Marmara depremi sonrasý hastanemize 532 yaralý kabul edilmiþtir. Bu çalýþmanýn amacý yatýrýlarak tedavi edilen olgularda infeksiyon sýklýðýný ve sorumlu mikroorganizmalarý retrospektif olarak incelemektir.

Hastanede iki günden fazla yatan 220 olgudan 43 ünde (% 19.5) nazokomial enfeksiyon epizotunun geliþtiði saptandý. Alýnan 81 kültür örneðinin (yara, kan, katater ve idrar kültürleri) 33’ünde Acinetobacter spp. (% 40.7), 20’sinde Staphylococcus aureus (% 24.6), 13’ünde Pseudomonas aeroginosae (% 16), 7’sinde E coli (% 8.6), 3’ünde klebsiella (% 3.7) ve 3’ünde de (% 3.7) Stenomaltophilia ürediði tespit edildi.

Sonuç olarak, Asinetobakter Baumani’nin deprem sonrasý dönemde hastanemizde en sýk gözlenen infeksiyon etkeni olduðu tespit edildi.

532 patients were admitted to GATA Haydarpasa Teaching Hospital after the Marmara Earthquake. Purpose of this study was to evaluate prevalence of the nosocomial infection and frequency distributions of the causative pathogen as a retrospectively.

Of the 220 patients whose hospitalized more than two days enrolled, 43 were clinical acceptable as a nasocomial infection. The most common pathogens identified were 33 (% 40.7) Acinetobacter Baumani, 20 (% 24.6) Staphylococcus aureus, 3 (% 16) Pseudomonas aeroginosae, 7 (% 8.6) E coli, 1 (% 1.2), P fluorescent, 3 (% 3.7) Klebsiella, and Steno-maltophilia 3 (% 3.7) in the 81 culture specimens.

As a result, Acinetobacter Baumani was the most common causative microbial agent after the earthquake period.

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Total abdominal histerektomi operasyonu geçirecek, ASA I-II grubunda, 60 kadýn hasta rasgele 3 gruba ayrýlarak 60-90 dk. önce Grup I’de 5 mg/kg klonidin, Grup II’de 0.1 mg/kg diazepam, Grup III’de 20 mg famotidin tablet ile oral yoldan premedikasyonlarý yapýldý. Premedikasyon öncesi ve sonrasý anksiyete (10 deðerli VAS) skorlarý kaydedildi. Ýndüksiyonda tüm hastalara 2 mg/kg fentanil, 60 saniye sonra kooperasyonu ve kirpik refleksi kaybolana kadar propofol ve 0.1 mg/kg vekuronyum ile endotrakeal entübasyon saðlandý. Anestezi idamesinde 100 mg/kg/dk propofol ve % 50 O2-N2O karýþýmý kullanýldý. Premedikasyon öncesi, cerrahi insizyonun 30. ve postoperatif 60. dakikada kan glukoz, kortizol ve laktat seviyeleri için kan örnekleri alýndý. Hemodinamik parametreler premedikasyon öncesi ve sonrasýndan itibaren tüm operasyon süresince 5’er dakikalýk aralýklarla ölçüldü.

Ýndüksiyon öncesi VAS skorlarý premedikasyon öncesi deðerlere oranla Grup I’de II’ye göre anlamlý (p<0.05), III’e göre çok ileri düzeyde anlamlý (p<0.001), Grup II’de ise III’e göre anlamlý olarak düþük bulundu (p<0.05). Anestezik gereksinimi Grup I’de II ve III’e göre ileri derecede anlamlý olarak düþük bulundu (p<0.01).

Kan glukoz deðerlerinde, Grup II ve III’te bazal deðerlere oranla anlamlý yükselme kaydedilirken (p<0.05), gruplar arasý fark istatistiksel olarak anlamlý deðildi (p>0.05). Grup içi ve gruplar arasý kan laktat düzeyleri istatistiksel olarak anlamlý bulunmadý (p>0.05). Her 3 grupta da postoperatif 60. dakikadaki kan kortizol düzeylerinde premedikasyon öncesi bazal deðerlere oranla istatistiksel olarak anlamlý yükselmeler kaydedildi (p<0.05). Gruplar arasý karþýlaþtýrmalarda Grup I ve II’deki yükselmeler III’e oranla anlamlý olarak düþük kaydedildi (p<0.05). Sonuç olarak, klonidinin anksiyetenin giderilmesi, anestezi maliyetinin azaltýlmasý, entübasyona hemodinamik yanýtýn baskýlanmasý, stres yanýta olumlu katkýsý ve hemodinamik açýdan stabilitenin saðlanmasý açýsýndan premedikasyonda oral diazepama iyi bir alternatif olabileceði kanýsýna varýldý.

60 females patients in ASA I-II groups under going total abdominal hysterectomy, randomized into 3 groups and premedicated orally with 5 mg/kg clonidine, 0.1 mg/kg diazepam and 20 mg famotidine tablets respectively. 10-points visual analoge scale (VAS) was recorded before and after premedication. During anesthesia induction, after 60 sec later of 2 mg/kg fentanyl administration, propofol was given till the lost of eyelash reflex and cooperation in all patients. Endotracheal entubation was provided by 0.1 mg/kg vecuronium. Ýn maintenance of anesthesia, 100 mg/kg propofol and 50 % N2O-O2 was used. Blood samples for glucose, cortisole and lactate levels were collected before premedication, 30. min of surgical incision and 60 min of postoperative period. Haemodynamic parameters were recorded before premedication and 5 min intervals after premedication and during surgical period. After premedication, VAS score declines were statistically significant in Group I and II compared to Group III (p<0.05) but in Group II, VAS scores were significantly less than group III (p<0.001).

Anesthetic requirements were significantly less in group I (p<0.01). Blood glucose levels were significantly high related to basal values in Group II and III (p<0.05) but the differences were not significant between these three groups (p>0.05). Blood cortisole levels were significantly high related to basal levels on 60 min of postoperative period in all groups (p<0.05). Rising of blood cortisole levels in Group I and II were significantly less compared to Group III (p<0.05). As a result, it’s concluded that clonidine could be a
good alternative to oral diazepam in premedication because of the reducing anxiety, cost, stress response to endotracheal entubation and surgery beyond the haemodynamic stability.

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Pansitopeni, kanýn þekilli elemanlarýnýn 3 ana serisinde birden azalma olmasýdýr. Pansitopeni, sýk rastlanan ve geniþ ayýrýcý taný spektrumu olan bir klinik problem olmasýna raðmen, ana hematoloji ve dahiliye kitaplarýnda göreceli olarak az tartýþýlmýþ bir konudur. Bu kitaplardan pansitopeniye yol açan hastalýklarýn listesi edinilebilir ve hatta en sýk nedenleri de tartýþýlmýþ olabilir. Fakat, yayýnlanmýþ birkaç çalýþma dýþýnda pansitopeni yapan hastalýklarýn sýklýðý hakkýnda yeterli bilgi bulunmamaktadýr. Bizim çalýþmamýzda amaç, pansitopeni yapan hastalýklarýn ne sýklýkta bulunduðunu saptamaktý. Aralýk 1997-Haziran 2001 tarihleri arasýnda Haydarpaþa Numune Hastanesi III. Dahiliye Kliniði’ne pansitopeni tespit edilerek yatýrýlan 56 hastanýn pansitopeni nedenleri ve sýklýklarý araþ-týrýldý. Tüm hastalardan kliniðe yatýrýldýktan sonra periferik yayma ve kemik iliði aspirasyon biyopsisi, hastalarýn klinik tablosuna göre kemik iliði biyopisisi yapýldý. Pernisiyöz ane-mi ön tanýsý olan hastalarýn B12 vitamini ve folik asid düzeylerine bakýldý. Yapýlan laboratuar tetkikleri sonucunda, tüm hastalarda pansitopeninin altýnda yatan patoloji saptandý. Pansitopeninin en sýk nedeni olarak pernisiyöz anemi (% 23.21) tespit edildi.

Pancytopenia is defined as an overall decrease in erythrocytes, leucocytes and platelets. Although pancytopenia is a common clinical problem with an extensive differential diagnosis there is relatively little discussio of this abnormality in mojor textbooks of internal medicine and hematology. The diffrential diagnosis of pancytopenia most commonly reviewed in chapters.Altough lists of possible underlying etiologies are frequently provided, only occasional author discusses the most common cause of pancytopenia. The aim of our study was to stabilize the frequency of the diseases caused
by pancytopenia. Between the dates December 1997-June 2001 the causes and the frequencies of the pancytopenia of the 56 patients whom pancytopenia determined. After all patients were hospitalized blood smears and bone marrow aspiration biopsies and according to clinical tables of patients, bone marrow biopsies were performed. Vitamine
B12 and folic acid levels were examined which patients have pernicious anemia was thougt. The laboratory results show that underlying pathology of pancytopenia in all patients. The most common reason of pancytopenia is determined as pernicious
anemia (% 23.21).

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Bu çalýþmada amacýmýz, anormal uterin kanamalý hastalarýn endometrial submukosal ve intrakaviter lezyonlarýnýn tanýsýnda transvaginal sonohisterografinin deðerini araþtýrmaktý.

Bu çalýþma, bir prospektif kontrollu çalýþmadýr. 105 hasta transvaginal ultrasonografi ile deðerlendirildi. Transvaginal ultrasonografide endometrial kalýnlýðýn artmýþ olduðu gösterilen ya da iyi tanýmlanamayan endometriumu olan anormal uterin kanamalý 50 kadýna (yaþ 33-64) sonohisterografi uygulandý. Direkt ultrasonografik baký altýnda 10-30 ml steril saline solüsyonu endometrial kaviteye enjekte edildi. Endometrial kavite geniþlediðinde polip ya da submuköz myom varlýðý, anterior ve posteroendometrial kalýnlýk deðerlendirildi. Ardýndan endometrial biyopsi yapýldý. 50 hastanýn 26’sýna histerektomi yapýldý.

Sonohisterografi, anormal uterin kanamalý hastalarda intrakaviter, endometrial ve submukozal lezyonlarýn ayrýmýný saðlayan oldukça kesin bir yöntemdir.

Our objective was evaluate the value of transvaginal sonohysterography in the diagnosis of endometrial submucosal and intracavitary lesions in patients with abnormal uterine bleeding.

This was a prospective case controlled study. 105 patients were evaluated with an transvaginal ultrasonography. Sonohysterography was performed in 50 women (aged 33-64) with abnormal uterine bleeding in whom transvaginal sonography suggested an increased endometrial thickness or poorly defined endometrium. Sterile saline solution, 10-30 ml, was injected into the endometrial cavity under direct ultrasonographic visualization. Once the endometrial cavity was expanded, the presence of polyps or submucous myomas and the anterior and posterorendometrial thickness was assessed. Then endometrial biopsy was performed. 26 of 50 patients underwent hysterectomy.

Sonohysterography is highly accurate method which allow differentiation of intracavitary, endometrial and submucosal lesions in patients with abnormal uterine bleeding.

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Bu çalýþmada, primer açýk açýlý glokomu olan hastalarda kan; trigliserid (TG), düþük dansiteli lipoprotein (LDL), çok düþük dansiteli lipoprotein (VLDL) ve kolesterol düzeylerinin risk
faktörü olup olmadýðýný deðerlendirdik. Glokom biriminde primer açýk açýlý glokom nedeniyle takibedilen 50 hastanýn LDL, kolesterol, VLDL, TG kan düzeyleri ölçüldü. Kolesterol yüksekliði grup A’da; % 68, grup B’de, % 47 olup anlamlý olarak yüksek bulundu.

Sonuçta; PAAG olan hastalarla kontrol gurubu arasýnda lipid profilleri karþýlaþtýrýldýðýnda kolesterol düzeyleri anlamlý olarak yüksek bulundu. Diðer parametrelerde fark bulunmadý (p<0.05).

We carried out analysis of plasma lipid and lipoprotein levels in 50 patients treated for primary open angle glaucoma in Glaucoma Department. We evaluated whether plasma cholesterol, trigliceride, LDL, VLDL levels were a risk factor in glaucoma patients. There were similar results in POAG group compared to control group, except statistically significantly higher cholesterol levels in former group (p<0.05).

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Kliniðimizde 01.02.1999-01.08.1999 tarihleri arasýnda izlenen 207 indirekt hiperbilirubinemi olgusu retrospektif olarak deðerlendirilmiþtir. Olgular etyolojik faktörler açýsýndan araþtýrýlmýþ ve nedeni belirlenemeyen sarýlýk oraný % 66.2 olarak saptanmýþtýr. Bu olgularda anne sütü ile beslenme, ilk beslenmede gecikme, günde 8'den az beslenme, tartý kaybý, geç mekonyum çýkýþý, erkek cinsiyet, oksitosin kullanýmý, anne yaþýnýn ³35 olmasý, parite>1 olmasý, asfiksi ve vakum ekstraksiyonu gibi sarýlýk açýsýndan risk oluþturan faktörler incelenmiþ, bu faktörlerin bilirubin düzeyine olan etkileri deðerlendirilmiþtir. Olgularýn % 48'inde ³3 risk faktörü bir arada bulunmuþ, ancak risk faktörü sayýsýndaki artýþ ile total bilirubin düzeyi arasýnda korelasyon saptanmamýþtýr (r=-0.067; p>0.05).

Sarýlýk nedeni bilinmeyen bebeklerin % 94'ünün anne sütüyle besleniyor olmasý, yüksek tartý kaybý oraný ve % 60'ýnda sarýlýðýn 2 ve 3. günlerde ortaya çýkmasý anne sütüyle hiperbilirubinemi arasýnda yakýn iliþki olduðunu düþündürmektedir. Ancak, tüm olgular içinde en yüksek bilirubin düzeyi saptanan (51 mg/dL) olgunun bu grupta yer alýyor olmasý ve 2 olguda kernikterus geliþmesi dikkat çekicidir. Günümüzde, hiperbilirubinemili saðlýklý term bebeklerde fototerapi ve kan deðiþimi sýnýrlarý yukarý çekilmekteyse de, bu bebekler risk faktörleri açýsýndan dikkatle araþtýrýlmalý ve bilirubinin toksisite riski her zaman akýlda tutulmalýdýr. Çalýþmamýzda, G6PD enzim eksikliði sýklýðý % 3.9 bulunmuþtur. Bu yüksek oran, hiperbilirubinemi etyolojisinde G6PD eksikliðinin de araþtýrýlmasý gerektiðini düþündürmektedir.

Two hundred seven newborns with indirect hyperbilirubinemia followed between February 1, 1999-August 1, 1999 were evaluated retrospectively. Etiological factors of the cases
were analyzed and the rate of jaundice with unknown cause was 66.2 %. Those cases were scrutinized in respect to risk factors of the jaundice like breast-feeding, latency in the first feeding, less than 8 feedings in a day, loss of weight, delayed passage of meconium, male sexuality, use of oxytocin, mother’s age (35, parity>1, asphyxia, vacuum extraction and the influence of those factors on bilirubin level was evaluated. Forty eight percent of the cases had at least 3 risk factors at the same time. However, there was no correlation between the increase in the number of risk factors and the total bilirubin level (r=-0.067; p>0.05).

The fact that 94 % of the newborns having jaundice with unknown cause are breast-fed, they have high amount of loss of weight and the occurence of jaundice in the 2nd and 3rd
days in 60 % of those infants imply that there is a strong association between breast-feeding and hyperbilirubinemia. On the other hand, it was found that the case with the highest bilirubin level (51 mg/dl) was in this group and 2 cases developed kernicterus. Nowadays, although tresholds for phototherapy and exchange transfusion in the healthy term infants with hyperbilirubinemia are being moved to higher levels, risk factors should be examined carefully in those infants and the risk for bilirubin toxicity should always be kept in mind. In our study, incidence of G6PD deficiency is 3.9 %. This high rate of
incidence shows that G6PD deficiency needs to be taken into consideration in etiology of hyperbilirubinemia.

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Preterm eylemin magnezyum sülfat ile tokolitik tedavisi ve gebelikte oral magnezyum desteklemesinin pretem eylem, preeklampsi, intrauterin geliþme geriliði üzerine olumlu sonuçlar vermesi, riskli gebelerde normal gebelere oranla artmýþ magnezyum defisitinin olabileceðini akla getirmiþtir.

Bu çalýþmada amacýmýz, preterm eylem tanýsý alan gebelerde ve normal gebelerde magnezyum seviyelerini ölçerek magnezyum ile preterm eylem arasýndaki iliþki olup olmadýðýnýn araþtýrýlmasýdýr.

Bu amaçla 28-36. gebelik haftasýnda olan 45 preterm eylem tanýsý alan gebe ile 45 normal gebe çalýþmaya dahil edildi. Prospektif ve randomize olarak yürüttüðümüz bu çalýþmada hastalarýmýzýn hiçbiri gebelik süresince magnezyum tuzu preparatlarý kullanmamýþ olup hepsi ayný sosyoekonomik düzeyde gebelerden oluþmaktaydý.

Hasta ve kontrol gruplarýndan alýnan kan örneklerinden serum magnezyum seviyeleri atomik absorbsiyon spektrofotometri metodu ile tayin edildi. Serum magnezyum düzeyi için eþik deðer 1.6 mg/dL olarak kabul edildi. Çalýþma grubunda 43 olguda serum magnezyum düzeyi normalin altýnda, 2 olguda normal sýnýrlarda bulundu. Kontrol grubunda 28 olguda serum magnezyum düzeyi normal sýnýrlarda, 17 olguda normalin altýnda bulundu. Ortalama magnezyum seviyesi çalýþma grubunda 1.219 mg/dL, kontrol grubunda ise 1.728 mg/dL olarak bulundu. Bu deðerler arasýnda istatistiksel olarak ileri derecede anlamlý fark bulundu.

Sonuç olarak, düþük magnezyum seviyelerinin preterm eylem için risk teþkil ettiði ve magnezyumun gebelik için önemli bir element olduðu kanýsýna varýldý.

Tocolytic treatment of preterm labor with magnesium sulphate and oral magnesium supplementation during pregnancy have been shown to decrease the incidence of preterm delivery, preeclampsia and intrauterin growth retardation in some studies. This finding suggests the possibility of magnesium deficiency in high risk patients compared to normal pregnant women.

The aim of our study was to evaluate magnesium levels in normal healty pregnant women and in women with pretem labor or/and delivery and to find out if there is a correlation between magnesium levels and preterm labor.

45 patients in preterm labor and 45 healty pregnant women between 28-36 gestational weeks were included in the study. In this prospective and randomize study none of the patients had used magnesium salt supplementation and all patients were of similar socioeconomic states. Serum magnesium levels were evaluated by atomic absorbtion spectrophotometry technic in the study and control groups.

It was accepted 1.6 mg/dL cut off value for serum magnesium level ýn both group. In the study group serum magnesium levels were below normal limits in 43 cases and in 2 cases within normal limits. In the control group serum magnesium levels were within normal limits in 28 cases whereas in 17 cases magnesium levels were below normal limits. Mean magnesium levels in the control group was 1.728 mg/dL and in the study group it was 1.219 mg/dL. Difference between magnesium levels in the study and control groups was found to be highly statistically significant.

In conclusion it was suggested that low serum magnesium levels is a risk factor for preterm labor and magnesium is an important element for healthy pregnancy.

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Nonoküler cerrahi anestezisi sýrasýnda göz komplikasyonlarý olabilmektedir. Oluþan komplikasyonlar postoperatif dönemde aðrý, kýzarýklýk hatta görme kaybýna neden olurlar. Çalýþmamýzda, genel anestezi sýrasýnda göz korunmasýný saðlamak amacýyla nonallerjik flasterle göz kapatma, antibiyotikli göz pomadý, antibiyotikli göz damlasý ve yapay gözyaþýnýn etkinliði karþýlaþtýrýldý. Kurum izni ve hasta onayý alýnarak, elektif cerrahi için supin pozisyonda genel anestezi alacak ASA I-III risk grubundan 50’si kadýn 50’si erkek 18-70 yaþ arasý 100 hasta rastgele 4 gruba ayrýldý. Baþ-boyun bölgesi operasyonu geçirecek ve gözlük kullanma dahil oküler patolojisi olanlar çalýþma dýþý býrakýldý. Operasyon günü, operasyondan sonraki 1., 2., 3. günler gözde batma, kýzarýklýk ve fotofobi ile tedavi ihtiyacý deðerlendirildi. Gruplar arasýnda istatistiksel farklýlýk görülmedi. Maliyet açýsýndan deðerlendirildiðinde, gözün nonallerjik flasterle kapatýlarak korunmasýnýn tercih edilebileceði düþünüldü.

There can be eye complicat›ons during the anesthesia of nonocular operation. These complicat›ons are ache,reddening and even lossof the ability of seeing in the postoperative period. In this study,in order to maintain the eye protection the effectiveness of covering the eye with non-allergic boindage of pomade with antibiotics, of eyedrops with antibiotics and of artificial tears were compared. Having the permision of the institution and, 100 patients for elective operation from ASA I-III risk groups, who would have general anesthesia in supine position, 50 of whom were women who were aged between 18 and 70 were separated in to 4 groups at random. The ones who would have the operation in the head-neck area and had ocular pathology including using spectacles were brought out of the study. At the 0.,1.,2.,3. days after the operation, hurt in the eye, reddening and the need for curing by photophobia were considered. There was no statistical difference between these groups. When evaluated their costs, it was
thought that it can be preferred to protect the eye by covering it with non-allergic bandage.

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Reversibilite astým tanýsýnda önemli bir parametredir ve bir çok faktör reversibiliteyi etkilemektedir. Biz çalýþmamýzda yaþýn, cinsiyetin, hastalýk baþlama yaþýnýn, hastalýk süresinin, bazal FEV1 deðerlerinin, hastanýn astým ilaçlarý kullanma öyküsünün, atopi ve allerjik rinitin erken ve geç reversibilite üzerine etkilerini araþtýrdýk. Bu amaçla, ulusal astým rapor kriterlerine göre astým bronþiale tanýsý almýþ 104 hastanýn dosyasý retrospektif olarak incelendi. Hastalar; yaþlarýna göre 40 yaþ altý ve 40 yaþ üzeri, cinsiyetlerine göre kadýn ve erkek, hastalýk süresine göre 0-5 yýl, 6-10 yýl, 11 ve üzeri olmak üzere üç gruba, hastalýk baþlama yaþýna göre 15 yýl ve altý, 16-25 yýl ve 26 yýl ve üzeri olmak üzere üç gruba, bazal FEV1 deðerlerine göre % 49 ve altý, % 50-% 65, % 66-% 75, % 76 ve üzeri olmak üzere dört gruba ve atopi ve allerjik rinit durumuna göre var ve yok þeklinde iki gruba ayrýldýlar. Sonuçlar student-t testi ile deðerlendirildi.

Biz bu çalýþmada; yaþýn, hastalýk baþlama yaþýnýn, hastalýk süresinin, bazal FEV1 deðerlerinin reversibiliteyi etkilerken, cinsiyetin, atopi ve allerjik rinit’in reversibilite üzerinde herhangi bir etkisi olmadýðýný bulduk.

Reversibility is an important parameter in the diagnosis of asthma but we today know that some factors can affect the reversibilty. In this study we evaluated affects of age, gender, onset age of the disease, duration of the disease, baseline FEV1 levels,whether the patient used some medications or not, atopy, allergic rhinitis parameters on the early and the late reversibilty in bronchial asthma. For this purpose, 104 patient’s files that have diagnosed as asthma bronchiale according to the national asthma report’s criteria were evaluated retrospectively. Age condition; cases were divided into two subgroups such as under and over 40 years. Gender; cases were divided into two subgroups such as male and female. Duration of the disease; cases were divided into three subgroups such as 0-5 years, 6-10 years and over 11 years. Onset age of the disease; cases were divided into three subgroups such as under 15 years,16-25 years and over 26 years.Baseline FEV1 levels; cases were divided into four subgroups such as % 49 and less, % 50-% 65, % 66-% 75, % 76 and over. Allergy; cases were divided into two subgroups such as positive and negative. Rhinitis; cases were divided into two subgroups such as positive and negative. The results were compared with student-t test.

In this study we found that; age, onset age of the disease, duration of the disease, baseline FEV1 level could affect the reversibility although gender, atopy, allergic rhinitis did not have any affect on the reversibility.

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Erken doðum tüm gebeliklerin % 7-11’inde görülmekte ve yenidoðan mortalite ve morbidite nedeni olarak önemini korumaktadýr. Bu açýdan gebeliðin erken dönemlerinde erken doðum riskini belirlemek önem taþýr.

Çalýþmamýzýn amacý asemptomatik tekil gebelerde transvajinal ultrasonografi (TVUSG) ile ölçülen servikal uzunluk ve servikal kamalaþmanýn erken doðumun önceden belirlenmesindeki etkisini deðerlendirmektir.

Erken doðum yönünden hiç risk faktörü bulunmayan ya da daha önce erken doðum ve abortus öyküsü olan 60 gebede TVUSG ile gebeliðin 16., 20., 24., 28., 32., ve 36. Haftalarýnda servikal uzunluk ölçüldü, kamalaþma incelendi. Servikal uzunluðun 30 mm ve altýnda olmasý ile servikal kamalaþmanýn varlýðýnýn 37. gebelik haftasýndan önce doðum yapma riski arasýndaki iliþki istatistiksel olarak deðerlendirildi.

Doðuma kadar takip edilen 60 gebeden 7’sinde erken doðum gözlendi (% 11.7). Bu grupta serviksin 30 mm ve altýnda olmasý ile erken doðum yapmasý arasýndaki iliþki 28 ve 32. haftalardaki servikal uzunluk deðerleri ile istatistiksel anlamlýlýk gösterdi (p: 0.0001; p: 0.001). Bir hastada servikal funneling saptandý ve erken doðum riski açýsýndan anlamlý bulunmadý (p>0.05).

Erken doðum riskini belirlemek için gebeliðin 24 ve 28. Haftalarý nda TVUSG ile saptanan servikal uzunluðun 30 mm altýnda olmasý diðer gebelik haftalarýna göre daha anlamlýdýr. Funneling ise gebeliðin erken dönemlerinde belirlenememekte, bu nedenle erken doðumun önceden saptanmasýnda kriter olarak kullanýlamamaktadýr.

Preterm delivery has been faced in all delivery with a 7-11 percentage and it keeps its importance by causing perinatal mortality and morbidity. Therefore it is important to define preterm delivery risk during the earlier period of the delivery.

The aim of our work is evaluating the influence of the cervical length and funneling which are measured by transvaginal ultrasonography (TVUSG) in the asemptomatic singleton
pregnant women, to predefine preterm delivery.

The cervical length at 16th, 20th, 24th, 28th, 32th and 36th week of the pregnancy has been measured by TVUSG within a sample of 60 pregnant women who don’t have any risk about the preterm delivery or who have already had a preterm delivery or an abortus case before. Also the funneling has been observed within the same sample. The relation of a cervical length less than or equal 30 mm and the existence of the
funneling with a preterm delivery risk before the 37th week of the delivery has been evaluated statistically.

We have observed the preterm delivery in the 7 of the 60 pregnant women which were until the delivery (% 11.7). In this group, the relation between the preterm delivery controlled and a cervix which is less than or equal 30 mm, has showed a statistical reasonabilty with the cervical lenght value at the 28th and 32th week (p: 0.0001; p: 0.001). A servical funneling has been found in one patient and it has been not defined as meaningful with regard to the preterm delivery risk (p>0.05).

In order to define the risk of the preterm delivery, it is more meaningful if the cervical lenght is less than 30 mm and measured at the 28th and 32th week of the delivery. On the other hand, funneling could not been determined during the earlier period of the delivery; therefore it is not used as a criteria to predefine the preterm delivery.

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A 53 year old woman admitted to our clinic for epigastric and left subcostal pain for 3-4 months. We found out giant splenic artery aneurysm near the hilus at spleen by doppler ultrasound and angiography, splenectomy and splenic artery aneurysm were performed. It must be removed if its larger than 2 cm and symptomatic, splenic artery aneurysm are seen
very rarely.

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High dose intravenous immunglobuline (IVIG) preparations used in the childhood idiopathic thrombositopenic purpura (ITP) management can induce aseptic meningitis and so longer hospitalization. In our Pediatric Hematology-Oncology Department IVIG is successfully used in the treatment of the ITP cases. Drug-induced aseptic meningitis developed as a result of IVIG administration in 3 patients of ITP and 24 hours after perfusion, the symptoms and signs subsided. Recently studies pointing out the beneficial affect of corticosteroid prophylaxis in the prevention of IVIG-induced aseptic meningitis are reported.

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Ascariasis is a benign and common disease in south region of our country. This disease leads to serious abdominal complications such as intestinal obstruction. Here we present a case of intestinal obstruction due to ascariasis. The findings of ultrasonography and computerized tomography have critical role in the diagnosis and in the treatment of our patient and she treated with medication instead of operative intervention.

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Apocrine carcinoma is a rare entity among other breast tumors. In this study, apocrine carcinoma was discussed on pathological base and literature findings were reviewed.

The fine needle aspiration biopsy of 44 years old woman who had a mass 8 cm in diameter in her right breast was reported as malign lesion. Than simple mastectomy and axillary dissection was performed. The mastectomy specimen was stained by H&E, PAS, toluidine blue, mucin, S-100, estrogen, progesteron, PRL and CEA. In fine needle aspiration biopsy three dimensional groups composed of cells with eosinophilic, granular cytoplasm, distinct cytoplasmic borders, vesicular nuclei, prominent nuclei were seen. In the sections of tumor generally solid islands of cells which was similar of that shown in FNA Bx were seen. In PAS and toluidine blue staining cytoplasmic granules were shown. Lesion was reactive for CEA and PRL.

In the view of these findings in this case was diagnosed as invasive apocrine carcinoma of breast and differential diagnosis was made.

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Bartter syndrome is first recognized by Bartter in 1962 and characterized by hiperreninemia, hiperaldosteronism, hipokalemia and metabolic alkalosis with normal blood pressure. Young children typically present with growth failure, muscle weakness, constipation, polyuria and dehydration. This case, who is a 6 years old boy with a history of antenatal polyhidramniosis and premature delivery, presented to the clinic with vomiting, fever, cardiac arrhythmia and acute respiratory arrest. He was diagnosed as Bartter syndrome with the results of clinical and laboratuary findings.

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According to current wisdom, there are five diffuse connective tissue diseases (DCTDs): Systemic lupus erythematosus (SLE), scleroderma (SCL), polymyositis (PM), dermatomyositis (DM) and rheumatoid arthritis (RA). All five classic DCTDs are descriptive syndromes whitout a “gold standard” for diagnosis and clinical symptoms are not apper alltogether. Usually, it takes long time to get well established in. In such cases, the diagnosis is not always so obvious but patient needs to a diagnosis. This is often referred to as undifferentiated connective tissue disease. In some instances, one DCTD evolves into another DCTD over time, or continues same diagnosis, or situation of disease gets lost completely.

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Mixed connective tissue disease is a syndrome that has overlapping features with other connective tissue disease, including SLE, systemic sclerosis, and rheumatoid arthritis. Women are affected more commanly than men (7-8).

A 32 year old woman with the diagnosis of rheumatoid arthritis was admitted to our clinic with progresive muscle weakness for a month. Dermatomyositis diagnosed with electrophysiological evaluation and muscle biopsy. Rhumatoid arthritis which is a connective tissue disease associated with inflammatory myositis in our patient. So we discussed a
patient with mixed connective tissue disease.

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We present a case of transient cortical blindness following cerebral angiography, which resolved totally within three days. There were no pathologic findings in cranial computed
tomography or cerebral angiography. Transient cortical blindness is a rare complication caused by direct neurotoxicity of contrast media, reported following cerebral, aortic,
carotid, and coronary angiography.

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The mitochondrial encephalomyopathies caused by a disorder in the mitochondrial DNA structure are rare multisystem disease. MERRF (myoclonic epilepsi, ragged-red fibers), MELAS (mitochondrial ensefalomyopathy, lactic acidosis, stroke like episoddes) and KSS (Kearns-Sayre Syndrome) are the well known mitochondrial encephalomyopathies. The criteria for KSS include a triad of (1) onset before age 20 year, (2) progressive external ophthalmoplegia, and (3) pigmentary retinopathy. There must be also be at least one of the following: heart block, cerebellar syndrome, or a cerebrospinal fluid protein above 100 mg/dl. Other nonspecific but comman features include demantia, sensorineural hearing loss, and endocrine abnormalities, including short stature, diabetes mellitus, and hypoparathyroidism. The prognosis is poor despite plecement of pace-maker. Ragged-red fibers are found in muscle biopsies. Almost all patients have mtDNA deletions.

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Herpes gestationis (H.G.) is a rare bullous dermatosis of pregnancy and the postpartum period. It is an autoimmune disease and presents dramatic vesiculobullous skin lesions
and pruritus. A definitive diagnosis can be made with specific immu-nopathological and histopathological studies. The treatment of choice is local measures and systemic corticosteroids. We presented a 38 weeks of gestational age pregnant
woman with a herpes gestationis case.

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Laurence Moon Biedl syndrome, an autosomal recessive disorder, characterized by retinitis pigmentosa, obesity, polidactyly, hypogonadism and mental retardation. A 5.5 years old male child was admitted to hospital because of pneumonia. During his hospitalization, symtoms of night blindness were detected. Retinitis pigmentosa was determined in his visual examination. He had been operated because of polidactyly
in his infancy. Another 5 years old famale child was taken to our clinic by convulsion. Obesity and polidactyly that are cardinal features of Laurence Moon Biedl syndrome, were
recognized in her physical examination. Careful family history and physical examination alerted us about a genetic disorder. In this study, on the basis of the consannguinity and the familirity of the disorder, we reviewed Laurence Moon Biedl syndrome by discussing these two case reports comparing to the previous published literature.

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