Akut koroner sendromlarýn en ciddi formu olan akut miyokard infarktüsü (AMI) günümüzde en önemli ölüm nedenlerindendir. Ýnfarktüsten sorumlu arterin açýk olmasý veya geç de olsa açýlmasý, miyokardýn elektrofizyolojik özellikleri üzerine etki yaparak, ventriküler aritmi riskini, böylece de mortaliteyi azaltabilir. Çalýþmamýzda sinyal ortalamalý EKG’nin (SOEKG) infarkt iliþkili arter oklüzyonunu belirlemedeki deðerini, MI tipinin arter oklüzyonuna ve SOEKG parametrelerine etkilerini saptamayý amaçladýk.
Ýlk kez MI geçiren 122 hasta çalýþmaya alýndý. Ýnfarktüsün 9±3’üncü günü SOEKG kayýtlarý alýndý, 10±3’üncü gününde de sað-sol koroner anjiografi ile ventrikülografileri yapýldý. Akut MI geliþiminin 6-12’inci günlerinde genel hasta popülasyonunda geç potansiyeller ve SOEKG parametrelerinin her biri ile arter oklüzyonu arasýnda istatistiksel anlamlý iliþki saptandý (p>0.05).
Akut MI sonrasý risk sýnýþandýrmasýnda, ventriküler geç potansiyellerin, arter oklüzyonu varlýðýnýn deðerlendirilmesinde tek baþýna duyarlý bir noninvaziv yöntem olduðu sonucu çýkarýlabilir.

Acute myocardial infarction (MI) is one of the acute coronary syndromes, and an important cause of death. Patency of the infarct related artery, or restoration of its patency, may influence the electrophysiologic features of the myocardium, decrease the risk of ventr›cular arrythmia and therefore mortality. The value of the signal averaged electrocardiography (SAECG) in determining the occlusion of the infarct related artery and SAECG parametres are evaluated.
One hundred and twenty two patients with diagnosis of first MI included in study. SAECGs of the patients on 9 th (±3) day of the MI are recorded and left and right coronary arteriography and left ventriculography performed on 10 th (±3) day. There were significant relation between infarct related artery occlusion and all of the SAECG parameters and late potentials in all patients on 6-12 th day of MI.
Our results suggests that ventricular late potentials on SAECG are sensitive noninvazive test in determining presence of artery occlusion for risk stratification of the patients with MI.

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Çalýþmamýzýn amacý hastalarýn anestezi hakkýndaki bilgilerini sorgulamak, anestezi ile ilgili korkularýný saptamak ve bilgilendirmenin etkinliðini araþtýrmaktýr.
Preanestezik deðerlendirmedeki tüm hastalara bilgilendirme kitapçýðý verildi. 14 soruluk bir anket formu ile postoperatif ilk gün “Anestezi nedir?”, “Kim uygular?”, “Korkunuz var mý?” sorularý cinsiyet, eðitim düzeyi ve kitabýn okunma durumuna göre deðerlendirildi. Ayrýca kitabýn anlaþýlabilirliði, kullanýþlýlýðý ve geçerliliði araþtýrýldý. Ýstatistiksel deðerlendirmede ki-kare testi kullanýldý. P<0.05 anlamlý kabul edildi.
Toplam 1542 hasta çalýþmaya katýldý, bunlardan 904’ü kadýn, 638’i erkek; ortalama yaþ 46.64±15.65 (11-96) idi. Kitapçýk pozitif (K+) hastalarýn % 68.1’i ve Kitapçýk negatif (K-) hastalarýn % 31.6’sý “Anestezinin ne olduðunu biliyorum” dediler (p<0.0001). Anesteziyi bilmeyenlerin % 67’si kadýndý ve % 53.6’sý okur-yazar deðildi (p<0.0001). Katýlýmcýlarýn % 51.6’sý anestezinin anestezist tarafýndan uygulandýðýný doðru olarak bildiler (p<0.0001). Hastalarýn % 35’inin anestezi hakkýnda korkularý vardý, bu korkular kitapçýðý okuduktan sonra kýsmen veya tamamen kayboldu (p<0.0001). K+) hastalarýn % 60.8’i kitapçýðý iyi anlamýþtý, % 73.8‘i yararlý buldu, % 40.6’sý kitapçýk hakkýnda bir baþkasýyla konuþmuþtu ve % 94.5’i kitapçýðý muhafaza ediyordu.
Özellikle eðitim düzeyi düþük hastalarýn anestezi ile ilgili yetersiz bilgisi ve ciddi korkularý vardýr. Bilgilendirme kitapçýðýný okumak, hastalarýmýzda preoperatif anksiyeteyi azaltýp, anestezi ve anestezistler hakkýndaki bilgilerini artýrmýþtýr. Yazýlý bilgilendirmenin bu sorunlarýn çözümüne yardýmcý olacaðýna inanýyoruz.

The aim of our study was to question the patients about anaesthesia knowledges; to find out their fear about anaesthesia and to determine the efficiency of informing.
The informing booklet was given to each patient at preanaesthetic evaluation."What is anaesthesia?", "Who administeres it?", "Have you any fear about it?" questions were evaluated on the first postoperative day according to gender, educational level, the book's reading status with a 14 subject questionnaire. Additionally, the booklet's comprehensibility, usefulness and reliability were examined. Statistical analysis was made by chi-square test. P<0.05 accepted as significant.
Total 1542 patients were participated into this study; 904 of them were female, mean age was 46.64±15.65 (11-96). 68.1 % of Booklet pozitive (+); 31.6 % of Booklet negative (-) patients said "I know what anaesthesia is." (p<0.0001) Anaesthesia ignorants were 67 % female and 53.6 % illiterate (p< 0.0001). 51.6 % of participiants correctly know that anaesthesia is administered by an anaesthesist. 71 % of B+ ans 33.4 % of B- patients answered same question correctly (p<0.0001). 35 % of patients have fear about anaesthesia; in 64.7 % of them fears have disappeared partly or completely after
reading the booklet (p<0.0001). In B+ patients 60.8 % of them understood the booklet well, 73.8 % of them found it very useful, 40.6 % of them have talked with someone else
about it and 94.5 % of patients kept the booklet.
Especially the inadequately educated the population hasn't got enough information about anaesthesia and has got serious fears about it. Reading the information booklet reduced
preoperative anxiety and increased knowledge about anaesthesia and anaesthesists in our patients. We believe that written information is important to solve these problems.

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GÝRÝÞ ve AMAÇ: Postmenopozal dönemde hormon replasman tedavisinin, lipid profili ve internal karotis arteri pulsatilite indeksi üzerine etkisini araþtýrmak.
YÖNTEM ve GEREÇLER: Menopozal þikayetler ile kliniðimize baþvuran doðal menopozlu 30 olgu çalýþma kapsamýna alýndý. Tedavi öncesi olgularýn internal karotis arteri doppler pulsatilite indeksleri ve lipid profiline bakýldý. Olgulara oral kesintisiz konjuge östrojen (0.625 mg/gün) ve her dört haftalýk siklusun son 12 gününde siklik medroksiprogesteron asetat (5 mg/gün) verildi. Tedavinin 3. ayýnda tekrar internal karotis arteri doppleri ve lipid profili deðerlendirilmesi yapýldý.
BULGULAR: Hormon replasman tedavisi sonrasý lipid profilinde LDL, total kolesterol, LDL/HDL ve total kolesterol/HDL oranlarýnda anlamlý düþüþ tesbit edildi. HDL konsantrasyonlarýnda anlamlý bir deðiþim izlenmedi. Tedavi sonrasý ortalama internal karotis arter doppler pulsatilite indeksi deðerinde ise tedavi öncesine göre anlamlý bir düþüþ izlendi.
TARTIÞMA ve SONUÇ: Hormon replasman tedavisi, kardiyovasküler sistemi lipid profili üzerinden indirekt, kalp ve damarlar üzerinden direkt olarak etkilemekte ve bu etki postmenopozal kardiyovasküler riski azaltýcý yönde olmaktadýr.

INTRODUCTION: We aimed to investigate the effect of hormone replacement therapy on lipid profile and internal carotid artery pulsatility index.
METHODS: We worked on 30 postmenopausal patients who applied for our clinic with menopausal complaints. Before the treatment we monitored the internal carotid artery pulsatility index and lipid profile. 0.625 mg/gün continue conjugated estrogens and at last 12 days of cyclus 5 mg/day medroxyprogesterone acetate treatment were given. On the 3rd month of the treatment, internal carotid artery doppler and lipid profile evaluation
were repeated.
RESULTS: After the hormone replacement therapy, we found out a significant decrease in the lipid profile; LDL, total cholesterol, LDL/HDL ve total cholesterol/HDL rations. After the treatment we noticed a significant decrease on mean internal carotid artery doppler pulsatility index.
DISCUSSION AND CONCLUSION: Hormone replacement therapy effects the cardiovascular system indirectly by lipid profile and by direct effects on heart and vessels. This effect decreases the postmenopausal cardiovascular risks.

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Organa sýnýrlý tümörlerin preoperatif saptanabilmesi için çeþitli prognostik göstergeler ortaya atýlmýþtýr. Bunlar içinde en sýk kabul göreni Partin ve ark. tarafýndan bildirilen preoperatif serum PSA düzeyi, klinik evre ve Gleason skorudur. Ancak, bu sistemde bile progresyonu öngörmede oluþan baþarýsýzlýklar nedeniyle prognozu öngörmede yeni alternatiflere ihtiyaç duyulmaktadýr.
Normal prostat hücrelerinin habis transformasyonuna sebep olan faktörler arasýnda peptid büyüme faktörleri de sayýlmaktadýr. Bunlar arasýnda en önemlilerinden biri de insülin benzeri büyüme faktörü (IGF)’dür. IGF ailesinde IGF-1 ve -2 olmak üzere iki hormon bulunmaktadýr. IGF-1 insan prostat hücreleri için mitojendir. Aktivitesi IGF-baðlayýcý protein (IGFBP)’ler ile düzenlenir. IGF’nin prostat üzerindeki etkisini etkileyen ise IGFBP-3’tür. IGFBP-3, IGF-1’in indüklediði prostat hücre proliferasyonunu inhibe eder.
Bu çalýþmada IGFBP-3’ün dokuda ekspresyon düzeylerinin klinik olarak organa sýnýrlý prostat kanserinde patolojik evre ve prognoz ile olan iliþkisi araþtýrýldý. Bu amaçla, lokalize prostat kanseri tanýsý konulup radikal prostatektomi operasyonu gerçekleþtirilen toplam 38 hastanýn cerrahi spesimenlerinden doku örnekleri alýnarak IGFBP-3 ekspresyonu dokularda immünohistokimyasal olarak araþtýrýldý.
Ýmmünohistokimyasal çalýþma sonucunda, tümör dokularýnda IGFBP-3 ekspresyonunun azaldýðý, BPH hastalarýndan alýnan dokularda ise arttýðý görüldü. IGFBP-3 boyamasý tüm tümör dokularýnda azalmýþ olarak bulundu.
Sonuç olarak, IGFBP-3’ün prostat kanseri geliþiminde önemli rolünün olabileceði, ancak immümhistokimya ile doku ekspresyonu düzeylerinin saptanmasýnýn patolojik evre ve prognozu öngörmede mevcut yöntemlere ek bir fayda saðlamadýðý saptandý.

Introduction: There are some prognostic factors for the preoperative prediction of organ confined prostatic carcinoma. The mostly accepted ones include preoperative blood PSA level, clinical stage and Gleason score. But, the predictive values of these factors are not very effective. So, we need more efficient prognostic factors. One of the most important factor to be investigated is the insulin like growth factor (IGF).
There are two peptide hormones in IGF family: IGF-1 and IGF-2. IGF-1 is mitogen for human prostate cells. Its activity is regulated by IGF-binding proteins (IGFBP). IGFBP-3 is
the most effective one which regulates prostatic activity.
In this study, we investigated the expression of IGFBP-3 in prostatic cancer specimens, and its relation to pathological stage and prognosis.
For this purpose, 38 patients which were diagnosed as localized prostate cancer and underwent radical prostatectomy were investigated. Tissue samples of radical prostatectomy specimens were examined by immunohistochemistry for detection
of IGFBP-3 expression.
As a result of immunohistocehemical study IGFBP-3 expression was decreased in the tumoral tissues whereas increased in BPH tissues. Expression also decreased in the BPH tissues closer to the tumoral areas and increased in BPH tissues away from the tumoral area.
As a conclusion, we found that IGFBP-3 may have an important role in the development of prostate cancer. But, examining the tissue expression by immunohistochemistry do not give any additional benefit to existing methods for prediction of pathological stage and prognosis.

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Serebral beyaz dokuyu özellikle sentrum semiovale bölgesini etkileyen radyolojik anomaliler son yýllarda oldukça dikkat çekmektedir. Bunun nedenlerinden biri yeni görüntüleme yöntemleriyle bu deðiþikliklerin daha sýk olarak serebrovasküler olaylarla, bazen de yalnýzca yaþlanmayla birlikte saptanmasýdýr. Görüntüleme yöntemleriyle bu beyaz doku anomalileri lökaryozis olarak tanýmlanýr. Bu deðiþiklikler kranial tomografide genellikle bilateral, yama þeklinde, diffüz hipodansiteler olarak ya da manyetik rezonans görüntülemede T-2 aðýrlýklý kesitlerde hiperintens lezyonlar olarak seçilmektedir.

Serebrovasküler olay geçiren hastalarda lökaryozis varlýðýnýn morbidite ve mortaliteye etkisini ve risk faktörleriyle korelasyonu olup olmadýðýný saptayabilmek için; 1998-2000 yýllarý arasýnda serebrovasküler olay kliniði ile yatýrýlýp izlenen hastalarýn kranial tomografi ve manyetik rezonans görüntülemeleri, lökaryozisin varlýðý açýsýndan retrospektif olarak deðerlendirildi.

247 hastada lökaryozis saptandý. Hastalarýn yaþ ortalamasý 64.3 idi. Hastalar 128 erkek ve 119 kadýndan oluþmaktaydý. 94 hastada intrakraniyal hematom, 153 hastada iskemik serebrovasküler olay saptandý. Hastalar risk faktörleri olarak hipertansiyon, diabetes mellitus, aterosklerotik kalp hastalýðý, obesite, sigara, alkol açýsýndan deðerlendirildi. Nörolojik muayene bulgularý kaydedildi. Lökaryozis ile birlikte sýk görülen risk faktörleri hipertansiyon ve ateroskleroz olarak saptandý. Ayrýca yaþ, hiperlipidemi, obesite daha az oranda lökaryozise eþlik eden faktörlerdi. Daha önceki klinik veriler deðerlendirildiðinde hastalarýn bir bölümünde daha önceden geçirilmiþ serebrovasküler olay ve geçici iskemik atak saptandý. Bütün bu veriler ve iskemik olayýn tipi lökaryozis ile birlikte görülme açýsýndan istatistiksel olarak c2 ve korelasyon analizi yöntemleri ile deðerlendirildi.

Lökaryozisin patogenezinin ve hastalarýn yaþam kalitesi ile yaþam süresi üzerindeki etkisinin tam olarak anlaþýlabilmesi için prospektif olarak, serebrovasküler olay geçirmiþ ve geçirmemiþ kiþilerin belli aralýklarla kranial tomografi ve manyetik rezonans görüntülemelerinin incelenmesi, klinik tablolarýnýn takip edilmesi ve bulgularýn risk faktörleriyle korele edilmesinin uygun olacaðý düþünülmektedir.

The radiologic anomalies which effect the cerebral white tissue, especially the centrum semiovale section, attract attention in the recent years. One of the reasons of this is that these changes are, with new monitoring methods, are determined more frequently with cerebrovascular phenomena and sometimes only with growing older. With monitoring methods, these white tissue anomalies are identified as leukoaraiosis. These changes usually are viewed as bilateral, patch-styled diffuse hypodensities in the cranial tomography or as hyperintense lesions in the T-2 burdened cross-sections in the magnetic resonance imaging.

In order to understand if there is a correlation between the risk factors and the existence of leukoaraiosis and the impact of the leukoaraiosis to morbidity and mortality, the cranial tomography and magnetic resonance imaging of the patients who were put in hospital for cerebrovasculer events between 1998 and 2000 were retrospectively evaluated.

In 247 patients, leukoaraiosis was spotted. The average age of the patients were 64.3 (range 59-71). The patients consisted of 128 males and 119 females. In 94 of the patients, intracranial hematome, and in 153 of them ischemic cerebrovasculer event was spotted. The patients were evaluated according to the risk factors of hypertansion, diabetes melitus, atherosclerotic heart disease, obesity, smoking and alcohol. The neurologic examination evidences were recorded. The most frequent risk factors together with leukoaraiosis were identified as hypertansion and atherosclerose. Hyperlipidemi,
obesity and age accompanied the leukoaraiosis as risk factors in a less frequent manner. After the evaluation of the older clinical data, it was seen that most of the patients had previously cerebrovasculer event and transient ischemic attacks. All these data and the type of the ischemic phenomenon have been evaluated statistically through c2 and the correlation analysis according to their occurance together with leukoaraiosis.
In order to understand the precise affect of the patogenese of the LA over the life quality and the life time of the patients, prospective examination of the cranial tomography and magnetic resonance imaging of the patients who previously had or did not have cerebrovasculer event, the prosecution of the clinical tables and the correlation of the evidence with risk factors are thought to be convenien.

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GÝRÝÞ ve AMAÇ: Olopatadin HCl % 0.1 ve ketorolak % 0.5‘in alerjik konjonktivit olgularýndaki klinik bulgu ve belirtiler üzerine etkilerinin klinik gözlem yoluyla karþýlaþtýrýlmasý.
YÖNTEM ve GEREÇLER: Alerjik konjonktivit tanýsý konulan 59 hasta araþtýrma için seçilerek her iki gözlerine de 30 gün süre ile rastlantýsal yöntemle belirlenen olopatadine veya ketorolac tedavisi uygulandý. Hastalarýn belirti ve bulgularý deðerlendirilip 0 ile 3 arasýnda derecelendirildi. Sonuçlar Student T-testi ile deðerlendirildi.
BULGULAR: Olopatadin HCl grubunda 15. günde yanma-batma, sulanma, kaþýntý, göz kapaðý ödemi, konjonktival kemozis ve konjonktival kýzarýklýkta istatistiksel olarak anlamlý düþüþ saptanýrken; 30. günde yanma-batma, sulanma, fotofobi, kaþýntý, konjonktival kýzarýklýk parametrelerinde anlamlý düþüþ görüldü. Ketorolak trometamin grubunda ise 15. günde gözlerde þiþlik, yanma-batma, sulanma, fotofobi, kaþýntý ve konjonktival kýzarýklýkta istatistiksel olarak anlamlý düþüþ görülürken; 30. günde gözlerde þiþlik, yanma-batma, sulanma, yabancý cisim hissi, fotofobi, kaþýntý ve konjonktival kýzarýklýkta anlamlý düþüþ görüldü. Ketorolak trometamin 15. günde kaþýntýyý, 30. günde fotofobi ve kaþýntýyý azaltmada daha etkin bulundu.
TARTIÞMA ve SONUÇ: Her iki ilaç da alerjik konjonktivit tedavisinde etkin olmakla birlikte ketorolak trometamin’in uzun dönemde kaþýntý ve fotofobi üzerine daha etkili olduðu görüldü.

INTRODUCTION: Aim of the study is to compare the effectivity of olopatadine HCl % 0.1 and ketorolac tromethamine % 0.5 in allergic conjunctivitis.
METHODS: 59 patients diagnosed for allergic conjunctivitis were treated randomly with Olopatadine HCl or Ketorolac Tromethamine. The symptoms and findings of the patients were scored between 0 and 3. The results were compared using student T-test.
RESULTS: In the olopatadine HCl group a statistically significant decrease was seen in burning sensation, epiphora, itching, eyelid edema, conjonctival chemosis and conjonctival hyperemia on the 15 th day and in burning sensation, epiphora, photofobia, itching and conjonctival hyperemia on the 30 th day. In the ketorolac tromethamine group a statistically significant decrease was seen in eyelid swelling, burning sensation, epiphora,
photofobia, itching and conjonctival hyperemia on the 15th day and in eyelid swelling, burning sensation, epiphora foreign body sensation, photofobia, itching and conjonctival
hyperemia on the 30 th day. Ketorolac tromethamine was found more effective on itching on the 15 th day and on photofobia and itching on the 30 th day.
DISCUSSION AND CONCLUSION: Both of the drugs are effective in the treatment of allergic conjonctivitis, but Ketorolac Tromethamine is more effective on itching and photofobia in long term folow up.

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Daha önce tip 2 diyabetik hastalarda yapýlan çalýþmalarda, nöropati ile plazma homosistein düzeyi arasýndaki iliþki konusunda çeliþkili yayýnlar yapýlmýþtýr ve bu konuda yeterli bilgi bulunmamaktadýr. Bu çalýþmanýn amacý, tip 2 diyabetik hastalarda diyabetin kronik komplikasyonlarýndan baþta nöropati olmak üzere, iskemik kalp hastalýðý (IKH), hipertansiyon ve homosistein düzeyi arasýndaki iliþkinin deðerlendirilmesidir.

Çalýþmaya Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi diyabet polikliniðine baþvuran ve ADA (American Diabetes Association) kriterlerine göre tip 2 diyabet tanýsý konulan, 53’ü kadýn, yaþ ortalamasý 56.9±9.2 olan 73 hasta alýndý. Hastalarýn açlýk plazma homosistein düzeyleri ölçülerek diyabetin makro ve mikrovasküler komplikasyonlarýndan iskemik kalp hastalýðý ve nöropati, geliþen ve geliþmeyen gruplar birbirleriyle karþýlaþtýrýldý. Çalýþmanýn sonucunda diyabetin makro ve mikrovasküler komlikasyonlarýndan, iskemik kalp hastalýðý ve nöropati geliþen hasta grubunda plazma homosistein düzeylerinin yüksek olduðu saptandý (sýrasýyla; 15.4±3.5 μmol/L'e karþý 11.3±2.7 μmol/L, p=0.001; 13.4±3.5 μmol/L'e karþý 11±2.7 μmol/L, p=0.001). Ayrýca arteriyal hipertansiyon saptanan hasta grubununda da plazma homosistein düzeyi yüksek idi (14.3±3.1 μmol/L'e karþý 10.1±2.1 μmol/L, p=0.001). Yapýlan çalýþma, Tip 2 diyabetik hastalarda yüksek plazma homosistein düzeyinin nöropati, iskemik kalp hastalýðý yada arteriyal hipertansiyon geliþmesinde risk faktörü olabileceðini desteklemektedir. Yüksek homosistein düzeyinin tedavi ile düþürülmesinin veya normalizasyonun saðlanmasýyla diyabetin kronik komplikasyonlarýnýn (IKH, nöropati) azaltýlýp, azaltýlmadýðýnýn gösterilmesi için multipl prospektif çalýþmaya gereksinim vardýr.

There is different results in studies made with type 2 diabetic patients to evaluate relationship between neuropathy with fasting plasma homocysteine levels, and also there is not enough knowledge on this subject. The purpose of this study is to evaluate relationship between chronic diabetic complications neuropathy, ischemic hearth disease and hypertension with fasting plasma homocysteine levels on type 2 diabetic patients.

We evaluated 73 type 2 diabetic patients ( 53 women, 20 men mean age 56.9±9.2 ) whose diagnosis established according to ADA criteria at Haydarpafla Numune Hospital Diabetes Mellitus Outpatientclinic. Plasma fasting homocysteine levels are determined. Patients are grouped according to presence and absence of ischemic hearth disease and neuropathy and then they compared with each other. As a result patients having ischemic hearth disease, neuropathy have high fasting plasma homocysteine levels (In order; 15.4±3.5 μmol/L to 11.3±2.7 μmol/L, p=0.001; 13.4±3.5 μmol/L to 11±2.7 μmol/L, p=0.00001). In addition patients who have arterial hypertension have higher fasting plasma homocysteine levels then patients who do not have arterial hypertension (14.3±3.1 μmol/L to 10.1±2.1 μmol/L, p=0.0001)

High plasma homocysteine level may be an important risk factor for ischemic hearth disease and diabetic neuropathy in type 2 diabetes mellitus. New researches are needed to prove the effects of lowering high plasma homocysteine levels with treatment on diabetic complications.

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Yüksek PÝN olgularýnda, prostatik adenokarsinomlarýyla ayýrýcý tanýda problem yaratan selim prostat lezyonlarýnda ve normal prostat dokusunda HMWCK 34βE12 ile immünohistokimyasal boyanma özelliklerinin deðerlendirilmesi amaçlandý. Olgularýmýz normal ve hiperplazik prostat dokusu, atrofi, bazal hücre hiperplazisi (BHH), adenozis ve yüksek PÝN içerecek þekilde seçildi. Olgularýn hepsine 34βE12 ile boyama yapýldý. Lezyonlarda prostatik bezlerde boyanma yüzdeleri, tipi (kesintisiz, kesintili ve yama tarzý) ve yoðunluðu (zayýf, orta, kuvvetli) tesbit edildi. Boyanma anlamlý olarak adenozis olgularýnda diðerlerine göre düþüktü. Normal ve atrofik bezlerde de yer yer boyanmama izlendi. % 98 kesintisiz ve kuvvetli boyanma gösteren BHH diðer gruplardan anlamlý olarak farklýydý. Yüksek PÝN lezyonlarýnda 34βE12 ile zaman zaman kesintili ve hatta yama tarzý boyanma izledik. 34βE12 ile boyanmýþ bir lezyon deðerlendirirken boyanmayan bezler yakýnlarýndaki benzer sitolojik özelliklere sahip bezlere göre ve lezyondaki yerleþimlerine göre deðerlendirilmelidir. Az sayýda þüpheli bezde boyanma izlenmemesi tek baþýna kanser tanýsý koydurmaz. 34βE12 ile çalýþýrken yanlýþ negatif boyanma olabileceði akýlda tutulmalýdýr.

Our objective is to search the HMWCK 34bE12 immunoreactivity in high grade PIN lesions, atrophy, adenosis, basal cell hyperplasia (BCH) and normal prostatic tissue. Cases were immunostained by 34bE12. We determined the percentage, type (continuous, focally interrupted and patchy) and the density (weak, intermediate and strong) of staining. The percentage of staining was significantly low in adenosis cases. Normal or atrophic prostate glands sometimes didn’t show positive staining. The staining properties of BCH group (% 98 continuous and strong in density) were significantly different from others. High grade PIN lesions also sometimes showed focally interrupted or even patchy staining. Nonreactive glands must be utilized according to their location in the lesion and compared to the cytologically similar ones. It is not recommended to diagnose a lesion as cancer by showing nonreactivity in a small amount of suspicious glands. The probability
of false negative staining must be always in mind.

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GÝRÝÞ ve AMAÇ: Kalkeneusta tespit ettiðimiz selim kemik tümörleri arasýnda nadir görülen intraosseöz lipomlarýn cerrahi tedavi sonuçlarýnýn deðerlendirilmesi.
YÖNTEM ve GEREÇLER: 1992-2004 yýllarý arasýnda röntgenografide kalkeneusta litik lezyon görülen ve MRG ile intraosseöz lipom düþünülen 11 hastanýn 12 ayaðý çalýþmaya dahil edildi. Hastalarýn ortalama yaþý 38.9 (18-52) yýl idi. Hastalarýn 8’i kadýn, 3’ü erkek idi. Ýntraosseöz lipomlarýn 6’sý sað, 4’ü sol tarafta, 1’i bilateral idi. Hastalarýn tümüne genel anestezi altýnda, turnike kontrolünde biyopsi ve küretaj uygulandý. 8 hastaya ipsilateral iliak kanattan alýnan spongioz greft ile greftleme ve 3 hastaya iliak kanattan alýnan greft ve allogreft ile greftleme uygulandý.
BULGULAR: Hastalar ortalama 69.4 ay (39-137 ay) takip edildi. Hiçbir hastanýn ayak bileðindeki cerrahi sahada ve greft alýnan iliak bögede infeksiyon ve cilt nekrozu görülmedi. Hiçbir
hastada ameliyat esnasýnda ve sonrasýnda damar ve sinir yapýlarýna ait komplikasyon geliþmedi. Hastalarýn 2’sinde üç hafta süren greft alýnan iliak kanatta aðrý þikayeti mevcuttu. Aðrý þikayetleri 6 hastada 4 ay içinde, 4 hastada 8 ay içinde, bir hastada da 12 ay içinde sona erdi. Radyolojik olarak lezyon içine yerleþtirilen greftin tam konsolidasyonu ortalama 3 ay (1.5-4 ay) sonra gerçekleþti. Hiçbir hastada patolojik kýrýk ve nüks tespit edilmedi.

TARTIÞMA ve SONUÇ: Kalkeneusta bulunan intraosseöz lipomlarýn tedavisinde küretaj ve greftleme hastanýn aðrý semptomlarýný ortadan kaldýrmasý, olasý patolojik kýrýklarýn önlenmesi ve ameliyat sonrasý dönemde nüksün görülmemesi ile etkin bir tedavi yöntemidir.

INTRODUCTION: Aim of the study is to evaluate the results of the surgery that was performed for intraosseos lipomas in calcaneus which is a rare benign bone tumor.
METHODS: Eleven patients’ 12 feet which were diagnosed as intraosseos lipoma radiologically, had been analyzed. The mean age was 38.9 years (18–52 years). Eight patients were female (73 %) and 3 patients were male (27 %). Six of the lipomas were at the right side, 4 of them were at left side and one was bilateral. All of the patients were treated surgically. Surgery was performed under general anestesia, with tourniquet. Curetage and bone grafting which was taken from the ipsilateral iliac crest, was performed to 8 patients. We had used allograft and autograft together for three patients because of the insufficiency
of the grafts taken from iliac crest.
RESULTS: The mean follow up time was 69.7 months (39-137 months). No infection and skin necrosis were seen at the surgery regions on ankle and iliac crest. There were no neurovascular complications intraoperative and postoperative. Two patients had iliac pain for three weeks. The pain at ankle was ended in 4 months for 6 patients, 8 months for 4 patients and 12 months for one patient. The mean time for the consolidation of the grafts was 3 months (1.5-4 months). There was no recurrence during the follow up period.
DISCUSSION AND CONCLUSION: Curetage and grafting is an effective treatment for intraosseos
lipomas in calcaneus to prevent pain and recurrence.

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Bu çalýþmanýn amacý, asemptomatik postmenopozal olgularda kalýn endometriumu (çift kat 5 mm veya daha fazlasý) tespit edip, küretaj yaparak endometrium kalýnlýðýnýn önemini vurgulamaktýr.

Asemptomatik postmenopozal 41 hipertansif ve 25 normotansif olguya transvajinal ultrasonografi yapýldý. Endometrial kalýnlýk sagital kesitte endometriumun en kalýn olduðu yerde ölçüldü ve bütün olgulara endometrial küretaj yapýldý.

Hipertansif grupta endometrium kalýnlýðý 4.4±2.8 mm, normotansif grupta ise 3.2±1.5mm bulundu. Çalýþma grubunda 13 olguda endometrium kalýnlýðý 5 mm’nin üzerinde ölçüldü. Kontrol grubunda 5 olguda endometrium kalýnlýðý 5 mm’nin üzerinde ölçüldü. Küretaj sonucunda hiçbir olguda habaset saptanmadý.

Hipertansif postmenopozal olgularda endometrium kalýnlýðý istatistiksel olarak anlamlý olmasa da artmýþ olarak bulundu.

The aim of this study was to estimate the prevalance of a thick endometrium (5 mm or greater double measurement) in asymptomatic postmenopausal women and to evaluate the significance of th›s finding using curettage.

Forty one asmptomatic hypertensive postmenopausal women and 25 normotansive asymptomatic postmenopausal women examined by transvaginal ultrasound. Endometrial thickness was measured at the level of its maximum thickness in the uterine sagittal plane and curettage was performed at the and of the study.

In hypertensive group the mean endometrial thickness was 4.4±2.8 and in normotansive group 3.2±1.5. The endometrium measured 5 mm or more in 13 women in hypertensive group and 5 women in normotensive group. Curettage revealed no case of malignancy.

The prevalence of a thick endometrium was high in hypertensive postmenopausal group but not statistically significant.

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Bu çalýþmada, hasta, anestezist ve gözlemci tarafýndan, spinal anestezi öncesinde iki deðiþik zaman aralýðýnda uygulanan EMLA (Eutectic Mixture of Local Anesthetics) kremin etkinliði deðerlendirilerek karþýlaþtýrýldý.

Çalýþmaya ASA I-II grubundan, ürolojik giriþimler için spinal anestezi uygulanacak, yaþlarý 45-85 arasýnda deðiþen 45 erkek hasta alýndý. L3-L4, L4-L5 aralýklarýna gelen deri yüzeyine 2.5 gr EMLA krem uygulanarak yapýþkan þeffaf bantla kapatýlan hastalar iki gruba ayrýldý. 1. grupta uygulamadan 15-45 dk, 2. grupta uygulamadan 46-90 dk sonra 22-gauge spinal iðne ile EMLA kremin uygulandýðý bölgedeki aralýklardan spinal anestezi gerçekleþtirildi. Aðrý duyan hastalara ek olarak 20 mg lidokain derialtýna enjekte edildi. Lokal deri reaksiyonu, yapýlan giriþim sayýsý, ek doz lokal anestezik gereksinimi kaydedildi. Aðrý, 10 cm’lik vizüel analog skala ile hasta, anestezist ve bir gözlemci tarafýndan ayrý ayrý deðerlendirildi. Her iki grupta lokal deri reaksiyonu görülmedi. Her iki grubun aðrý skorlarý arasýnda da fark olmadýðý saptandý (p>0.05). Spearman’ýn eþleþtirme testi ile hasta ve anestezistin (r: 0.72), hasta ve gözlemcinin (r: 0.74), daha yüksek oranda da anestezist ve gözlemcinin (r: 0.90) belirttiði aðrý skorlarý arasýnda birlik gözlendi.

Sonuç olarak, spinal anestezi giriþiminden önce EMLA krem uygulamasýnýn etkinliðinin; hasta, anestezist ve bir gözlemci tarafýndan da benzer þekilde deðerlendirilmesi üzerine, her iki zaman aralýðýnda da ayný olduðu kanýsýna varýlmýþtýr.

This study was performed to evaluate the efficacy of EMLA (Eutectic Mixture of Local Anaesthetics) cream application for spinal needle insertion pain in two different time intervals.

Forty-five ASA I-II male patients (45-85 years) who underwent urological operations under spinal anaesthesia were included in this study. The patients who applied 2.5 gr EMLA cream and adhesive band to their skin over L3-4, L4-5 intervertebral spaces were divided into two groups. Spinal anesthesia was performed with 22-gauge Quincke needle 15-45 min and 46-90 min after application of EMLA cream in Goup I and in Group II respectively. Lidocaine 20 mg was injected to the patients who had felt pain during needle insertion. Local skin reaction, number of attempts, neccesity of local anaesthetics were recorded. Assessment of quality of skin anesthesia by a 0-10 cm visual analogue pain scale was completed independently by patient, anesthetist and observer. Any skin reaction was not seen in both groups. There was not significant difference in pain scores between two groups. Spearman’s rank correlation showed a significant agreement in pain
scores recorded by the patient and the anesthetist (r: 0.72), by patient and observer (r: 0.74) and to a higher degree, by anesthetist and observer (r: 0.90).
We concluded that application of EMLA cream, prior to spinal needle insertion may be an effective method to provide good analgesia in both groups. The evaluation of EMLA cream’s effect by patient, anesthetist and observer is similiar.

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Brown tumour is one of the forms in which fibrous cyctic osteitis, which represents the terminal stage of the bone remodelling processes during hyperparathyroidism, is manifested. In histological terms, Brown tumours are made up by a cell population consisting of plurinucleate giant cells, resembling osteoclastic cells, among which recent haemohagic infiltrates and homosiderin deposits (hence the Brown colour) are ofen
found.

For years Brown tumour was regarded as a typical lesion of primary hyperparathyroidism, but cases of Brown tumour in patients with hyperparathyroidism secondary to renal failure
were increasingly often reported in the literature.

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Tay-Sachs disease is accumulation of GM2 ganglioside in neuronal cell lisosomes and, results from the absence of hexosaminidase A enzyme. Affected infants appear normal until approximately 6 months of age. After the first year, irritability, hyperacusis, intellectual retardation, blindness, convulsions, spasticity and opisthotonus may occur. We present, a case of a child who was admitted to our hospital with intracranial mass on clinical and radiological signs and, previously diagnosed as Tay-Sachs disease.

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Langerhans cell histiocytosis (LCH) is a rare disorder in wich lesions contain pathologic Langerhans cells (PLC). A quarter of patients with LCH has pulmonary lesions. Patients with pulmonary involvement are either asymptomatic or manifest adry unproductive cough with dyspnea and chest pain. The basic lesions of LCH is formed by collections of PLC. The presence of Birbeck granules by electron microscopy or the expression of the CD1a antigen on the cell surface are necessary for a definitive diagnosis of LCH. High resolution CT (HRCT) can show reticular, reticulonodular, nodular opacities and diffuse cysts and cavity. When the characteristic nodular, cavitary and cystic lesions are together they are highly suggestive of LCH, especially when they predominate in the upper to mile lung fields.

LCH must be considered in the diferansial diagnosis of interstitial lung disease associated with cavitary and cystic lesions.

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Severe, life threatening conditions, septicemias, have a mortality rate of about 20-50 %, and their rate of incidence is increasing. While single-agent septicemias are encountered frequently, double-agent septicemias have been diagnosed rarely and sometimes responsible agents can not be found easily.In our case, we isolated salmonella and leptospira species at the same time from a patient presenting us with hepatosplenomegaly, fever, renal and hepatic dysfunction. While enterally-acquired salmonellas show a broad spectrum of manifestations from local infections to septicemias, leptospiras, acquired by liquids and foods not undergoing to proper sanitization methods, manifest as a condition resembling a wide-spread vasculitis. For all septicemia cases, if “the golden hours” is not wasted and proper management is done timely, mortality rate will decrease significantly.

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Chronic granulomatous disease (CGD), is a rare immune deficiency which has x-linked or autosomal recessive inheritance. Although neutrophils and monocytes have normal phagocytic activity, intracellular killing (bactericide) function is defective. Infections with fungi and catalase- positive bacteria such as staphylococcus aureus is frequent. We present two siblings with CGH diagnosed recent years in our clinic.

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The malignant mixed epithelial-mesenchymal tumors of uterus are adenosarcoma, mixed müllerian tumor (carsinosarcoma), homologous and heterologous tumors (WHO). Adenosarcoma is a biphasic tumor macroscopically having a polypoid apperance with benign epithelial structures and malignant stroma. The 40 year old female patient, G2P2, had applied to our clinic with the complaints of menometrorhagia and her D&C and TAH-BSO was reported as mixed epithelial-mesenchymal tumor/adenosarcoma. We present this rare case with the litrature findings.

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Fungal infections have become a leading cause of morbidity and mortality in cancer patients. One particular problem in the management of these infections is the diffuculty in early diagnosis and delay in specific treatment.

A candidal meningitis case has been presented in a patient who was hospitalized with acute lymphoblastic leukaemia diagnosis in SSK Göztepe Training Hospital Paediatrics Clinic Haematology-Oncology Deparment. A 4 year old girl developed neutropenia in the 23th day of chemotherapy. She was receiving TRALL-BFM 2000 protocoll. Following neutropenia she had fever, abdominal pain and anorexia. Candida parapsilosis was found in cerebrospinal fluid culture. She had been given conventional Amphotericin B according to the antibiogram but fever persisted. Then the drug was changed to liposomal Amphotericin B. Clinical and laboratory recovery was seen after liposomal Amphotericin B.

In oncology patients candidal infections must be considered due to abundance of risk factors and contamination routes. In high risk neutropenik patients antifungal therapy must begun not later than 7th day of fever. Therapy should be changed to liposomal Amphoterecin B in the case of irresponsiveness to conventional Amphoterecin B therapy because of the probability of resistant candidiasis.

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Thrombotic thrombocytopenic purpura (TTP), is a disease, characterized by thrombocytic microangiopathy.In thrombocytopenic angiopathy, microvasculer obstructive lesions produced by systemic or intrarenal trombocyt aggregation, thrombocytopenia and mechanic injury of erythrocytes lead to tissue ischemia. TTP first defined by Moschcowitz at 1924 and
it can not be clarified completly at 1980.

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Alveolar adenoma is a rare and a benign tumor of the lung. There is few case of alveolar adenoma in the literature. This paper presents a case with this rare tumor. A 52 years old female patient was admitted with complaints of cough and dispnea for five months. Chest radiograph showed a solitary pulmonary nodule between third and fourth anterior costa with 3 cm diameter and well defined borders. Computed tomography of the thorax demonstrated a well circumscribed, cystic nodulan lesion without calcification on right middle lobe. Fiberoptic bronchoscopy revealed normal endobronchial system. Cytology was not diagnostic of any disease. MR angiography of the thorax showed a solitary pulmonary nodule on right middle lobe. No relation with vascular structures were detected. Solitary pulmonary nodule was palpated during thoracotomy. Frozen cytology of the nodule was reported as benign and wedge resection was performed for excision. Pathological diagnosis of surgical specimen was alveolar adenoma.

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