17 Aðustos 1999 tarihinde saat 03.05’de, merkez üssü Gölcük olan 7.4 Richter ölçeðindeki Marmara depremi, büyük ölçüde ölümlere ve yaralanmalara neden olmuþtur. Resmi rakamlara göre 17.465 insanýmýz hayatýný kaybetmiþ, 43.953 insanýmýz yaralanmýþ ya da sakat kalmýþtýr. Deprem sonrasý Gülhane Askeri Týp Akademisi Haydarpaþa Eðitim Hastanesi Acil Servisine 632 yaralý getirilmiþtir. Bu yaralýlarýn 532’sine ilk yardým yapýlýp yatýrýlmýþ, 100 yaralý da çevre hastanelere nakil edilmiþtir. Deprem sonrasý acil servise sadece travma olgularý gelmemiþ, panik nedeniyle yüksekten atlayan toplam 12 yaralý da getirilmiþtir. Deprem sonrasý bir haftalýk periyotta cerrahi aciller dýþýnda çok sayýda hipertansif ve kardiyak acil olgu da acil servise müracaat etmiþtir. Bu hastalardan 85 hipertansif hastanýn dördünde hipertansif ensefalopati, 19’unda hipertansif acil durum tespit edilmiþtir. 38 hasta da kardiyak nedenle acil servise getirilmiþtir.

The “Marmara Earthquake”, on 17th August 1999, at 03: 05 measuring 7.4 on the Richter scale caused one of the greatest number of deaths and injuries in Turkey. According to official reports 17.465 people were killed, 43.953 people were injured or permenantly disabled. After the earthquake 632 patients were transported to Gülhane Military Medical Academy Haydarpaþa Training Hospital. 532 of them after first aid were interned and other 100 survivors were transported to other centers. After the earthquake the patients that were brought to the emergency service were not only from the affected area
but from Ýstanbul who were jumped down because of the panic. They were a total of 12 patients with minor injuries. Apart from these surgical cases, in a week’s time numerous
patients with hipertensive, cardiac and phychiatric complaints attended to emergency department. Of these 85 hypertensive patients, 4 patients were with hypertensive encephalopathy and 19 with hypertensive urgency. A total of 38 patients with
cardiac emergency were brought to the emergency department. Of these 5 patients were with acute myocardial infarction; of them 3 from the disaster region.

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Bu çalýþmanýn disseksiyonlarý formalinle fikse olmuþ 24’ü sol, 24’ü de sað taraf olmak üzere toplam 48 kadavra eli üzerinde gerçekleþtirildi. N.ulnaris’e ve n.medianus’a ait dallar arasýndaki kommunikan dallarýn 5 farklý tipi gözlendi. Bu kommunikan dallarýn tipine, sayýsýna ve kommunikan dal olmamasýna dayanarak bu iki sinire ait dallar arasýndaki iliþki aþaðýda belirtildiði gibi 6 farklý biçimde sýnýþandýrýldý.

Tip a: N.digitalis palmaris communis’ten (n.ulnaris) n.digitalis palmaris communis’e (n.medianus) uzanan kommunikan dal
Tip b: Birden fazla sayýda kommunikan dal
Tip c: R.superficialis n.ulnaris’in bifurkasyo yerinden n.digitalis palmaris communis’e (n.medianus) uzanan kommunikan dal
Tip d: Kommunikan dal yokluðu
Tip e: N.digitalis palmaris communis’ten (n.medianus) n.digitalis palmaris communis’e (n.ulnaris) uzanan kommunikan dal
Tip f: N.digitalis palmaris communis (n.medianus) ile n.digitalis palmaris communis (n.ulnaris) arasýnda kommunikan dal

Bu sýnýflamaya göre, n.medianus ve n.ulnaris’e ait dallar 15 örnekte Tip a (% 31.25), 2 örnekte Tip b (% 4.17), 5 örnekte Tip c (% 10.42), 24 örnekte Tip d (% 50), 1 örnekte Tip e (% 2.08) ve 1 örnekte Tip f (% 2.08) þeklinde iliþki gözlendi.

N.ulnaris ve n.medianus dallarý arasýndaki bu kommunikan dallarýn bilinmesinin el cerrahisinde ve periferik sinir lezyonlarýnýn tanýsýnda yol gösterici olacaðý kanýsýndayýz.

Anatomic dissections for this study were performed on formalin fixed 48 cadaveric hands, 24 left sides and 24 right sides. The communicating branches between the median and ulnar nerves in the palm were determined as five types. The relationship between these two nerves was classified as six different types according to the types, the numbers and the absence of the communicating branches.

Type a: The communicating branch from the palmar branch of the common digital nerve (ulnar nerve) to the common digital nerve (median nerve)
Type b: Multiple communicating branches
Type c: The communicating branch from the bifurcation point of the superficial ramus of the ulnar nerve to the palmar branch of the common digital nerve (median nerve)
Type d: Absence of the communicating branch
Type e: The communicating branch from the palmar branch of the common digital nerve (median nerve) to the common digital nerve (ulnar nerve)
Type f: The communicating branch between the palmar branch of the common digital nerve and the palmar branch of the common digital nerve (ulnar nerve)

Type a was observed in 15 (% 31.25), type b in 2 (% 4.17), type c in 5 (% 10.42), type d in 24 (% 50), type e in 1 (% 2.08) and type f in 1 (% 2.08) of our samples according to this classification.

We consider that to be aware of these variations will be usefull for the assessment of nerve injuries and hand surgery.

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Bu çalýþmada, olumlu farmakokinetik özellikleri bilinen sevofluran-remifentanil ve propofol-remifentanil kombinasyonlarýný anestezi derinliðinin kontrolü ve hemodinami parametreleri açýsýndan karþýlaþtýrmayý amaçladýk.

Normotensif, ASA I-Il, 40 hasta rastgele iki gruba ayrýlarak çalýþma kapsamýna alýndý.Tüm hastalara 1 μg/kg bolus dozundan sonra 0.5 μg/kgldk remifentanil infüzyonu, 1 mg/sn hýzda propofol ve 0.1 mg/kg vekuronyum ile indüksiyon yapýldý. Ýndüksiyondan sonra, propofol-remifentanil grubunda (Grup Propofol) propofol infüzyonuna, sevofluran-remifentanil grubunda (Grup Sevofluran) sevofluran inhalasyonuna baþlandý. Ventilasyon % 50 02/hava ile saðlandý. Entübasyondan 5 dakika sonra remifentanil infüzyon hýzý % 50 azaltýldý. Yüzeyel anestezi bulgularý bolus ve infüzyon artýþlarý ile kontrol edildi. Son cilt dikiþleri ile birlikte bütün ilaçlar sonlandýrýldý. Hastalarýn sistolik, diyastolik kan basýnçlarý ve kalp atým hýzlarý takip edildi.

Entübasyona hipertansiyon ve taþikardi yanýtý her iki grupta da izlenmezken, propofol grubunda anestezi idamesinde hipotansiyon insidansý daha yüksek bulundu (p<0.01). Sevofluran grubunda ise bradikardi insidansý yüksek olmasýna raðmen anlamlý farklýlýk saptanmadý.

Her iki grupta da entübasyona ve cerrahi uyarýlara yanýt güçlü olarak baskýlanmakla birlikte hipotansiyon ve bradikardi insidansý yüksek bulunmuþtur.

The aim of the present study was to compare the effects of remifentanyl on controlling the depth of anaesthesia and haemodynamic parameters while using as a part of inhaled
anaesthetic tecnique or TIVA.

Normotensive, ASA I-Il, 40 patients were randomly divided into two groups. Anaesthesia was induced with 1 μg/kg remifentanyl bolus followed by 0.5 μg/kg/min infusion, propofol
given at a rate of 1 mg/sec and vecuronium 0.1 mg/kg. After induction, sevoflurane inhalation was started in sevoflurane-remifentanyl grup (Group S) and propofol infusion in
propofol-remifentanyl group (Group P). Lungs were ventilated with O2/air mixture. Five minutes after intubation, remifentanyl infusion rate was decreased by 50 %. Symptoms of
light anaesthesia were managed by bolus doses and infusion rate increases. All of the drugs were discontinued at the end of operation. Systolic and diastolic blood pressures and heart rates were recorded throughout the operation.

Hypertension and tachycardia responses to intubation were not observed in both groups, but the incidence of hypotension was higher in the maintanence period of anaesthesia in propofol group (p<0.01). Although incidence of bradycardia was higher in sevoflurane group, it was not significantly different. Both of the anaesthetic tecniques successfuly controlled the response to intubation and surgical stimulation, but incidence of hypotension and bradycardia were found to be high.

As a result, we concluded that a remifentanyl infusion rate below 0.25 μg/kg/dk may provide better haemodynamic parameters.

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Kolorektal yabancý cisimler acil cerrahi pratiðinde sýk karþýlaþýlmayan, hastalarýnda saklama eðilimi nedeni ile akla gelmediði taktirde taný ve tedavide güçlüklerin yaþanabileceði bir hastalýk grubudur. Çalýþmamýzda 1998 Ocak-2001 Haziran tarihleri arasýnda tetkik ve tedavi edilen 8 olgudaki taný ve tedavi sonuçlarýmýz deðerlendirilmiþtir.

Colorectal foreign bodies sometimes could easily be misdiagnosed and have difficulties in treatment if not kept in mind, because of hiding tendency of the patients and they are rare in
surgical practice. In our study we evaluated our results in 8 patients admitted to emergency service and treated between January 1998 and January 2001.

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Çalýþmamýzda, farklý pediatrik yaþ gruplarýnda mivakuryumun intubasyon kalitesi, etki baþlama süresi ve derlenme sürelerinin karþýlaþtýrýlmasý amaçlanmýþtýr.

Her biri 15’er kiþiden oluþan; 2-12 ay (Grup 1), 1-5 yaþ (Grup II), 6-12 yaþ (Grup III) olmak üzere 3 grup oluþturuldu. Anestezi indüksiyonu sevofluran inhalasyonu ile yapýldý. Tüm hastalarda 0.3 mg/kg mivakuryum için nöromüsküler ileti monitörize edildi. 90’ncý saniyede endotrakeal intubasyon deðerlendirildi. TOF yanýtýnda % 90 azalma, T25 derlenme zamaný, indüksiyondan önce, indüksiyondan sonra, nöromüsküler blokerden sonra; endotrakeal intubasyondan 1 ve 5 dakika sonra kalp hýzý, sistolik kan basýncý, diyastolik kan basýncý ve oksijen satürasyonu kaydedildi.

T90 zamanýnýn Grup I’de Grup II’ye göre, T25 süresinin Grup I’de Grup III’e göre daha kýsa olduðu görüldü (p<0.05). Sistolik arter basýncý (SAB), diyastolik arter basýncý (DAB) ve kalp atým hýzý (KAH) deðerlerinde özellikle endotrakeal entübasyon sonrasý tüm olgularda baþlangýç deðerlerine göre anlamlý artýþlar oldu (p<0.001).

Sonuç olarak; mivakuryumun özellikle 2 aydan büyük tüm pediatrik olgularda, özellikle kýsa süreli operasyonlarda kullaným için uygun bir alternatif olduðu kanýsýna varýldý.

In our study, we aim to compare the intubation quality, initial T90 period and T25 recovery times of mivacurium in different pediatric age groups.

Three groups each of consisting 15 people were assembled as 2-12 months (Group I), 1-5 age (Group II) and 6-12 age (Group III). Anaesthesia was inducted with sevoflurane. The neuromuscular transmission was monitorized for a dose of 0.3 mg/kg mivacurium in all of the patients. In 90th second intubation quality was evaluated by scoring endotracheal intubation. % 90 decreases in TOF response, T25 recovery time, heart rate(HR), systolic blood pressure( SBP), diastolic blood pressure (DAB) and pulse oxymetry (SpO2) were re-corded in pre and post induction period, after neuromusculer bloker and 1 and 5 minutes after endotracheal intubation.

It was occured that T90 timing was shorter in Group I than Group II; T25 period in Group I was shorter than Group III (p<0.05) too. In values of HR, SAP and DAP meanings especially after endotracheal entubation, meanings were increased in all cases, comparing to initial values (p<0.001).

As a result; it is concluded that especially in short operations mivacurium is a good alternative to use for pediatric cases older than 2 months.

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Meme malignitelerinin tedavisinde görülen lenfödem olgularýnýn pek çoðu cerrahi eksizyon veya radyoterapinin yol açtýðý iatrojenik hasar sonucu ortaya çýkar. Lenfödem riski primer tümörün tipine, rezeksiyonun geniþliðine ve radyoterapiye göre deðiþkenlik gösterir. Postoperatif yara infeksiyonu bu riski daha da arttýrabilir. Aksiller nod diseksiyonuna sekonder geliþen üst kol ödemi insidansý, nod diseksiyonu seviyesine baðlý olarak % 2-30 arasýnda görülür. Biz bu çalýþmamýzda postoperatif geliþen lenfödem sýklýðýmýzý, nedenlerini ve kol egzersizlerinin lenfödem tedavisindeki yerini araþtýrdýk.

Most cases of lymphedema occur as a result of iatrogenic damage following surgical excision or radiotheraphy in the treatment of breast malignancy. The risk of lymphedema
varies depending upon the type of primary tumor and the extent of the resection and radiotherapy. Postoperative wound infection may increase this risk further. The incidence of secondary lymphedema of the upper limb following axillary node dissection depends upon the level of node clearance, but is approximately 2-30 %. In this study, we searched our postoperative lymphedema insidence, reasons and the role of arm exercises in lympedema treatment.

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Bu çalýþmada, son beþ yýl içinde akut solunum yetersizliði nedeniyle kurum dýþý hastanelerin yoðun bakým ünitelerine sevk edilen toplam 74 hastanýn genel özellikleri ve kurumumuza maliyetini araþtýrmayý amaçladýk. 1996-99 ve 2000-01 yýllarýna ait bilgiler iki ayrý dönem olarak deðerlendirildi ve I. Dönemde 33 hasta, II. dönemde ise 41 hastanýn sevk edildiði belirlendi. Toplam hastane gideri I. dönem için 51.5 milyar TL (152.353$), II.dönem için 183.2 milyar TL (466.259$); hasta baþýna günlük maliyet ise I.dönemde ortalama 171.5 milyon TL (308±61$), II. dönemde 279.7 milyon TL (465.5±211.6$) idi, iki dönem arasýndaki fark anlamlý bulundu (p=0.01). Hasta yaþý ve primer tanýsýnýn günlük maliyet üzerine anlamlý bir etkisi olmadýðý; ancak II. dönemde mortalitenin günlük maliyeti anlamlý derecede artýrdýðý saptandý. Sonuç olarak, yoðun bakým masraflarýnýn son iki yýlda önceki yýllara oranla önemli ölçüde arttýðý; aðýr ve kötü prognozlu hastalarda günlük maliyetin sað kalan hastalara göre anlamlý derecede yüksek olduðu saptandý.

In this study we evaluated general characteristics and costs of the patients been sent to the other hospitals in order to intensive care and mechanical ventilation in the last five years. The information of the patients between 1996-99 were accepted as the first period and between 2000-01 were accepted as the second period. There were 33 patients in the first period and 41 in the second.Total hospital costs were 152.353$ in the first period and 466.259$ in the second. Cost/day/patient was 308±61$ in the first period and 465.5±211.6$ in the second (p=0.01). The daily cost was not affected patient’s age and the primary diagnosis. However mortality significantly affected the daily patient cost in the second period.In the result, we concluded that intensive care cost was higher in the last two years than previous years and high cost was a marker of poor prognosis.

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Akciðer kanserinin kemik iliðine yayýlým yaptýðýnýn tespit edilmesi; hastalýðýn evrelendirilmesinde, muhtemel prognoz tayini ve seçilecek tedavinin belirlenmesinde çok yararlý olmaktadýr. Kemik iliði biyopsisi kemik iliði yayýlýmýnýn tespitinde kullanýlan güvenilir metotlardan biridir. Bu nedenle küçük hücreli akciðer kanserinin tedavi öncesi evrelendirilmesinde, kemik iliði biyopsisinin rutin olarak yapýlmasý tavsiye edilmektedir. Bu çalýþmamýzýn amacý, akciðer kanserinin tanýsýnda ve tedavi öncesi evrelendirilmesinde kemik iliði aspirasyon ve iðne biyopsisinin önemi, kemik iliðine yayýlým sýklýðý ve yayýlým olan olgulardaki laboratuvar ve klinik deðiþikliklerin araþtýrýlmasýdýr. Yapýlan kemik iliði biyopsisi sonucu 7 olguda (% 17.5) kemik iliði yayýlýmý tespit ettik. Histopotolojik tipe göre ise 25 küçük hücreli akciðer karsinomu olgusunda % 24 (6 olgu), 15 küçük hücreli olmayan akciðer karsinomu olgusunda ise % 6.6 (1 olgu) oranýnda kemik iliði metastazý saptadýk. Çalýþmamýzda küçük hücreli akciðer kanserinde % 24 oranýnda kemik iliði infiltrasyonu bulunduðundan, kemik iliði biyopsisinin hastalýðýn evrelendirme ve kesin tanýsýnýn konmasýnda faydalý olduðunu saptadýk.Küçük hücreli olmayan akciðer kanserinde ise % 6.6 oranýnda kemik iliði tutulumu saptadýk ve diðer metotlarla taný konulamayan olgulara kemik iliði biyopsisi yapýlmasýnýn tanýda faydalý olabileceðini düþündük. Ýstatistiksel olarak kemik iliði tutulumu ile uzak metastazlardan sadece kemik metastazý arasýnda anlamlý iliþki saptandý.

Detecting the pulmonary carcinoma spreading to the bone marrow is very useful for staging the disease, predicting possible prognosis and determining the treatment of choice. The biopsy of bone marrow is one of the convenient methods to detect any metastasis to bone marrow. Thus, during staging process prior to the treatment of small cell pulmonary carcinoma, it is recommended to perform a biopsy of bone marrow
in the routine practice. The object of our study is to investigate the importance of bone-marrow aspiration and needle biopsy for diagnosing the pulmonary carcinoma and staging process prior to the treatment, frequency of bone-marrow metastasis, and assess laboratory and clinical changes in the cases with metastasis. A biopsy of bone-marrow showed that 7 cases (17.5 %) had a metastasis to bone marrow. According to histo -patological grading, of 25 cases with small cell pulmonary carcinoma and 15 cases with none-small cell pulmonary carcinoma, 24 % (6) and 6.6 % (1) had a metastasis to
bone marrow, respectively. In this study, since small cell pulmonary carcinoma had an infiltration of bone marrow by 24 %, it was suggested that the biopsy of bone marrow was useful for staging process and diagnosing the disease accurately. As non-small cell pulmonary carcinoma had an involvement of bone marrow by 6.6 %, we suggested that the biopsy of bone marrow may be useful for the diagnose of those patients undiagnosed with other methods. There was statistically significant relationship between the involvement of bone marrow and bone metastasis, that is only among the far metastasis.

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Amaç, preeklamptik ve normal gebelerde serum lipid düzeyini karþýlaþtýrmak.

15 peeklamptik ve 15 normal gebe kadýnda total kolesterol, trigliserid, HDL-kolesterol (HDL-K), LDL-Kolesterol (LDLK) ve VLDL-kolesterolün (VLDL-K) plazma deðerleri ölçüldü. Total trigliserid ve VLDL-kolesterolün plazma düzeyi preeklamptik gebelerde anlamlý olarak yüksekti. Total kolesterol, HDL-kolesterol ve LDL-kolesterol düzeylerinde anlamlý
fark saptanmadý.

Sonuç; trigliserid ve VLDL-K düzeyleri preeklamptik gebelerde artmaktadýr.

The goal of this trial is to compare the serum lipid level in preeclamptic and normal pregnancies.

Plasma levels of total cholesterol (total-c), triglyseride (TG), HDL-Cholesterol (HDL-C), LDL-cholesterol (LDL-C) and VLDL-cholesterol (VLDL-C) was measured in 15 preeclamptic
and 15 normal pregnant women. The plasma levels of triglyseride and VLDL-C were significannly higher in preeclamptic womens than in normals. Levels of total-C, HDL-C, LDL-C did not differ significantly.

The level of TG and VLDL-C increase in preeclamptic womens.

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Gastrik karsinomlar, doðu ülkelerinde daha yüksek oranda görülmekle birlikte tüm dünyada ölüme neden olan karsinomlar arasýnda 2. sýklýkta bulunmaktadýr. Tümörün tedavisinde, nüks ve metastaz ihtimallerinin deðerlendirilmesinde prognostik faktörlerin büyük önemi vardýr. Çalýþmamýzda prognostik faktör olarak Lauren sýnýþandýrmasýna göre mikroskopik karsinom tipi (intestinal tip/diffuz tip/miks tip), grade, lenf nodu tutulumu (tutulumun mevcut olmasý L1, olmamasý L0), TNM sýnýþamasýna göre invazyon derinliði (pT1, pT2, pT3), perinöral invazyonun ve vasküler tutulumun mevcudiyeti, nekroz içeriði, ve inþamatuar yanýtýn bulunmasý deðerlendirildi. Tümörlü bloklara p53 antikoru ile yapýlan immünohistokimyasal boyamada nükleer boyanma izlendi: Po: boyanma olmayanlar P1: (+)<% 25 boyanma olanlar, P2: (++) % 25-50 boyanma olanlar, P3: (+++)>% 50 boyanma olanlar deðerlendirildi. Olgularýn 15’inde (% 33.3) Po, 8’inde (% 17.7) P1, 7’sinde (% 15.5) P2, 15’inde (% 33.3) P3 tipinde boyanma saptandý. Sonuç olarak, p53 immünoreaktivitesi ile prognostik faktörleri karþýlaþtýrdýðýmýzda sadece damar invazyonu (p<0.05) vke perinöral invazyon (p<0.05) ile aralarýnda istatistiksel olarak anlamlý bir iliþki saptanmýþtýr.

Though gastric carcinomas are more common in eastern countries, they are the second most common tumours causing death world wide. Prognostic factors are very important for deciding treatment modalities and the determination of recurrences and metastasis. In our study microscopic types of adenocarcinomas according to Lauren’s classification (intestinal/diffuse/mixed type), grade of the tumour, presence of lymph node metastasis (L1), absence of lymph node metastasis (L0), depth of tumoural invasion according to TNM classification (pT1, pT2, pT3), perineural and perivascular tumoural infiltration, presence of necrosis and inflammatory reactions are evaluated as prognostic factors. Parrafin blocked sections of tumoural tissues are stained with anti p53 immunohistochemically. Nuclear staining with anti p53 is accepted as immunopositive. Immunonegative tissues are evaluated as P0, immunopositivity in less than 25 % of
tumour is evaluated as P1(+), tumours with 25 % to 50 % immunopositivity are P2 (++) and tumours with more than 50 % immunopositivity are P3 (+++). 15 of the cases (33.3 %) are diagnosed as P0, 8 of the cases (17.7 %) are diagnosed as P1, 7 of the cases (15.5 %) are P2 and l5 of the cases (33.3 %) are diagnosed as P3. As a result when p53 immunoreactivity is compared with the prognostic factors, we found that only perivascular tumoural invasion (p<0.05) and perineural tumoural invasion (r=0.155, p= 0.045) are correlated with p53 immunopositivity and these results are statistically significant.

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Bu çalýþmada, annelerin çocuklarýnýn ateþli durumu ile ilgili olarak neler düþündükleri, doðru veya yanlýþ neler yaptýklarýnýn araþtýrýlmasý, aksayan yönlerin ortaya çýkarýlarak annelerin eðitiminin hedeflerinin belirlenmesine katkýda bulunulmasý planlandý. Annelerin çoðu çocuklarý ateþlendiðinde mikrobik bir hastalýðý düþünüyordu. Ateþ, hiçbir anne tarafýndan malign hastalýklarýn veya inflamatuar hastalýklarýn belirtisi olarak düþünülmedi. Annelerin yalnýzca % 21’inin evinde derece vardý. Annelerin çoðu (% 83.2) çocuklarýnýn ateþli durumlarýnda ilk olarak kendi tedavi yöntemlerini uyguluyorlardý. Bunlar arasýnda en çok ýlýk su pansumaný yapýlýyordu. Ateþ tedavisinde annelerin yalnýzca % 9.2’sinin antibiyotik kullanmasý olumlu bir davranýþ olmakla birlikte, antibiyotik kullanan annelerin % 87.2’sinin eðitim düzeyi düþüktü. Sonuç olarak, annelerin ateþ, ateþ nedenleri ve ateþli durumlarda ilk yapýlmasý gerekenler konularýnda eðitilmeleri gerektiðine karar verildi.

This study was planned to determine the knowledge and attitudes of mothers living in Erzurum about febrile illness of their children and to find out which type of home remedies
they use in these conditions. The majority of mothers thought that febrile conditions were probably caused by any infectious disease and inflammatory disorders. It was found that 21 % of mothers had a thermometer at their house. In practice, the most preferred method for treating fever was the sponging tepid water. Antibiotics were given without physician consultation by 9.2 %. As the mothers educational status increased, more appropriate home remedies were applied. In conclusion, education of mothers about fever and its treatment is necessary.

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Menapoza giren kadýn hastalarýn sýcak basmasý ve terleme gibi birçok þikayeti hormon replasman tedavisinden (HRT) sonra belirgin derecede azalmaktadýr. Menapoza baðlý
þikayetlerin yanýnda hormon replasman tedavisi kadýnlarý osteoporoza karþý korumakta, kardiyovasküler mortalite ve morbiditeyi de azaltmaktadýr.

Bu çalýþmada, Kadýn Hastalýklarý ve Doðum Kliniðine baþvuran ve oral transdermal hormon replasman tedavisi baþlanan 30 postmenapozal ultrasonografi yöntemiyle incelenmiþtir.

HRT alan postmenapozal kadýnlarda uterin sirkülasyonda direnç azalmasý uzun dönem HRT tedavisinin vasküler sistem üzerinde pozitif etkisini göstermektedir.

Hormone replacement therapy significantly relieves postmenopausal symptoms like hot flushes and sweating. Hormone replacement theraphy not only relieves menopausal
symptoms but also protects againts osteoporosis and decreases cardiovasvular morbidity and mortality.

In this study Doppler ultrasonographic evaluation of uterine artery changes in postmenopausal 30 patents who attended to the Obstetrics and Gynecology Department and who were started oral or transdermal hormone replacement therapy were examined.

Decrease in uterine circulation resistance in postmenopausal women on hormone replacement theraphy shows the positive effect of hormone replacement theraphy on the vascular system.

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Adult intussusception represents 1 % of all small bowel obstruction. Intussuception occurs rarely in adults. Intra-luminal lesions alter normal bowel peristaltisis and form leading
edges for the Intussusception. CT scanning proved to be the most useful diagnostic radiologic method. The diagnosis and treatment of adult intussusception are surgical. It presents with a variety of acute, intermittent, and chronic symptoms, thus making its preoperative diagnosis diffucult. These patients admitted to medical clinic for incomplet obstruction. Barium studies have shown diagnostic efficacy but were not used in
our case. A female 32 years old patient was admitted our emergency room with complaints nausea, vomiting, obstipation, abdominal discomfort. Abdominal mass and abdominal rebound was present. And the patient was operated due to ileus, tumor and ileal invagination was seen. Small bowel resection and end to end anastomosis was done.Inflamotory Fibroid polyp was diagnosed pathologically.

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Unilateral absence of pulmonary artery is a rare malformation that can present as an isolated lesion. A 38 year-old male was admitted to the hospital with dispnea, hemoptysis. Physical examination revealed no abnormalites, but there was “left destroyed lung” apperance on chest radiography. Absence of the left pulmonary artery was demonstrated by arteriography of the pulmonary arteries.

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Paroxysmal nocturnal haemoglobinuria is an acquired clonal stem cell disease, characterized by chronic intravascular haemolytic anemia, hypercoagulability, deficient haematopoiesis and rarely leukaemic conversion. The mechanism of haemolysis appears to be unregulated complement activation on the abnormal red cell surface, because of reduction or absence of regulatory membrane molecules protecting cells against the membrane attack complex of complement mediated lysis. Thrombosis in hepatic, portal, mesenteric, renal and cerebral veins (which has an incidence of 12-40 %) is one of the important complications of paroxysmal nocturnal haemoglobinuria.

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Castleman disease is a rare lymphoproliferative disease with typical systemic manifestations and spesific histopathological findings. Accurate diagnosis can be maintained only by demonstration of typical histopathological findings with excisional biopsy of involved lymph node.

In this study we presented a 40 years old male patient with a history of progressively growing servical mass on the left side of the neck who had Castleman disease diagnosed by an excisional biopsy.

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Moya Moya disease is a chronic vasculopathy which causes unilateral or generaly bilateral progressive oclusion of internal carotid arteries resposible for circulation of anterior part
of cerebrum. This disease cause cerebrovascular insuffiency and that incuffiencies multiple anastamosis and collaterals between internal and external carotid arteries. In this article,
we presented this very rare disease occuring in a two year nine months old boy with a down syndrome who has localized convulsions.

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A dissecting aneurysme of the great cervical vessels causes local pain over the involved vessel, when the carotid artery involved there is severe retroorbital and frontal pain. Temporary severe visual loss is a rare symptom after dissection of the aneurysme We present a 52- year- old woman who developped sudden painful loss of vision in the left eye At first, we thought that she was having a retrobulber optic neuropathy. After a follow-up period the diagnosis was compressive optic neuropathy. This report emphisizes that the difficulty in imaging intracranial aneurysms of various sizes, the rapidity with which intracranial aneurysms can enlarge, and the importance of continued follow up examinations in patients thought to have optic neuritis.

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Mecury poisoning is one of the most common heavy metal poisoning. Unless it is diagnosed and treated earlier, it may lead to multiple organ dysfunction and irreversible brain damage. Acute mercury poisoning is characterized by interstitial pneumonia, fatigue, anorexia, weight loss, gastrointestinal tract disturbances followed by tremor, increased excitability, amnesia, insomnia and delirium. Chronic mercury poisoning produces especially the central nervous system dysfunction.

Presenting a case of acute mercury intoxication who developed fatique, fever, rash and neurologic deficit, we aim to call attention to its irreversible consequences especially in the central nervous system and may be fatal if it is diagnosed and treated too late.

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