar, Rotavirüs (% 24), Giardia Lamblia (% 20), H. ‹nþuanzae (% 20), Pnömokok (% 16), Klepsiella Pneumonia (% 8) ve E. Coli’di.

Sonuç olarak; tekrarlayan veya kronik sinopulmoner ve intestinal enfeksiyonlarda humoral immün yetmezliðini ekarte temeliyiz.

Between primary immunodeficiency diseases (PIDs), humoral immunodeficiency diseases are predominated. Humoral immunodeficiency has got a problem in antibody production.
So encapsulated microorganisms mediated sinopulmoner infections and intestinal infections are the most common seen.

In this study, we evaluate 25 patients who has got humoral immunodeficiency between January-1997 September-2000 in SSK Göztepe Hospital Pediatri Department. Male/female
ratio is 2.5. The types of humoral immunodeficiency diseases are IgA deficiency (% 44), IgG4 deficiency (% 24), Hyper IgE Syndrome (% 12), IgG2 deficiency (% 8), Bruton Disease (% 8) and common variable immunodeficiency (% 4). We determinated Rotavirus (% 24), Giardia Lamblia (% 20), H. Influanzae (% 20), Pneumococ (% 16), Klepsiella Pneumonia (% 8) and E. Coli (% 4) as a most common pathogens in our
series.

Conclusions; in this situation that, repeatedly or chronic sinopumonary and intestinal infection, we must evaluate the humoral immunodeficiency diseases.

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Oligüri, yaygýn abdominal distansiyon, CVP artýþý ve baskýlanmýþ ventilasyon kliniði, cerrahý abdominal kompartman sendromuna yönlendirmelidir. Abdominal kompartman sendromunda
hastaya esas yaklaþým dekompresyon olmalýdýr.

Bu çalýþmada, Kasým 1999-2000 tarihleri arasýnda karýn içi ve mesane içi basýnç ölçümüyle Abdominal Kompartman Sendromu teþhis edilmiþ 21 olgu sunulmuþtur.

The clinical findings of oliguria, massive abdominal distension, increased CVP and compromised ventilation should direct the surgeon to a possible diagnosis of abdominal compartmant syndrome. The definitive management of a patient who has abdominal compartmant syndrome should be decompression.

In this study, we present 21 cases with abdominal compartmant syndrome between November 1999-2000, comfirmed by measuring abdominal and bladder pressure.

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Mycobacterium tuberculosis enfeksiyonunun atopi geliþimini ters yönde etkilediði ileri sürülmektedir. Bu açýdan literatüre katkýda bulunmasý amacýyla astým tanýsý ile izleme alýnan toplam 252 çocuk hastada PPD reaksiyonlarý ve allerji deri testi (Prik) reaksiyonlarý arasý iliþki incelendi. PPD reaksiyonu için 5 mm’nin üzerindeki deðerler pozitif kabul edildi. Prik deri testinde en sýk rastlanan aeroallerjenler kullanýldý. Üç milimetre ve üzerinde endürasyon veren reaksiyonlar pozitif kabul edildi.

Toplam 139 hastada PPD negatif (<5 mm) sonuç elde edildi. PPD pozitif reaksiyon veren 113 hasta vardý. PPD (-) olan vakalar içinde 89 kiþi (% 64) en az bir aeroallerjene pozitif yanýt verirken, PPD (+) hastalar içinde 80 tanesi (% 71) en az bir aeroallerjene pozitif yanýt verdi. Bu iki hasta grubu içinde allerji deri testi pozitiþiði Fisher’s Exact Test kullanýlarak karþýlaþtýrýldý. Ýki grup arasý bu açýdan istatistiksel olarak anlamlý bir fark bulunamadý (p=0.283).

Sonuç olarak bu çalýþmada Mycobacterium tuberculosis enfeksiyonu ile atopi arasýnda zýt bir iliþkinin varlýðý gösterilememiþtir.

It has been postulated that there is an inverse association between mycobacterium tuberculosis infection and atopy. We investigated if there is a similar relation in our study group, consisting 252 asthmatic children. In tuberculin testing indurations greater than or equal to 5 mm were accepted as positive. The most common aeroallergens were used in skin prick testing and reactions < or = 3 mm were accepted as positive.

In 139 patients PPD was negative, where as in 113 patients PPD was positive. Among the PPD (-) patients skin prick test was positive in 64 % (n=89). Among the PPD (+) patients
skin prick test was positive in 71 % (n=80). As the two groups were compared for having positive skin prick test reactions no statistically significant difference was detected between them (p=0.283).

In conclusion; no inverse association was found between tuberculin reactivity and atopy in our study group of asthmatic children.

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Bu çalýþmamýzda oral glukoz tolerans testi (OGTT) sýrasýnda serum glukozu ile eþ zamanlý olarak alýnan serum insülin ve C-peptid’inin; normal glukoz toleranslý, bozulmuþ glukoz toleranslý ve tip II diabetli gruplardaki düzeylerini saptayarak aralarýnda anlamlý bir fark olup olmadýðýný bulmayý amaçladýk. Ayrýca, bu üç grup arasýnda insülin direnci göstergesi olan homeostaz ölçüm indeksi (HOMA) yönünden de deðerlendirdik.

Bu çalýþmaya Ankara Numune Eðitim ve Araþtýrma Hastanesinde OGTT uygulanan yaþlarý 20-81 arasýnda deðiþen 108’i kadýn 57’si erkek olmak üzere toplam 165 kiþi alýnmýþtýr. Bu kiþiler National Diabetes Data Group’un taný kriterlerine göre normal glukoz toleranslý; bozulmuþ glukoz toleranslý ve tip II diabetli grup olarak sýnýflanmýþlardýr. Bu üç grup insülin, C-peptid ve HOMA indeksi yönünden karþýlaþtýrýlmýþtýr.

Bozulmuþ glukoz toleranslý ve tip II diabetli grubun 30.’ Ýnsülin düzeylerinin, normal glukoz toleranslý gruptan düþük bulunmuþtur. Bu durum her iki grupta görülen ilk faz insülin salýnýmý yetersizliði lehine yorumlanabilir.

Bozulmuþ glukoz toleranslý grubun 180.’ ve 240.’; Tip II diabetli grubun 120.’, 180.’, 240.’ ve 300.’ insülin düzeyleri normal glukoz toleranslý gruptan yüksek bulunmuþtur. Yine tip II diabetli grubun 180.’ insülin düzeyi bozulmuþ glukoz toleranslý gruptan yüksek bulunmuþtur. Bu bulgular bozulmuþ glukoz toleranslý ve tip II diabetlilerde görülen insülin direncini yenmek için Pankreas beta hücrelerinin ikinci faz insülin salýnýmýný artýrdýklarý þeklinde yorumlanabilir.

HOMA indeksi kullanýlarak yapýlan karþýlaþtýrmalarda ise gruplar arasýnda en belirgin fark 180.’ da olup 120.’ ve 240.’ deðerleri de istatistiksel olarak oldukça anlamlý bulunmuþtur.

Simultaneous insulin and C-peptide levels obtained during oral glucose tolerance test (OGTT), are compared in three groups of patients: first, with normal glucose tolerance; second, with inappropriate glucose tolerance and third with type II Diabetes Mellitus (DM). Also these three groups were compared by and indicator of Homeostasis Model Assessment Insulin Resistance Index (HOMA) to find out any significant difference.

165 patients (108 female, 57 male) between ages of 20 and 81, who undergo OGTT at Ankara Numune Hospital were included in the study. These patients were classified according to the criteria of the National Diabetes Data Group as one group with normal glucose tolerance, one with inappropriate glucose tolerance, and another with type II DM. These three groups were compared via insulin and C-peptide levels and HOMA indexes.

Insulin levels at 30.’ of the groups with inappropriate glucose tolerance and type II DM were found to be lower than the group with normal glucose tolerance. These results can be explained by the first phase insulin secretion inefficiency in these two groups. Insulin levels at 180.’ and 240.’ in the group with inappropriate glucose tolerance and those at 120.’, 180.’, 240.’ and 300.’ in the group with type II DM were higher than the group with normal glucose tolerance. Also the insulin level at 180.’ in the group with type II DM was found elevated when compared with the group with inappropriate glucose tolerance and type II DM is overcame by the increment of pancreatic insulin secretion in the second phase. The comparisons using the HOMA index has shown that the most remarkable difference between the groups was at 180.’ levels. The values at 120.’ and 240.’ were also found to be significant.

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Genel cerrahi kliniklerinde acil þartlarda gerçekleþtirilen operasyonlardan en sýk olarak yapýlan akut apandisitin tüm geliþmelere raðmen tanýsýnda ve tedavisinde kullanýlan yöntemler hakkýnda tartýþmalar devam etmektedir. Bu amaçla kliniðimizde akut apandisit ön tanýsý ile Kasým 98-Ekim 99 tarihleri arasýnda opere edilen 100 ardýþýk hasta prospektif ve randomize edilerek incelenmiþ, taný ve tedavi yöntemleri deðerlendirilmiþtir. Tanýda anamnez ve defans en deðerli etkenler olarak saptanmýþ, lökositozun duyarlýlýðý yüksek, özgüllüðü düþük bulunmuþtur. Operasyon tekniklerinin deðerlendirilmesinde, basit baðlama ile inversiyon yöntemleri arasýnda komplikasyon oranlarý arasýndaki farkýn anlamlý olmasý (p<0.05) basit baðlamanýn kolay uygulanabilmesi, daha kýsa sürmesi ve olasý kolon grafilerini etkilememesi nedenleri ile tercih edilebilecek yöntem olduðu düþünülmüþtür.

Controversies on the diagnosis and treatment methods of acute appendicitis, the most common operation done in general surgery boards, are still continuing. We evaluated
prospectively 100 consecutive patients operated in our clinic between November 98 - October 99 and criticized the diagnostic parameters and treatment modalities. We considered the history of the patient and abdominal rigidity as the most important parameters, and found that leucocytosis has a high sensitivity and low spesifity. In the evaluation of operation techniques we found a significant difference (p<0.05) between the simple ligation and inversion methods and thought that simple ligation could be the prefered method because it takes less time, easy to perform, and do not interfere with any future colonic graphies.

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Çalýþmamýzda Klinik Mikrobiyoloji laboratuvarýmýza çeþitli kliniklerden gönderilen muayene maddelerinden hastalýk etkeni olarak izole edilen 79 Enterokok suþu (52’si idrar,12’si yara-abse, 5’i kan, 5’i vajinal ifrazat, 2 kateter, 2 endotrakeal tüp, 1 boðaz ifrazatý) fluorokinolon grubu antibiyotiklere (ofloksasin, siprofloksasin) ve vankomisine direnç durumlarý standart disk diffüzyon (NCCLS’ye göre) metodu ile incelenmiþtir. Elde edilen suþlarda fluorokinolonlara % 15.78 oranýnda direnç belirlendiði halde, vankomisine direnç saptanmamýþtýr.

Buna göre, fluorokinolonlarýn bu grup bakteri infeksiyonlarýnýn tedavisinde yer alabilecek antibiyotiklerden olduðu görülmektedir. Duyarlýlýk testlerinin yapýlamadýðý durumlarda ve/veya klinik tedavi baþarýsýzlýðý halinde vankomisinin halen ideal bir seçenek olduðu açýktýr.

In this study, 79 strains of Enterococci isolated from samples of chirurgical and internal clinics, are searched for the resistance to fluoroquinolons and vancomycine according to
NCCLS by disc diffusion method. Resistance rate was % 15.78 for fluoroquinolons whereas not at all for vancomycin.

In conclusion, fluoroquinolons can be situated on the therapy of infectious disease due to this bacteria. If the susceptibility tests could not be performed and/or in the event of failured
threatment vancomycine is still and ideal choosing.

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Kasýk fýtýðý ameliyatlarý genel cerrahide en sýk yapýlan ameliyat yöntemlerindendir. Lokal anestezi yöntemi ile fýtýk ameliyatlarý güvenli, basit, etkili, ekonomik olmasý ve anestezi sonrasý yan etkilerinin olmamasý nedenleri ile giderek popüler hale gelmektedir. Çalýþmamýzda bu hasta gruplarýndaki deneyimlerimizi sunmayý amaçladýk.

Inguinal hernioraphy is one of the most common operations performed today. Repair of inguinal hernia with local anesthesia is gaining popularity because it is an easy to perform,
safe, effective, economic method and discludes the side effects of general anesthesia. We aimed to present our experience in this operation type.

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Bu çalýþmanýn amacý, genel kardiyoloji polikliniðine çarpýntý þikayetiyle baþvuran hastalarda ventriküler ve supraventriküler aritmilerin günlük sirkadiyen ritmini deðerlendirmektir.

Kýzýlay Altýntepe Araþtýrma ve Tedavi Klinikleri Kardiyoloji polikliniðine çarpýntý þikayetiyle baþvuran 65’i bayan, 35’i erkek ve yaþ ortalamalarý 57±14 olan 100 hasta çalýþmaya alýndý. Tüm hastalarda Del-Mar ritm holter aletiyle günlük aktivitelerinde deðiþiklik yapmamalarý öðütlenerek 24 (±1) saat süreyle, 3 bipolar göðüs derivasyonuyla elektrokardiyografik kayýtlarý gerçekleþtirildi. Tek baþlarýna veya ardý ardýna görülen bütün ekstrasistolik vurular adet olarak, görüldükleri saate kaydedildi. Saatler arasýndaki ekstrasistol görülme sýklýðý, ventriküler ve supraventriküler vurular için ayrý ayrý, repeated Anova testiyle istatistiksel olarak karþýlaþtýrýldý ve p<0.05 istatistiksel olarak anlamlý kabul edildi.

Toplam 100 hastanýn 24±1 saat yapýlan elektrokardiyografik kayýtlarýnda toplam 46.905 adet supraventriküler ve 50.509 adet ventriküler ekstrasistol kaydedildi. Ventriküler ekstrasistollerin gündüz saatlerinde geceye göre istatistiksel olarak anlamlý derece daha sýk görüldüðü tespit edildi (p=0.0049). Buna karþýn, supraventriküler ekstrasisollerin gün içindeki daðýlýmýnda anlamlý bir farklýlýk görülmedi.

Genel kardiyoloji polikliniðine çarpýntý þikayetiyle baþvuran hastalarda ventriküler ekstrasistoller gündüz saatlerinde geceye oranla anlamlý derece sýk görülürken, supraventriküler ekstrasistollerde anlamlý bir sirkadiyen ritm saptanmadý.

To evaluate the daily circadian rhythm of ventricular and supraventricular arrhytmias in patient who apply to general cardiology clinics with palpitation.

The study performed in 100 patients (65 female, 35 male and mean age was 57±14) with palpitation who examined in cardiology department of Kýzýlay Altýntepe Searching and Treatment Center. All patients are warned against not to change the daily activities and than with Del-Mar rhythm holter 3 bipolar precordial derivations are recorded in 24±1 hours. All single or repeated extrasistolic beats are recorded including time and quanty. By using repeated anova test; the prevalance of extrasistols between hours, ventricular and supraventricular beats are compared seperatly (p<0.05 is accepted statistically significant)

Totally 46.905 supraventricular and 50.509 ventricular extrasistols were recorded. The ventricular extrasistols were more prevalance on days than in the nights and it was statistically significant (p=0.0049) On the other hand the prevalance of supraventricular extrasistols could not be recognized significant difference days and nights.

Patients with palpitation the ventricular extrasistols were more prevalance on days than in the nights but supraventricular extrasistols don’t show significant circadian rhythm.

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Bu çalýþmada, primer açýk açýlý glokomu olup topikal antiglokomatöz olarak b bloker kullanan hastalarýn; plazma trigliserit, düþük dansiteli lipoprotein (LDL), çok düþük dansiteli lipoprotein (VLDL), kolesterol düzeylerinin, b bloker olmayan topikal antiglokomatöz tedavi alan hasta gurubundaki plazma düzeyleri kýyaslanmýþtýr. Glokom biriminde takip edilen primer açýk açýlý glokom tanýsý olup; grup I’de en az bir yýldýr topikal latanaprost ve/veya dorzolamid kullanan; 50 hasta, grup II’de b bloker kullanan 49 hastayla çalýþýlmýþtýr.

Sonuçta iki gurup arasýnda plazma lipid parametreleri yönünden fark bulunmamýþtýr (p>0.05).

We conducted a prospective, randomised study.We compared the effect of topical b blocker medications on plasma lipid profile including LDL, VLDL, cholesterol, trigliseride measurements. There were two groups; group I; patients using latanaprost or dorzolamid, group II; those using b blocker agents. Patients were using the same drug more than one
year. Patients using systemic b blockers were excluded. We took measurements after 12 hour fasting period.

At conclusion there was no difference on any measurement between two groups (p>0.05).

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Development of invasive diagnostic and theurapatic methods has increased the incidence of iatrojenic vascular complications. Vascular complications from the cannulation site have
wide clinical spectrum, from bleeding to dissection. After the catheterization procedures, over all complication rate related to femoral artery area is % 1.7. Vascular grafts need to be used in severe vascular injuries. Vascular graft infections are commonly encountered in femoral area. Every surgeon probably may confront with such a situation so has to know obturator channel bypass technique. So that can treat femoral graft infections and even save the life of the patient.

In our center, we evaluated two cases with the aid of literature that we have encountered. Although surgical operations had been successful we lost one of the patients due to sepsis.

We believe that when technique is known obturator canal bypass is safe and quite simple for extremity revascularization.

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NS is characterised with typical phenotipic features, mild mental retardation, short stature, congenital heart diseases (especially valvular pulmonary stenosis) and usually transmitted sporadically.

An 11 years old male patient was admitted to our hospital with bilateral knee pain. On the physical examination he had short neck, low located ears, down slanting palpebral fissures, hypertelorism, micrognathia, high palate and low, widely spaced nipples. On auscultation 2/6 systolic ejection murmur was heard over the pulmonic area. He was mildly mentally retarded.

Bilateral patella luxation and spina bifida on L4-5, L5-S1 were diagnosed by direct X-ray roentgenograms. ECG showed rSR’ complex in V1, V2 waves. Echocardiographic
examination revealed mild pulmonary valvular stenosis. The audiologic evaluation showed sensorineural hearing loss of the right ear. Genetic consultation confirmed the diagnosis of NS.

To our knowledge, this is the first case of NS reported with bilateral patellar luxation.

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Three sublings who ate wild mushrooms collected from the fields applied to hospital six hours with symptoms of vomiting and diarrhea. The patients were sent home after their symptoms cleared up with fluid therapy. However, 40 hours later they applied to the emergency department of our hospital, with worsening symptoms. All had nausea, vomiting, diarrhea and abdominal pain. At arrival findings of coagulapathy (INR >2.5, aPTT >2 min., PT: 65 (9 sec, PTA < % 30), increased SGOT, SGPT and LDH levels, hyperbilirubinemia and hypoglycaemia were present.

They were diagnosed with amatoxin intoxication and hemoperfusion was begun immadiately for the patients who presented late. Activated charcoal was applied crystallized penicillin infusion was started to neutralize the circulating toxins and a mannitol infusion was applied to induce diuresis. Regardless of thearpy,all three patients died of hepatic and renal failure in 3.66±0.94 days.

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Osteomalacia is a pathologic clinical feature caused by the impaired bone and cartilage mineralization. Clinical manifestations are not apparent. Vitamin D provides adequate calcium and phosphorus concentration for mineralization in extracellular matrix. In vitamin D deficiency mineralization is impaired.

Clinical symptoms and signs of osteomalacia are mild and thus not useful for diagnosis. In severe cases bone pain and tenderness, muscle atrophy can be observed. If the diagnosis of the osteomalacia is delayed, it can easily be mixed up with osteoporosis which is observed in elderly people. The case which had been presented with diffuse muscle spasm, osteoporosis and pseudofracture reminded us about the late complications
of gluten enteropathy and about how the diagnosis is delayed, and thus we decided to report it.

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Vascular tumors of the testis are uncommon. A case diagnosed as venous cavernous hemangioma is presented with its clinical and histological findings.

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Mucosal malignant melanoma is a very rare disease with an unfortunately bad prognosis. In this article a 71 years old patient who had malignant melanoma in the nasal cavity is presented. He had the complaints of epistaxis and nasal stuffiness. The lesion was excised using the technique of lateral rhinotomy.

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Thrombotic thrombocytopenic purpura (TTP) is a systemic disorder characterized by platelet aggregation in the microcirculation. TTP is an uncommon but not a rare disease which affects individuals of all ages but primarily young adults. Its incidence is increasing. Thrombocytopenia and hemoliytic anemia due to fragmentation of the red cells. Etiology is
obscure.

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Hereditary methemoglobinemia is an autosomal dominant disorder which is due to either to the presence of one of the M hemoglobins or the deficiency of the enzyme cytochrome B5 reductase. Cytochromeb5 reductase reductase deficiency have lifelong cyanosis of variable degree, depending on the level of methemoglobin, but usually have no associated symptoms or other physical findings.

A 18 year old male referred our hospital with breathlessness, weakness, headache, central cyanosis which is sustained from the birth. He had been investigated by cardiology and pneumonology departments of different hospitals in respect of congenital
heart diseases and lung diseases. Our diagnostic evaluation revealed hereditary methomoglobinemia. We found cytchrome b5 reductase enzyme deficiency in this patient.
Methoboglobinemia especially hereditay form is rare cause of central type cyanosis that is way when we investigate cyanosis in adult patient, we should keep hereditary methomoglobinemia in our minds.

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Acute gastrointestineal bleeding is an emergency case. With the advance of endoscopic technique, the necessity for surgical intervention of upper gastrointestineal bleeding has been reduced to 6 % to 10 %. However, gastrointestineal bleeding remains a common cause of morbidity and mortality. Duodenal diverticula is thought to be uncommon and few cases of
bleeding from a duodenal diverticulum have been reported. Most were diagnosed and managed by angiography or surgery. In this study, we present a case with bleeding from a
giant duodenal diverticulum, diagnosed by enteroclisis and successfully treated with surgery.

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Iniencephaly is not a rare but although a not very common anomaly. Its triad contains an occipital bone defect, cervical disraphy and a retroflexed fetal head. We present a case where the patient with no former prenatal clinic controls at 30 weeks of gestation according to her last menstrual date who came to our clinic in active labor. Our aim is to show the difficulty in choosing the right birth modus (C/S vs. vaginal birth) and the difficulties in diagnosing this not common seen anomaly.

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