Hepatik steatoz için risk faktörleri ve derecesini artýran faktörler halen net olarak bilinmemektedir. Bu çalýþmada, ultrasonografik olarak steatoz derecesi belirlenen hastalarda, steatoz derecesi ile yaþ, cinsiyet, vücut kitle indeksi (VKÝ), hipertansiyon, hiperlipidemi ve diyabet varlýðý, diyabetin süresi ve kullanýlan tedavi metodu, karaciðer fonksiyon testleri arasýnda bir iliþki olup olmadýðý ve kolelitiasis birlikteliði araþtýrýldý.

Çalýþmaya, Nisan 2000-Aralýk 2001 tarihleri arasýnda hastanemizde ultrasonografik incelemede steatoz tanýsý alan, alkol alým öyküsü olmayan ve HCV ve HBS Ag negatif olan 136 hasta alýndý. Veriler retrospektif olarak incelendi. Hastalarýn 68’i erkek (% 50, yaþ ortalamasý: 48.5±11.7), 68’i kadýndý (% 50, yaþ ortalamasý: 56.6±9.2). Diyabeti olan hastalar diyabet süresine göre gruplandýrýldý. Hepatik steatoz ultrasonografik görünümüne göre evrelendirildi. Verilerin istatistiksel analizi ki-kare ve anova testleri ile yapýlmýþtýr. Hastanýn yaþý, cinsiyeti, diyabet süresi ve kullandýðý tedavi yöntemi ve hipertansiyon varlýðýnýn steatoz derecesi ile iliþkili olmadýðý, fakat artan VKI ile steatoz evresinin de arttýðý gösterilmiþtir (p<0.05). Lipid düzeyleri, transaminaz, LDH, GGT düzeyleri ve kolelitiasis varlýðý ile steatoz derecesi arasýnda bir iliþki bulunamadý. Sonuç olarak, steatoz için majör bir risk faktörü olduðu bilinen obesite, steatoz derecesini de etkileyen bir faktördür ve steatoz tedavisi için en etkili yöntem kilo vermektir. Steatoz olgularýnda kesin prognostik faktörler halen tam olarak açýklanamadýðýndan, karaciðer biyopsisi hastalarýn deðerlendirilmesi ve takibinde altýn standard özelliðindedir.

The risk factors for hepatic steatosis and the factors which increases the grade of steatosis still remain unclear. In this study, the relationship between the grade of hepatic steatosis, which was detected by ultrasonographic examination, and age, sex, body mass index (BMI) of the patient, presence of hypertension, hyperlipidemia, daibetes mellitus, the duration and the treatment modality used for diabetes, the liver function tests and the presence of cholelithiasis were evaluated. 136 patients admitted to our hospital between April 2000-December 2001, who were diagnosed as having hepatosteatosis by ultrasonographic examination but without a history of alcohol intake and with negative HCV and HBSAg by serological test were included in the study. Data were evaluated retrospectively. 68 patients were male (50 %, mean age: 48.5±11.7 years), 68 were female (50 %, mean age: 56.6±9.2 years). The patients with diabetes were grouped
according to the duration of diabetes. Hepatic steatosis was graded according to ultrasonographic appearance. Chisquare and anova tests were used for the statistical analysis of datas. There was no relationship between age and sex of the patient, the duration of and the treatment modality used for diabetes and the presence of hypertension, but it was shown that as the BMI increases, the grade of steatosis also
increases (p<0.05). There was no relation between lipid, transaminase, LDH, GGT levels, presence of cholelithiasis and the grade of hepatic steatosis. It was concluded that, obesity, which is known as the major risk factor for hepatic steatosis, is also a factor that determines the grade of the steatosis and the best way for the therapy of steatosis is losing weight. As the exact prognostic factors for steatosis cases are still unclear, liver biopsy is the gold standard tecnique for the evaluation and follow-up of patients.

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Spastik diparezi, bacaklarýn kollardan daha çok tutulduðu bilateral spastisite olarak tanýmlanýr ve sýklýkla pretermlerde rastlanan periventriküler lökomalazinin tipik klinik tablolarýndan biridir. Term bebeklerde de görülen spastik diparezide nedenler, pretermlere göre daha kompleks ve heterojendir. Spastik diparezideki intrakranyal hasarlarýn belirlenmesinde, magnetik rezonans görüntüleme (MRG)’nin, bilgisayarlý beyin tomografisinden daha duyarlý olduðu bildirilmektedir. MRG’nin geliþmesi, serebral palsi etyolojisine yeni yaklaþýmlar getirmiþtir. Beynin hasar verici etkiye yanýtýnýn, beynin maturasyonuyla iliþkili olduðu bilinmektedir. Bu çalýþma, 45 spastik diparezi olgusunda etyolojik faktörlere ve klinik özelliklerine iliþkin veriler elde etmek, nöroradyolojik incelemelerinde gözlenebilecek patolojileri ortaya koymak, nöroradyolojik görünümler ile klinik tablo ve bilinen ya da öngörülen etyolojiler arasýndaki baðlantýyý araþtýrmak, olgularýn kranyal bilgisayarlý tomografi ile MRG bulgularýný karþýlaþtýrmak amacýyla yapýlmýþtýr.

Spastic diplegia is defined as bilateral spasticity that the legs are affected more severely than the arms. This disorder is a typical clinical feature of periventricular leukomalacia that usually found on preterm children. Causes of spastic diplegia in term infants are more complex and heterogen than preterm infants. Magnetic resonance imaging (MRI) is more sensitiv than computerize cranial tomography for determine of intracranial
pathology in spastic diplegia. Development of MRI provide new approaches on cerebral palsy etiology. We know that, damage on brain is related to cerebral development. The
purpose of this study was to investigasted the findings on neuro diolagic examinations, connections between clinical findings, etiologic factors and cranial magnetic resonance
imaging features and to compared the cranial computerize tomography and magnetic resonance imaging findings of spastic diplegic children.

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Histopatolojik olarak taný konulan 48 sarkoidoz olgusu, klinik ve radyolojik bulgular, taný yöntemleri, uygulanan tedavi ve tedaviye yanýt açýsýndan deðerlendirildi. Hastalarýn 30’u kadýn, 18’i erkek olup, yaþlarý 17-61 arasýnda deðiþmektedir. Baþvuru sýrasýnda % 22 olgu asemptomatikti. Kýrk sekiz olgunun 26’sý Evre I olarak sýnýþandýrýldý. Serum anjiotensin dönüþtürücü enzim düzeyi 21 olguda yüksek olarak saptandý. Hiperkalsiüri ise % 8.1 olguda mevcuttur. Akciðer dýþý organ tüberkülozu hastalarýn % 37.5’inde görüldü.

Otuz dört hastaya kortikosteroid verilmiþti. Tedavi verilen hastalarýn 21’inde tedavi ile klinik ve radyolojik bulgularda düzelme olmuþtu. Tedavi verilmeden izlenen 14 hastanýn ise 6’sýnda spontan düzelme görülürken, 8’i stabil seyretmiþtir.

Forty eight biopsy-proved sarcodosis cases (30 females, 18 males, age range 17-61 years) were evaluated respect to clinical and radiological findings, diagnostic procedures, treatment, and treatment outcome. Thirty two percent of the patients were asymptomatic. Of the 48 patients, 26 were classifield as Stage I disease. Serum angiotensin-converting enzyme level was increase in 21 patients. Hypercalciuria was detected in 3 patients. Eighteen patients had extapulmonary organ involvement.

Thirty four patients were received steroid treatment. Clinical and radiological improvement was detected in 21 patients. Among the 14 patients who were followed upwithout treatment, 6 were showed spontaneously remission, and 8 remain stable.

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Peptik ülsere sekonder olarak oluþan gastrik çýkýþ obstrüksiyonlu 14 hasta gastrik ultrasonografi ile endoskopik balon dilatasyon tedavisinden önce ve sonra deðerlendirildi. Gastrik ultrasonografik olarak antral bölgenin mm2 olarak ölçümü 60. dakikada baþlangýç deðerinin % 65-70’i, 90. Dakikada % 75-80’i kadar azalmasý normal olarak deðerlendirildi. Gastrik çýkýþ obstrüksiyonlu olgularda bu azalma sýrasýyla % 40 ve % 46 bulundu ve iki grup arasýndaki fark istatistiksel olarak anlamlý bulundu. Dilatasyon sonrasý hasta grubunda ölçülen deðerler ise sýrasýyla % 35.5 ve % 47 olup predilatasyon deðerler ile karþýlaþtýrýldýðýnda arada istatistiksel fark yoktu.

14 patients who had obtructions of gastric outlet secondary to peptic ulcer were evaluated before and after treatment of endoscopic balloon dilatation. In gastric ultrasonographical
measurement of the antral region by mm2, it was evaluated as normal that a decrease of % 65-70 at 60 minutes and % 75-80 at 90 minutes. The decrease was % 40 and % 46 in the
cases with gastric-outlet obstruction respectively. The difference between the two groups was considered statistically significant. In post-dilatation group, the values were % 35.5 and
% 47 as we have compared with pre-dilatation results there was no statistically important difference.

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Bu çalýþma, desmopressinin primer enürezis nokturna tedavisindeki etkinliðini araþtýrmak ve desmopressin ile en uygun tedavi yaklaþýmýný belirlemek amacýyla yapýldý.

Primer enürezis nokturna tanýsý alan ve yaþlarý 6 ila 14 arasýnda deðiþen 27 kýz, 28 erkek toplam 55 çocuk çalýþma kapsamýna alýndý. Hastalar iki gruba ayrýldýlar. Grup I’e yüksek doz, kýsa süreli (40 μg, tek doz, aylýk), Grup II’ye ise düþük doz, uzun süreli (20 μg, tek doz, altý aylýk) desmopressin tedavi protokolü uygulandý. Tedavi ile Grup I’de % 60, Grup II’de ise % 63 olumlu yanýt alýndý. Tedavi kesildikten sonra nüks oraný ise sýrasýyla % 94 ve % 76 olarak belirlendi.

The aim of this study was to investigate the efficacy of desmopressin in the management of primary enuresis nocturna and to determine the best approach to the treatment with desmopressin. 55 children ranging in age from 6 to 14 years with primary enuresis nocturna (27 girls, 28 boys) were included in the study. The patients were divided into two groups.
Desmopressin was applied to the Group I as a high dose, short term (40 μg, single dose, monthly) and to the Group II as a low dose, long term (20 μg, single dose, semi-annually)
therapy. The response to the therapy was 60 % in Group I and 63 % in Group II. The relapse rate after treatment was 94 % and 76 %, respectively.

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Talasemi majorlü 40 hastada serum leptin (RIA), ferritin (RIA) ve transferrin (nefelometrik) seviyelerini araþtýrdýk. Kontrol grubundaki 22 kýz ve 18 erkek cinsiyet, yaþ, beden kitle indeksi yönünden hasta grubuna yakýndý. Hasta grubu ortalama serum ferritin düzeyini (1656±1032 ng/ml) kontrol grubuna (45±46 ng/ml) göre anlamlý yüksekti (p<0.001). Hasta grubuyla (1.44±0.44 g/L) kontrol grubu (2.59±0.37 g/L) ortalama serum transferrin düzeyleri arasýndaki fark da anlamlý bulundu (p<0.05). Keza hasta grubu ortalama serum leptin (2.51±3.07 ng/ml) deðeri kontrol grubununkine göre (7.09±8.74 ng/ml) düþük bulundu; (p<0.001). Talasemi major hastalarýnda vücut demir depolarýnýn araþtýrýlmasýnda ve þelasyon tedavisinin izlenmesinde ferritin düzeyinin bilinmesi gereklidir. Plazmada transferrin ve özellikle transferrin satürasyonu araþtýrýlmasý anemilerin ayýrýcý tanýsýnda ve tedavi takibinde yararlýdýr.

Leptin hipotalamo-hipofizer aksý etkiler ve bir kýsým endokrinopatilerle yakýn iliþki içindedir. Sonuç olarak talasemi major hastalarda bulunan düþük serum leptin düzeyleri, endokrin bozukluklarýn (büyüme-geliþme geriliði, hipotiroidi, infertilite vs.) da eþzamanlý birlikte olabileceðini düþündürmekte olup, dikkate alýnmalýdýr. Demirin yað dokusunda birikmesi de serum leptin düzeyinde düþüklüðe yol açabilir.

We investigated serum leptin (RIA), ferritin (RIA), and transferrin (nephelometric) levels in 40 patients with thalassemia major. 22 girls and18 boys who made up our control group
were matched for gender, age, body mass index to the patient group. Mean serum ferritin level in patient group (1656±1032 ng/ml) were significantly higher than control group (45±46 ng/ml); (p<0.001). The difference between mean serum transferrin level of patient group (1.44±0.44 g/L) and control group (2.59±0.37 g/L) was also significant
(p(0.05). Mean serum leptin level in patient group (2.51±3.07 ng/ml) were lower than control group (7.09±8.74 ng/ml); (p<0.001). Investigation of ferritin level is necessary in
patients of thalassemia major to determine body iron store and monitor chelation treatment. Evaluation of plasma transferrin levels, especially transferrin saturation, is useful for the differential diagnosis of anemia and for monitoring treatment.

Leptin acts in hypothalamic-pituitary axes and is in close relation with some endocrinopathies. According to our results, low serum leptin levels in thalassemia major patients may suggest that endocrinologic abnormalities (growth retardation, hypothyroid, infertility, etc) may co exist and must be taken into consideration. In addition accumulation of iron in adipose tissue may be responsible of low serum leptin levels.

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Uzun kemiklerdeki foramen nutricium’larýn lokalizasyonlarýnýn bilinmesi, serbest vasküler kemik greftleri ve sirkülasyonun korunmasýný gerektiren bazý cerrahi giriþimler açýsýndan
önemlidir.

Bu çalýþmada tibia diafizinde bulunan major foramen nutricium’larýn sayý ve anatomik lokalizasyonlarý incelenmiþtir. Ýncelediðimiz 206 kemi¤in 180’inde (% 87.38) tek, 26’sýnda ise (% 12.62) çift foramen saptanmýþ ve bu deliklerin % 89.65’inin facies posterior’da yer aldýðý görülmüþtür. Ortalama kemik uzunluðu 35.41 cm, ortalama foraminal indeks (FI)
32.46 ve ortalama delik çapý ise 0.174 cm olarak tesbit edilmiþtir. Foraminal indeks deðerlerine göre deliklerin % 75’i kemiðin proksimal 1/3’ünde, % 24.57’si orta 1/3 ve 1 delik ise alt 1/3’te yer almaktadýr.

Elde ettiðimiz sonuçlar diðer araþtýrmacýlarýn bulgularý ile paralellik göstermekte olup, tibia diafizindeki foramen nutricium’larýn çoðunlukla kemiðin facies posterior’unda ve tek olarak, sýklýkla da kemiðin üst 1/3’ü ile orta 1/3’ünün birleþme yerine yakýn olarak lokalize olduðunu göstermektedir.

A knowledge of the location of the nutrient foramina on the long bones is important in free vascularized bone grafts and certain surgical procedures for keeping the circulation intact. In this study, the location and the number of the nutrient foramina on the diaphysis of the tibia were examined. In the 206 number of the examined bones, 180 bones (87.38 %) had a single foramen, 26 bones (12.62 %) had two foramina and
89.65 % of these foramina were found in the posterior surface of the tibia. The mean length of all tibias was 35.41 cm and the mean foraminal index was 32.46. 75 % of all foramina were observed on the upper third, 24.57 % of these were on the middle third and one foramen was observed on the lower third of the bone, the mean diameter of the foramina was measured as 0.174 cm.

The results of this study are similar with the former studies. According to these results, the nutrient foramina of the diaphysis of the tibia are always found to be single in the posterior surface of the bone and always located in the upper third or the joining point of the upper and the middle third.

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Bu çalýþmada, ortopedik cerrahi geçiren olgularda, petidin ile hasta-kontrollü analjezi (HKA) uygulamasýna ketamin ilavesinin etkilerini inceledik.

Gruplar rastgele ayrýlarak; grup P (petidin) (n: 50), grup PK (petidin+ketamin) (n: 50) ASA I-II toplam 100 olgu çalýþmaya alýndý. Tüm olgulara O2/N2O/Sevoþorane ile genel anestezi idamesi yapýlýp, opioid olarak fentanil kullanýldý. Postoperatif Grup P de; petidinin yükleme dozu;50 mg, bazal infüzyon 1 mg/st, istek dozu 5 mg, kilitli kalma süresi 15 dk olarak programlandý ve grup PK’da ayni programa ketamin 2.5 μgr/kg/dk olarak ilave edildi. Uygulama boyunca, VAS (Visuel Analog Skala), sedasyon skoru (SS), kalp tepe atýmý (KTA), solunum sayýsý (Sol. S), analjezik istek sayýsý, kullanýlan toplam ilaç miktarlarý ve yan etkiler, postoperatif 30. dk., 2. 6. 12. 24. saatlerde kaydedildi. Ýstatistiksel analizler SPSS Window programýnda t-testi ve Mann-Whitney UWilcoxon testi ile yapýldý ve p<0.05 anlamlý kabul edildi.

In this study, we have investigated the effects of ketamine addition in patient-controlled analgesia with petidine for patients operated for orthopedic problems.

Groups have been randomyl divided; group P (pethidine) (n: 50), group PK (pethidine with ketamine) (n: 50), 100 patients in ASA I-II have been included in the study. Maintenance of general anaesthesia with O2/N2O/Sevoflurane and fentanylas opioid have been used. In the postoperative period in group P; loading dose: 50 mg, basal infusion 1 mg/hr, bolus dose 5 mg, lock-out time: 15 min have been programmed andin the group PK 2.5 μgr/kg/min of ketamine have been added into the same programe. During yhis application, VAS (Visual Analoge Scale), sedation sscore (SS), heart rate (HR), respiration rate (RR), value of analgesic demanded, cumulative drug consumption and side effects have been recorded in the postoperative 30th min, 2nd, 6th, 12th and 24th hours. T- test and Mann-Whitney U-Wilcoxon Test in SPSS Windows program have been used for statistical analysis and p<0.05 has been accepted as statistically significant.

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Manyetik rezonans görüntüleme(MRG) etkin taný yöntemi olmakla beraber daima artroskopi ile ayný sonucu vermemektedir. Çalýþmamýzda, MRG bulgularý artroskopi sonuçlarý ile karþýlaþtýrýldý, taný hatalarýnýn nedenleri araþtýrýlarak sunuldu. Meniskal yýrtýk öntanýsý ile artroskopik tetkikleri yapýlmýþ 44 olguluk serinin MRG bulgularý araþtýrýldý. Meniskal yýrtýklar lokalizasyonlarýna göre anterior, orta 1/3 ve posterior olarak üç grupta deðerlendirilmiþtir. Hatalý sonuçlar a-Kaçýnýlmaz hata, b-Deðerlendirme hatasý olarak ayrýlmýþtýr. Retrospektif kaçýnýlmaz hata olarak deðerlendirilen olgular a-Yalancý pozitif, b-Yalancý negatif olarak sýnýþandýrýlmýþtýr. Artroskopi ile saptanan 50 adet meniskal yýrtýk olgusunda MRG ile medial meniskusta 36, lateral meniskusta 11 adet yýrtýk doðru tanýlandý, ancak 3 adedi görülemedi. MRG ile 8 adet kaçýnýlmaz hata, 3 adet taný hatasý saptandý. Retrospektif incelemede taný hatalarýndan birisinin deðerlendirme hatasýna, diðerlerinin anatomik variasyona baðlý olduðu gözlendi. Kaçýnýlmaz hatalarýn üçü yalancý negatif olup, orta 1/3 meniskusta idi ve ikisi meniskal dejenerasyon gösteriyordu. Kaçýnýlmaz hata grubunda, MRG ile yalancý pozitif bulgu veren 5 adet meniskal yýrtýðýn üçü medial (hepsi posterior boynuzda), ikisi lateral meniskusta (anterior ve posterior boynuzda) görüldü. Kaçýnýlmaz hata grubunda dejeneratif deðiþikliklerin ve anatomik variasyonlarýn daha çok görülmesi, gözden kaçan meniskal yýrtýklarýn daha çok orta 1/3 meniskusta bulunmasý, bu özelliklerin MRG’de taný oranýný düþürdüðünü göstermektedir. Kaçýnýlmaz hata grubundaki yalancý pozitif 3 olgunun teorik olarak a-artroskopistin deðerlendirmesine veya b-iyileþmiþ meniskal yýrtýðýn gerçek yýrtýk görünümü verebilmesine baðlý olabileceði düþünüldü.

Magnetic resonance imaging (MRI) is an accurate method in diagnosing meniscal tears.However MRI do not always correlate with arthroscopy. Discrepancies between the MRI findings and arthroscopy were reviewed Retrospectively. The various causes of incorrect MRI diagnoses we analyzed. The MRI of 44 patients with 50 meniscal ruptures were analyzed that were confirmed at arthroscopy. The meniscal ruptures were categorized within three groups according to their location as 1-Anterior 2-Medial 1/3 and 3-Posterior. The interpretations of MRI were correlated with the arthroscopic findings. The original incorrect diagnosis were classified as 1-Unavoidable errors and 2-Interpretation errors. Unavoidable errors were defined as a-false positive b-false negative diagnoses.
In the evaluation of 50 meniscal tears of 44 patients the MRI interpretations of 47 tears (% 6) were correct. However 8 unavoidable errors and 3 interpretation errors were
seen. Diagnostic errors consist of 3 cases in which were due to anatomic variations in two cases. Of the 8 unavoidable errors 3 were interpretation errors and 2 degenerative menisci at arthroscopy. The findings concluded that the meniscal degeneration lowers the diagnostic interpretation with MRI. Interpretation errors could be avoided also with experience about anatomic variations. We also concluded that middle third of meniscal ruptures carry higher incidence of false negative result. We could not find rupture in three arthroscopically proven cases even in retrospect and speculate that false positive results might be due to healed meniscus that shows the similar findings of meniscal ruptur or interpretation of arthroscopist.

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Çalýþmamýz, katarakt cerrahisinde preoperatif olarak kullanýlan, oral asetozolamid ile topikal dorzolamid’in, intra ve postoperatif göziçi basýncýna etkilerini karþýlaþtýrmak amacý ile yapýldý.

Aralýk 1998 ile fiubat 1999 tarihleri arasýnda katarakt operasyonu amacý ile kliniðimize yatan 105 hastanýn, 53’üne topikal dorzolamid, 52’sine oral asetazolamid preoperatif verilerek ilaçsýz ve ilaçlý olarak preoperatif göziçi basýnçlarý, Goldman applanasyon tonometresi ile ve postoperatif 1. gün göziçi basýnçlarý yine ayný yöntemle ölçülerek etkinlikleri karþýlaþtýrýldý. Topikal dorzolamid verilen 53 hastanýn preoperatif ilaçsýz göziçi basýnç ortalamasý 12.5 mmHg, preoperatif ilaçlý göziçi basýncý ortalamasý 10.8 mmHg, postoperatif 1. gün göziçi basýnç ortalamasý 11.7 mmHg olarak bulundu. Oral asetazolamid verilen 52 hastanýn preoperatif ilaçsýz göziçi basýnç ortalamasý 12.9 mmHg, preoperatif ilaçlý göziçi basýncý ortalamasý 9.6 mmHg, postoperatif 1. gün göziçi basýnç ortalamasý 11.2 mmHg olarak bulundu. Yapýlan deðerlendirme sonucu, her iki grup arasýnda, göziçi basýncýný düþürmek açýsýndan anlamlý bir fark bulunamadý.

In this study we compared the effect of oral acetazolamide to topicale dorzolamide given preoperatively, for intraoperative and postoperative intra ocular pressure regulation.

Between December 1998 and February 1999, 52 of 105 patients were medicated by acetazolamide given orally and 53 of them were medicated by dorzolamide applied topically before the operations. Intra ocular pressures were measured by applanation tonometry with and without medication preoperatively and on the first postoperative day after the cataract operation. The results were compared. Mean preoperative intra ocular pressure of 53 patients without medical therapy that were given topical dorzolamide was 12.5 mmHg, after medical therapy it was 10.8 mmHg. Mean intra ocular pressure
on the first postoperative day was 11.7 mmHg. Mean intra ocular pressure without medical therapy preoperatively for 52 patients that were given oral acetazolamide was 12.9 mmHg, after the medication it was 9.6 mmHg and intra ocular pressure on the first postoperative day it was 11.2 mmHg. There was not statistically meaningful difference between topical dorzolamide group and oral acetazolamide group for the intra ocular pressure lowering effect.

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Endoskopik subüreterik enjeksiyon yöntemi, son yýllarda vezikoüreteral reflü (VUR) tedavisinde atýlmýþ en önemli adýmlardan biridir. Yöntemin kolay uygulanabilirliði ve minimal komplikasyon riskine karþýlýk elde edilen yüksek baþarý, tedavi konusundaki görüþlerde oluþan deðiþikliðin en önemli nedenleridir.

VUR tanýsý alan 86 hastaya (121 üreter) tedavi amacýyla 3 farklý ajan kullanýlarak submukozal üreteral enjeksiyon uygulandý ve sonuçlarý deðerlendirildi. Altmýþ kýz, 26 erkek hastanýn yaþ ortalamasý 12.6 (5/12-51) olup, izlem süresi 3-88 ay arasýnda deðiþmekteydi (ortalama 34.9 ay).

Birinci enjeksiyon sonunda, teflon grubunda % 87, macroplastique grubunda % 73 ve deflux grubunda % 67 hastada reflü düzeldi. Bu oranlar ikinci enjeksiyon sonunda sýrasý ile % 88, % 85 ve % 83’dür.

Farklý ajanlar kullanýlmasýna karþýlýk, her üç grupta da elde edilen sonuçlar birbirine benzer olup, oldukça yüksek baþarý saðlanmýþtýr. Hangi ajan kullanýlýrsa kullanýlsýn VUR tedavisinde subüreterik enjeksiyon tedavisi, minimal invaziv ve kolay uygulanabilirliði sayesinde cerrahiye önemli ve öncelikli bir alternatif olarak kullanýlmasý gerektiðine inandýðýmýz bir yöntemdir.

Endoscopic subureteral injection technique has been one of the major advances in treatment of vesico-ureteral reflux (VUR). The main reasons for the change in the treatment choices has been related to the easy applicabilty and minimal complication risk as compared to high success rates observed with this procedure.

This study evaluates the results of 121 ureteral units of 86 patients who have undergone endoscopic submucosal injection therapy with three different agents. The patients consisted of 60 females and 26 males with the mean age of 12.6 (range 5/12 months-51 years). The mean follow-up of these patients were 34.9 months (range 3-88 months). An overall reflux-free success rates for Teflon 87 %, Macroplastique 73 % and Deflux 67 % were achieved after the first injections. These rates were 88 %, 85 % and 83 % at the end of the second injections.

In spite of the use of different materials, the results of the three groups are similar with quite a high success rate. We believe that the subureteral injection therapy, a minimaly
invasive and easily applicable procedure, whether of which the agents used, is and important alternative to surgery in VUR.

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Ýnsülin direnci, dolaþýmdaki normal sýnýrlardaki insüline hedef hücre cevabýnýn bozulduðu patolojik bir durumdur. Bu çalýþmanýn amacý; romatoid artritli hastalarda akut insülin cevabý deðiþiklikleri geliþimini ortaya koymaktýr. Çalýþmaya deðiþik derecelerde hastalýk aktivitesine sahip 36 romatoid artritli olgu (22 kadýn ve 14 erkek, 51.5±17.1 yaþlarýnda; 21-80 yaþ arasý, vücut kitle indeksi 27.1±5.0 kg/m2 olan) ve 20 saðlýklý kontrol dahil edilmiþtir. Tüm olgulara, 12 saatlik açlýðý takiben, IVGTT’den elde edilen verilerle belirlenen AIR (akut insülin cevabý) ölçümünden oluþan tanýsal protokol uygulandý.

Romatoid artritli hastalarda kontrollere oranla, AIR anlamlý derecede daha düþüktü (35.8±17 vs. 85.2±17.9 (IU/ml, p<0.001). Akut insülin cevabý bozukluðu, romatoid artritli hastalarda, glukoz metabolizmasýný bozan majör metabolik anormalliklerden biri olarak görülmektedir. Ayrýca, prediyabetik durum oluþturarak, romatizmal hastalýðý komplike hale getirmektedir.

Insulin resistance is a common pathologic state in which target cells fail to respond to ordinary levels of circulating insulin. The aim of this study was to assess the occurence of
acute insulin response changes in patients with rheumatoid arthritis. 36 subjects (22 women and 14 men, aged 51.5±17.1 years; range 21-80, BMI 27.1±5.0 kg/m2) with varying degrees of disease activity and 20 healthy controls were studied. After a 12-h overnight fast, all subjects underwent a diagnostic protocol including the estimation of Acute Insulin Response (AIR) changes that was calculated by datas obtained from intravenous glucose tolerance test. The AIR values were significantly lower in all patients with rheumatoid artritis than in control subjects (35.8±17 vs. 85.2±17.9 (IU/ml, p<0.001). Acute insulin response changes seems to be one of the major metabolic abnormality which alters glucose metabolism in patients with rheumatoid arthritis, and complicating rheumatic disease via an increase the risk of prediabetic state.

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Bu çalýþmada, bir yýl içerisinde hastanemizde doðuran multifetal gebelerin tüm gebelere oraný, maternal yaþlarý, pariteleri, maternal tansiyonlarý, gebe kalýþ þekilleri, doðum haftalarý, doðum aðýrlýklarý, cinsiyetleri, geliþ þekilleri, plasenta tipleri, ailevi faktörleri ve doðum þekillerinin deðerlendirilmesi amaçlanmýþtýr.

SSK Göztepe Eðitim Hastanesi’nde 2 Mart 2000-1 Mart 2001 tarihleri arasýnda doðuran 141 multifetal gebe retrospektif olarak incelendi. Çalýþmaya; ikizlerin ikisinin de canlý olduðu doðumlar ve son adet tarihi ve/veya ilk trimester ultrasonografiye göre 26 gebelik haftasýný dolduran olgular dahil edildi. Her bebeðin cinsiyeti, doðum tartýsý, doðum þekilleri, prezentasyonlarý ve plasenta tipleri standart formlara kaydedildi.

Bir yýl içerisindeki 18.288 doðumun 141’i multifetal gebelikti (tüm gebelerin % 0.74’ü ikiz, % 0.01’i üçüz, % 0.00005’i dördüz gebelik). Multifetal gebeliklerin % 76’sý spontan olarak, % 23.5’i ovulasyon indüksiyonu ile gerçekleþmiþti. Gebelik en sýk 36-38 gebelik haftalarý arasýnda sonlanmýþtý (% 32) ve bebek doðum aðýrlýklarý en çok 2500-3500 g arasýnda idi (% 44.1). En sýk rastlanan prezentasyonunun baþ/baþ (% 44.1) ve plasenta tipinin monokoryonik diamniotik olduðu gözlendi (%58.8).

Multifetal gebelerin anne yaþý, paritesi, doðum agýrlýklarý, doðum haftalarý, doðum þekilleri, prezentasyonlarý, plasental özellikleri, maternal tansiyonlarý, ailevi faktörleri ve cinsiyetleri retrospektif olarak degerlendirildi ve sonuçlar bildirildi.

In this study, we aimed to evaluate the ratio of multiple pregnancy to total pregnancy delivered in our hospital within one year, maternal ages, parities, maternal arterial tension values, types of conception, the length of gestation, birth weights, sexuality, presentations, chorionicity, genetic factors, way of delivery.

From March 2000-March 2001, we enrolled 141 multiple pregnancies at SSK Göztepe Hospital. The study sample is limited to pregnancies meeting the following inclusion criteria: Both twins born alive and ³26 weeks gestation as determined by last menstrual period or first trimester ultrasonography. Sexes, birth weights, the way of delivery, presentations of all infants and placental types were recorded on standard forms.

Total pregnancy delivered at SSK Göztepe Hospital in one year was 18288, 141 of which multiple pregnancy (0.74 % twins, 0.01 % triplet, 0.00005 % quadraplet). Among multifetal pregnancies, 76 % of these became pregnant spontaneously and 23.5 % have had ovulation induction. Delivery time was seen most frequently between 36-38 gestational weeks (32 %) and delivery weight most frequently was 2500-3500 gr (44.1 %) The most frequent presentation was vertex/vertex (44.1 %) and placental type was monochorionic-diamniotic (58.8 %).

Multiple pregnancies were evaluated retrospectively and reported according to the data based on maternal age, parity, birth weight, delivery time, the way of delivery, presentation, placental types, maternal arterial tension values, family tendency and sexuality.

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Çocuklarýn % 10-15’i tekrarlayan karýn aðrýlarýndan yakýnmaktadýr. Karýn aðrýsý yakýnmasý genellikle 5-6 yaþlarýnda baþlayýp, 7-12 yaþlarýnda yoðunlaþýr. Etiyolojisinden pek çok organik ve psikolojik neden sorumlu tutulmaktadýr. Bu çalýþmada, tekrarlayan karýn aðrýsý yakýnmasý ile Pediatrik Gastroenteroloji polikliniðine baþvuran çocuklarda etiyoloji incelenmesi amaçlanmýþtýr. Ocak 2001 - Mart 2002 tarihleri arasýnda tekrarlayan karýn aðrýsý yakýnmasý ile baþvuran 172 olgu incelendi. Olgularýn 84’ü kýz 118’i erkek olup, yaþ daðýlýmý 3-15 yýl (median 8 yýl) idi. Olgularýn 83’ünde kronik karýn aðrýsý nedeni gastrik ve peptik ülser idi. Diðer nedenler olarak konstipasyon 26 olgu, üriner sistem infeksiyonu 15 olgu, giardiasis 15 olgu, ailesel akdeniz ateþi 6 olgu ve çölyak hastalýðý 3 olgu olarak bulundu. Bir olgu ailesel intestinal len-fanjiektazi ve bir olgu da kolelityazis tanýsý aldý. Herhangi bir neden saptanamayan 22 olgu fonksiyonel karýn aðrýsý olarak deðerlendirildi. Sonuç olarak, giderek geliþen taný yöntemleriyle çocukluk çaðý tekrarlayan karýn aðrýlarýnýn nedenlerinin önceki yýllarda bildirildiði gibi sýklýkla fonksiyonel veya psikojenik nedenli olmayýp, daha fazla oranda organik nedenlere baðlý olduðunu vurgulamak istedik.

Recurrent abdominal pain (RAP) has been reported to occur in 10 % to 15 % of children. RAP usually starts at ages 5 to 6 and continues to increase and peaks around age 7 to 12
years. Many organic and funstional abnormalities may cause RAP in this report, we aimed to investgate the etiology of RAP in patients who were referred to Pedatric Gastorenterology between january 2001 and March 2002. 172 patients (84 famales and 118 males) were included in the study. 83 patients had gastric and peptic ulcus, which were the most prevalent diagnoses. 26 patients had constipation, 15 patients urinary infection, 15 patients giardiasis, 6 patients familial mediterranean fever and 3 patients were dignosed as celiac disease. One pateint had familial intestinal Iymphangiectasia
and one patient had cholelithiasis as the cause of recurent pain. 22 patients were evaluated as functional abdominal pain. In conclusion, our observations indicate that de to
advances in laboratory and imaging techniques, higher proportion of organic abnormalities are responsible from recurrent abdominal pain than has been found in previously reported studies.

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Cholesterol emboli are a common complication of advanced atherosclerotic disease. Cholesterol crystals dislodged from plaques through the circulation until they become trapped in smaller vessels, which leads to ischemia and infarction. Histological confirmation is made by biopsy of the target organs, which include kidneys, muscle, and skin.

A 71 year old woman admitted to our clinic with pain and black discoloration of left toes and right foot fingers. Her past medical history includes congestive heart failure. Severe aortic stenosis detected by echocardiography. Although she had atrial fibrillation, no atrial thrombus was detected. The appearance of the patient’s necrotic lesions was typical for
cholesterol embolism. No other spesific causes for this picture was found. Clinical and laboratory findings differential diagnosis of the patient will be presented in this report.

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TSH secreting hypophysis tumours, functioning thyroid adenoma and overdose of thyroid hormones cause hyperthyroidism and Graves disease. Hyperthyroidism is seen mostly
in women. The most important complication of hyperthyroidism is thyroid crisis. Anesthesia, surgical stress, vaginal delivery, infectious disease, and thyroiditis which developes 1
or 2 weeks after radioactive iodine therapy can initiate thyroid crisis.

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Pyoderma gangrenosum (PG) is a chronic inflammatory ulcerative skin disease of unknown etiology, often associated with various systemic disorders such as inflammatory bowel
disease, rheumatiod arthritis, chronic active hepatitis, diabetes mellitus and hematologic malignancies. Treatment of associated systemic disorders may improve the ulcers but lesions may be recalcitrant and persist for months to years.

Here we report a 43 year-old female patient who has PG with ulcerative colitis. Patients with PG must be examined for an underlying disease even if they are asymptomatic.

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A male patient who is 64 years old, admitted to the our outpatient clinics with complaints related to anemia. In his anamnesis ingestion of soya beans was present. The table of anemia was diagnosed as hemolytic anemia related to glucose-6 phosphate dehydrogenase (G-6PD) deficiency. This type of anemia usually causes symptomes at childhood. However with the detailed anamnesis we learned that this ingestion was the first time in his life.

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In patients being observed and treated with acute cholecystitis a rise in the liver enzymes hiperbilirubinemia could be seen due to choledocholithiasis and cholangitis rarely. Classically
this rise in the enzyme levels is moderate, but in some cases this rise could be severe. By taking this situation in consideration in patients with high enzyme levels observation and treatment should be carried out more carefully and surgical plan should be discussed exclusively with large case series.

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In this article, an inflammatory mass in inferior punctum of 8 years old girl was reported who had been a dacryocystorhinostomy and bicanalicular silicone tube intubation operation
one year ago and complications of bicanalicular silicone tube intubation was discussed.

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The risk of tuberculosis development has increased 10 times at chronic renal failure (CRF) patients receiving hemodialysis. In these cases, PPD sometimes may be negative due to immun defect. In this study, a CRF patient having disseminated tuberculosis with normal initial chest radiography and dying later was presented. 47-year old-female woman patient receiving dialysis for 7 years for CRF has been in the hemodialysis programme initially but because of her shunt’s failure peritoneal dialysis programme for the last 2 years. 3 months after the onset of the symptoms, granulomatous myelitis was shown in the bone narrow biopsy, tuberculosis basili was reported to be positive in the sputum and the peritoneal fluid and the chest x-ray revealed miliary findings at the same time. We aimed to present this case to underline the complications and mortality of these cases because of the delay of the diagnosis.

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Fungal organisms are increasingly recognized as serious and potentially fatal pathogens in the immunosuppressed host. There is a critical need for alternatives to amphotericin B as a treatment for such life-threatening fungal infections as invasive aspergillosis; because although amphotericin B is used to treat fungal infections that are resistant to other antifungal drugs, such as fluconazole and ketoconazole, there are severe toxic effects of amphotericin B include fever, chills, muscle pain, phlebitis, vomiting, potassium loss, kidney dysfunctions and anemia. Liposomal bounded amphotericin B also shows a
distinctly lower toxic profile, even in higher concentrations in the plasma, than conventional amphotericin B. This report describes the successful treatment of an immunsupressed host suffering from severe aspergillus osteomyelitis and tuberculosis co-infection, using liposomal amphotericin B.

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