Hastane malnütrisyonunu belirleyen faktörlerden birisi hastalarýn hastaneye kabul edildikleri andaki beslenme durumudur. Bu çalýþma, cerrahi operasyon için yatýþý yapýlan olgularýn malnütrisyon prevalansýný belirlemek ve subjektif global deðerlendirme (SGD) ile nütrisyonel risk indeksi (NRI) karþýlaþtýrmak için gerçekleþtirilmiþtir.
Etik kurul onayý alýndýktan sonra yatýþý yapýlan 741 olgu çalýþmaya alýndý. Olgularýn yatýþda SGD’leri, boy, kilo, vücut kitle indeksi (VKI), kol çevresi ölçümleri yapýldý, kan örneði alýnarak hemogram, albümin deðerleri saptandý, son 6 aylýk kilo kaybý ile NRI hesaplandý. Hastalarýn hastanede yatýþ süreleri, komplikasyonlarý ile patoloji cinsleri kayýt edildi.
NRI’ne göre olgularýn 45’i (% 6) hafif malnütrisyonlu, 49’u (% 6.54) orta malnütrisyonlu, SGD’ye göre olgularýn 26’sý (% 3.5) orta malnütrisyonlu olarak deðerlendirildi. NRI ve SGD ile antropometrik ve laboratuvar deðerleri iliþkisine bakýldýðýnda, boy dýþýnda tüm deðerler istatistiksel olarak anlamlý iliþkiye sahipti. Olgularýn çoðunluðunda komplikasyon görülmediðinden gruplar arasýnda fark yoktu.
Çalýþmamýzda kullandýðýmýz her iki metot da nütrisyonel durumu belirleyen faktörlerle iliþki göstermektedir. Bu yüzden her iki metodun da beslenme durumunu belirlemede kullanýlabileceði sonucuna varýldý.

The main factor used in malnutrition prevalance is the nutritional status of the patients at hospital admission. This study is to estimate the incidance of malnutrition in surgical patients and to compare the results of the subjective global evalution and nutritional risk index.
After ethic comittee aproval, SGE, height, weight, BMI, MAC, Hb, albumin, weight loss within 6 months and NRI of 741 patients were noted or calculated. Length of stay in the hospital, complications, pathologies (oncologic or non-oncologic) were also noted.
According to NRI 45 patients (6 %) mild malnutrition, 49 patients (6.54 %) moderate and according to SGE 26 patients (3.5 %) were evaluated as moderate malnutrition. NRI and
SGE were in correlation statistically in all parameters except height. There was no difference in complications rates.
Both methods correlate with the parameters used to evaluate nutrition. Either one, NRI or SGE can be used for nutritional assessment.

Abstract | Full Text PDF

Kronik obstrüktif akciðer hastalýðýnda (KOAH) evde uzun süreli oksijen tedavisi (USOT) ileri derecedeki olgularda farmakolojik tedavinin yanýsýra rutin uygulanan tedavi yöntemlerinden biridir. Çalýþmamýzda ileri derecede KOAH’lý olgularda USOT’un saðkalýma katkýsý ve hasta uyumunu araþtýrmayý amaçladýk.
Merkezimizde 1998-2000 yýllarý arasýnda ilaç tedavisine ilaveten USOT kullanan ve ölen 63 erkek hasta retrospektif olarak incelemeye alýndý. Evleri telefonla aranarak ölüm günleri ve günde kullandýðý oksijen (litre/dk) süresi kayýt edildi. Olgular daha sonra kullanýlan USOT süresine (6 saat/gün uzun ya da kýsa olmasý) göre 2 gruba ayrýldý.
USOT kullanan grup 1’de 34 hasta olup yaþ ortalamasý 61±.12 (35-75) idi. Ölümlerinden önce hastaneye son baþvuru arter kan gazý deðerleri sýrasýyla; PaO2 51±.11 mmHg, PaCO2 60±15 mmHg, SaO2 % 81±8, günlük ortalama nazal O2 kullaným süresi 12±2 saat/gün idi. USOT verildikten sonra ölümlerine kadar geçen süre ortalama 5.6±5.1 ay idi. USOT verildiði halde evde oksijen kullanmayan (<6 saat/gün) grup 2’de ise 29 hasta olup yaþ ortalamasý 63±9 (45-80) idi. En son arter kan gazlarý; PaO2 51±14 mmHg, PaCO2 50±14 mmHg, SaO2 % 82±9, ölüme kadar geçen süre ortalama 5.2±4.9 ay idi.
USOT tedavisine alýnan ileri KOAH’lý olgularda, USOT’ne uyumun kötü olduðu durumlarda KOAH’da USOT kullanýmýnýn mortalite üzerine etkisinin olmadýðý gösterildi. Bu durumun USOT önerilen hastalara verilen eðitimin yeterli olmamasýndan kaynaklandýðý, bu nedenle USOT önerildiðinde tedavinin kullanýmý hakkýnda daha iyi bir eðitim verilmesinin gerekli olduðu kanaatine varýldý.

Long term oxygen therapy (LTOT) at home is one of the routine treatment besides the pharmacologic therapy in severe chronic obstructive pulmoner disease (COPD). Our object in this study to investigate the survival of patients with COPD receiving LTOT.
Retrospectively, 63 death male patients using LTOT were examined in our center between 1998-2000. Their time of death and duration of oxygen using per day were recorded by calling patients’home. Patients were allocated to Group 1 and Group 2.
Group1 included 34 patients who were receiving LTOT; mean of their age 61±12 yr (range 35-75 yr), the arterial blood gas values which were registered at hospital just before their death time; PO2 51±11 mmHg, PCO2 60±15, SaO2 % 81±8, their daily nasal O2 using time was 12±2 hrs/day. The lasting period until their death time was 5.6±5.1 months. In Group 2 there are 29 patients who didn’t use oxygen at home (less or
more than 6 hrs/day) in spite of given LTOT. Their mean age was 63±9 yrs. (range 45-80). Their last artery blood gas values PaO2 51±14 mmHg, PaCO2 50±14 mmH, SaO2 % 82.9, and the lasting period until their death time was 5.2±4.9 months.
In our study we showed that compliance of patients with severe COPD whose taken LTOT were poor and therefore no any effect of oxygen therapy on the mortality. We conclude that this result may be related to the insufficiency of the education that is given the patients and so when we suggest LTOT more kind of education about using must be given to the patients.

Abstract | Full Text PDF

Bu çalýþmada, birincil açýk açýlý glokom tanýlý hastalarda komplikasyonsuz fakoemulsifikasyon cerrahisi ve göz içi lens implantasyonu sonrasý göz içi basýnç deðiþiminin deðerlendirmesi amaçlandý.
SSK Göztepe Eðitim ve Araþtrma Hastanesi Göz Kliniði Glokom Birimi’nde takip edilmekte ve katarakt cerrahisi geçirmiþ olan 22 olgunun 27 gözü retrospektif olarak incelendi. Hastalarýn preoperatif ve postoperatif görme keskinliði deðerleri, kullanýlan antiglokomatöz ilaçlar, preoperatif göz içi basýnç ortalamalarý ve postoperatif ilk 6 ay, ikinci 6 ay, ikinci yýl, üçüncü yýl göz içi basýnç ortalamalarý tespit edildi ve kendi aralarýnda karþýlaþtýrýldý.
Hastalarýn postoperatif 3 yýllýk takiplerde göz içi basýncýnda preoperatif deðerlere göre istatistiksel olarak anlamlý düþüþ gözlendi. Göz içi basýncýndaki bu düþüþün 2’inci yýl sonuna kadar devam ettiði, daha sonra artýþýn izlendiði, ancak hala basýncýn preoperatif deðerlerin altýnda olduðu saptandý. Bir hastada cerrahi sonrasý görme keskinliðinde deðiþiklik olmazken diðer hastalarýn tamamýnda en az 2 Snellen sýralýk artýþ olduðu tespit edildi. Postoperatif dönemde preoperatif döneme göre ilaç sayýsýnda azalma saptanmasýna raðmen bu fark istatiksel olarak anlamlý bulunmadý.
Katarakt geliþen birincil açýk açýlý glokomlu hastalarda komplikasyonsuz fakoemulsifikasyon cerrahisi ve arka kamara göz içi lensi implantasyonu sonrasýnda göz içi basýncýnda anlamlý þekilde düþüþ meydana geldiði saptandý. Bu hastalarda katarakt ekstraksiyonunun görme keskinliðinde artýþ saðlamanýn yanýnda göz içi basýncýnýn regülasyonuna katkýda bulunduðu sonucuna ulaþýldý.

In this study we aimed to evaluate the changes in intraocular pressure following uneventful phacoemulsification cataract extraction with posterior chamber intraocular lens implantation in primary open-angle glaucoma patients.
We retrospectively reviewed the 27 eyes of 22 patients with primary open-angle glaucoma who underwent cataract surgery and were followed in the glaucoma department of SSK Goztepe Educational Hospital.The preoperative and postoperative visual acuity, antiglaucoma medications, preoperative and postoperative intraocular pressures measured during the first 6 and 12 months postoperatively, 2’st and 3’rd years after the surgery were noted and compared.
During the 2 years follow up the posoperative intraocular pressure measurements were found to be significantly lower than the preoperative intraocular pressures. During the 3’rd
postoperative year the intraocular pressure started to increse but it still remained significantly lower than the preoperative measurements. All of the patients had two or more Snellen rows increase in visual acuity postoperatively except one patient
in whom the visual acuity remained the same. There was a decrease in the antiglaucoma medications postoperatively but this decrease was not statistically significant.
In this study we found that there was a statistically significant decrease in the intraocular pressure of patients with primary open-angle glaucoma after uncomplicated phacoemulsification and posterior chamber intraocular lens implantation surgery. The cataract surgery itsself may contribute to the intraocular pressure regulation in patients with primary open-angle glaucoma.

Abstract | Full Text PDF

Amaç: Sýk kullanýlan omuz muayene testleri ile omuz manyetik rezonans görüntüleme (MRG) arasýndaki duyarlýlýk ve özgüllüðün tespit edilmesi.
Materyal ve metot: Omuz MRG’si istenmiþ 117 hastaya ayný doktor tarafýndan kör olarak 8 omuz muayene testi yapýldý. Test sonuçlarý MRG raporlarý ile karþýlaþtýrýldý. MRG sonuçlarý ana taný testi olarak alýnarak duyarlýlýk ve özgüllüðü hesaplandý.
Sonuçlar: 1-Hawkins testi % 91, % 85; 2-Tump-up ve Global ROM % 95, % 32; 3-Yergeson testi % 28, % 50; 4-Speed testi % 26, % 59; 5- Lift-off testi % 70, % 99; 6-M.Supraspinatus stres testi % 82, % 92; 7-M.‹nfraspinatus ve M.Teres minör stres testi % 82, % 76; 8-O’Brein testi % 74, % 72 sýrasýyla duyarlýlýða ve özgüllüðe sahipti.
Hawkins testi omuz sýkýþma sendromu tanýsýnda yüksek duyarlýlýk ve özgüllük deðerlerine sahiptir. Omuz sýkýþma sendromu tanýsýnda MRG Hawkins testine destek olur. Adheziv kapsülitin tanýsý MRG ile konulmaz; Tump-up ve Global ROM testinin duyarlýlýðýnýn yüksek olmasý þüpheli olgularda MRG’nin desteðinin varolabileceðini, ancak düþük özgüllük deðerleri yüzünden taný koydurucu olmaktan uzak olduðunu göstermektedir. Yergeson ve Speed testleri çok düþük duyarlýlýk ve düþük özgüllük deðerleri ile tanýda deðerlerinin azlýðýný göstermektedirler. Lift-off testi: yüksek özgüllük deðeri ile m. Subscapularis rüptüründe önemli bir test olduðunu göstermektedir. M. supraspinatus stres testi, M. infraspinatus ve M. teres minör stres testi nispeten yüksek özgüllük ve duyarlýlýk deðerleri ile deðerli testler olduklarý gözlenmiþtir. Tanýsý muayene ile zor olan anterior labral defekti göstermesi açýsýndan O’Brein testinin özgüllük ve duyarlýlýk deðerleri yüksek bulunmuþtur.

To identify the sensitivity and specificity between the frequently used shoulder examination tests and magnetic resonance imaging (MRI) of the shoulder.
8 blind shoulder examination tests have been performed by the same physician on 117 patients, whose Shoulder MRI is demanded. Test results are compared with the MRI reports. On the basis of MRI results, taken as the main diagnosis test, sensitivity and specificity are calculated.
Results: 1-Hawkins test has 91 % sensitivity, 85 % specificity; 2-Tump-up and Global ROM has 95 % and 32 %; 3-Yergeson test 28 % and 50 %; 4-Speed test 26 % and 59 %; 5- Lift-off test 70 % and 99 %; 6-M. supraspinatus stress test 82 % and 92 %; 7-M. infraspinatus and m. teres minor stress test 82 % and 76 %; 8-O’Brein test 74 % and 72 % sensitivity and specificity respectively.
Hawkins test has high figures of sensitivity and specificity in the diagnosis of shoulder impingement syndrome. MRI is supportive to the Hawkins test in the diagnosis of shoulder impingement syndrome. Adhesive capsulitis is not diagnosed by MRI; the fact that Tump-up and Global ROM test has high sensitivity indicates that MRI support can be provided in cases that are suspicious, however it is far from being diagnostic because of the low specificity figures. With very low figures of sensitivity and specificity, Yergeson and Speed tests have low value in diagnosis. It has been observed that the Lift-off test is
a significant tool in m.subscapularis rupture with its high figure of specificity. It has been also observed that m. supraspinatus stress test, m. infraspinatus and m. teres minor stress test are valuable tests with their relatively high specificity and sensitivity. Specificity and sensitivity figures of O’Brein test are deemed to be high in terms of indicating anterior labral defect, which is difficult to diagnose by examination.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Ýnfantil dönemde geliþen epilepsilerde etiyolojiyi belirlemek, semptomatik olgularda altta yatan santral sinir sistemi hastalýðýný saptamak.

YÖNTEM ve GEREÇLER: Ýlk konvülsiyonlarý bir ay ile iki yaþ arasýnda baþlayan, epilepsi tanýsý alan 186 hastada etiyolojik faktörler araþtýrýlarak, etiyolojik gruplar ve bazý klinik özellikler karþýlaþtýrýldý.
BULGULAR: Olgularýn ortalama konvülsiyon baþlama yaþý 7.1±5.7 ay idi. 186 olgunun % 69.4’ü semptomatik, % 30.6’sý kriptojenik-idiyopatik grupta yer aldý. Semptomatik grupta epilepsiye yol açan nedenler arasýnda pre/perinatal faktörler % 50.3, geliþimsel serebral anomaliler % 12.4, menenjit/ensefalit sekeli % 8, nörokütanöz hastalýklar % 6.2 ve serebrovasküler hastalýklar % 4.6 ile en önemli gruplarý oluþturmaktaydý. Olgularýn % 21.7’si West sendromu tanýsý aldý. West sendromu tanýsý alan olgularýn, ortalama konvülsiyon baþlama yaþý 3.4±2.5 ay olarak saptandý.
TARTIÞMA ve SONUÇ: Ýnfantil dönemde baþlayan epilepsilerinde etiyolojik yönden en büyük grubu semptomatik olgular oluþturmaktadýr. Semptomatik grupta da yaygýn serebral hasara yol açan etiyolojik faktörlerin daha fazla bulunduðu görülmüþtür.

INTRODUCTION: The aim of this study was to evaluate the etiology of epilepsies in infancy and to identify underlying central nervous system disorders in symptomatic cases.
METHODS: One hundered eighty six patients diagnosis with epilepsy between 1 and 24 months were evaluated and the etiologic factors and clinical characteristics were compare.
RESULTS: The mean age of the onset of convulsions in infancy was found to be 7.1±5.7 months. Of the 186 cases, 69.4 % were symptomatic group and 30.6 % cryptogenic-idiopathic group.
In the symptomatic group, the main etiologic groups resulting in clinical condition were prenatal and perinatal factors (50.3 %), developmental cerebral anomalies (12.4 %), neurocutaneus syndromes (6.2 %) and cerebrovascular disorders (4.6 %). Of all cases 21.7 % were diagnosed as West syndrome. In of these patients, the mean age of onset was found to be 3.4±2.5 months.
DISCUSSION AND CONCLUSION: In epilepsies with the onset in infancy etiology of the majority is symptomatic epilepsy and in these patients the most common etiologic factors are generalized cerebral damage.

Abstract | Full Text PDF

Bu retrospektif çalýþmada katarakt ekstraksyonu sýrasýnda kapsüler desteðin yitirildiði olgularda kliniðimizde implante edilen ön kamara (AC ‹OL) ve skleral fiksasyonlu arka kamara göziçi lenslerinin (SF PC ÝOL) klinik sonuçlarýný karþýlaþtýrdýk.
Çalýþmaya SSK Göztepe Hastanesi Göz Servisinde Nisan 2001-Mayýs 2003 tarihleri arasýnda katarakt ekstraksyonu yapýlan ve arka kapsül desteði olmadýðýndan 26’sýna ön kamara göziçi lensi, 16’sýna da arka kamara skleral fiksasyonlu göziçi lensi implante edilen toplam 42 hasta dahil edildi.Hastalar iki gruba ayrýldý- AC IOL grubu ve SF PC IOL grubu olmak üzere-ve postoperatif görme keskinliði, To deðiþimleri, korneal pakimetri ve astigmatizma yönünden karþýlaþtýrýldý.
Postoperatif Vo, To deðiþimleri, pakimetri ve astigmatizma açýsýndan iki grup arasýnda anlamlý bir fark saptanmadý.
AC ve SF PC ÝOL implantasyonu katarakt ekstraksyonu esnasýnda kapsüler desteðin yitirildiði vakalarda baþvurulan iki yöntemdir. Son dönemlerde literatürde bu iki yöntemin birbirlerine üstünlükleri olmadýðý konusundaki görüþler aðýrlýk kazanmaktadýr. Bizim çalýþmamýz da bu görüþü desteklemektedir.

In this retrospective study we compared the clinical results of the anterior chamber ›ntraocular lenses and scleral fixated posterior chamber intraoculer lenses implanted in eyes with lack of posterior capsular support.We included 42 patients who were operated in SSK Göztepe Educational Hospital between the dates April 2001-May 2003, Anterior Chamber Intraocular lens (AC IOL) was implanted to 26 of the patients and Scleral fixated posterior chamber IOL (SF PC IOL) was implanted to 16 of them. We compared the Visual acuity, Intraocular pessure changes, corneal pachimetry and astigmatism
results of both groups and we found that there was no any significant difference between the two groups in neither of these parameters.
AC IOL and SF IOL implantation are two methods used in eyes with the lack of posterior capsular support. In the recent literature most authors agree that none of these methods is superior to the other. Our results also support this view.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Postmenopozal kadýnlarda hipertansiyon ve vücut kitle indeksinin (BMI), endometrial kalýnlýk ile iliþkisinin araþtýrýlmasý.
YÖNTEM ve GEREÇLER: Çalýþma gruplarýný 27 hipertansif (>140/90 mmHg) (hipertansif grup), 24 obes (BMI>27 kg/m2) (obes grup) ve 20 saðlýklý (BMI=20-25 kg/m2) (kontrol grubu) postmenopozal olgu oluþturdu. Tüm olgularda rutin incelemelerle birlikte transvaginal ultrasonografi ile anteriorposterior duvardan endometrial kalýnlýk ölçüldü. Endometrial kalýnlýðýn 5 mm’yi geçtiði olgulardan endometrial biyopsi alýnarak patolojik inceleme yapýldý. Endometrial kalýnlýk ile hipertansiyon ve obesite iliþkisi araþtýrýldý. Ýstatistiksel analizde Chi Square testi kullanýldý.

BULGULAR: 5 mm’yi geçen endometrial kalýnlýk ölçümleri; hipertansif grupta % 71, obes grupta % 80 ve kontrol grubunda % 15 oranýnda tespit edildi (p<0.05). Endometrial biyopsilerde hipertansif ve obes gruplarda % 5 oranýnda endometrial hiperplazi saptandý. Kontrol grubunda hiperplazi tespit edilmedi.
TARTIÞMA ve SONUÇ: Sonuç olarak; hipertansif ve obes postmenopozal kadýnlarda özellikle endometrial kalýnlýk ölçümü yapýlmalý ve 5 mm’yi geçen olgularda patolojik incelemeye gidilmelidir.

INTRODUCTION: To investigate the relationship between endometrial thickness and hypertension and body mass index in postmenopausal women.
METHODS: Seventy one postmenapausal women were enrolled in this study. 27 of the cases were hypertensive (> 140/90 mm Hg) (hypertensive group), 24 of the cases were obes (BMI>27 kg/ m2) (obes group ) and 20 of them were healty (BMI=20-25 kg /m2) (control group). Routine ultrasonographic examinations were performed for all women and endometrial thickness measured in anterior-posterior diamater. In cases with endometrial thickness > 5 mm endometrial biopsies were taken. The relationship between hypertension, obesity and endometrial thickness were investigated.For statistical analyses Chi-square test was used.
RESULTS: In hypertensive group 71 % of the cases, in obes group 80 % of the cases and in the control group 15 % of the cases had endometrial thickness >5 mm. Endometrial hyperplasia was detected in 5 % of both hypertensive and obes groups but not found in the control group.
DISCUSSION AND CONCLUSION: Endometrial thickness should be measured especially in hypertensive and obes postmenapausal women and endometrial thickness more than 5 mm should be investigated pathologically.

Abstract | Full Text PDF

Anesteziyologlarýn görev ve imajlarý týp camiasýnda tam olarak algýlanamamakta ve bazý problemlere neden olmaktadýr. Cerrahi tekniklerde geliþmeye de katkýda bulunan, anesteziyolojideki büyük ilerlemeye raðmen, anestezi doktorlarýnýn rolü genellikle arka planda tutulmaktadýr.
Biz ameliyathane çalýþanlarýnýn anestezi hakkýndaki fikirleri ve deneyimlerini araþtýrmak üzere bir anket düzenledik. Beraber çalýþtýðýmýz arkadaþlarýn iþimiz hakkýndaki düþündüklerini öðrenmenin önemli olduðunu düþünmekteyiz.
Anket, 326 ameliyathane çalýþandan 222 tanesinden (%67) geri döndü. Katýlýmcýlarýn % 80’i (173 kiþi) anesteziyologlarýn doktor olduðunu ve diðer çalýþma alanlarý olarak yoðun bakým (% 32), aðrý ünitesi (% 38) ve kardiyopulmoner resüsitsyon (% 13) bildirdi. Yetmiþ dört kiþi (% 71) operasyon geçirmiþ ve bunlarýn 48’i (% 47) anesteziden memnun kalmýþtý.
Sonuç olarak, büyük bir üniversite hastanesinde ameliyathene personelinin anestezi uygulamalarý ve uzmanlýðý hakkýndaki bilgileri ve tutumlarýna ýþýk tutan bir anket olmuþtur. Anesteziyologlarýn ameliyathane dýþýndaki görevleri ameliyathanedeki görevleri gibi bilinmektedir.
Biz anesteziyologlarýn, hastalarý ve ameliyathanedeki çalýþma arkadaþlarýmýzý iþimizin önemini ve çalýþma alanlarýmýzý doðru olarak anlamalarý için her fýrsatta daha fazla efor sarfetmemiz gerekmektedir.

The image and status of anaesthesiologists in the eyes of medical and lay communities has always been a problem. Despite a great evolution in anaesthesiology, which has contributed to the progress in the field of surgery, the network media does not always emphases the role of the anaesthetic team. We conducted a survey to explore the operating room team’s idea about anaesthesia and their experiences. We think it is important to know what do our work team think about our job.
Surveys were returned by 222 person (67 %) of 326. Eighty percent of respondents (173) thought that anesthesiologists are doctorsand other working area of the anestesiologist are Intensive care unit (32 %), pain unit (38 %) and Cardiopulmonary
resuscitation (13 %) seventy four (71 %) person had an operation and 48 of them (47 %) are satisfied from anaesthesia.
In conclusion, our survey highlights operating room teams’ knowledge and attitudes about the speciality and practice of anaesthesia in large university hospital. The appreciation of anaesthesiologists’ “nonoperating“ roles and role in safe recovery
was high as well.
We anaesthesiologist should do more efforts to enlighten patients and our operating room team at every opportunity so that they would understand our work fields and evaluate anaesthesiologists correctly

Abstract | Full Text PDF

Kronik obstrüktüf akciðer hastalýðý (KOAH) tanýsýnda birinci basamak doktorlarýn hata yaptýklarý ve spirometriyi az kullandýklarý bilinmektedir. Bu çalýþmada doktorlarýn KOAH ile
ilgili yaklaþýmlarýný öðrenmek amaçlanmýþ ve alýnacak önlemler tartýþýlmýþtýr.
Kasým 2003’te Diyarbakýr ve Mardin’de 1., 2. ve 3. Basamak saðlýk kuruluþlarýndan 230 doktora 13 soruluk anket uygulandý. Çalýþmaya 119 (% 51.7) pratisyen, 68 (% 29.6) intern ve 43 (% 18.7) uzman (9 göðüs hastalýklarý, 23 iç hastalýklarý ve 11 diðer branþ uzmanlarý) alýndý.
Doktorlarýn 157’si (% 68.3) nefes darlýðý, 54’ü (% 23.5) öksürük, 15’i (% 6.5) balgamýn öncelikli semptom olduðunu belirttiler. Süre ile semptom bilgisi karþýlaþtýrýldýðýnda, çalýþma
süresi arttýkça bilgi düzeyi azalmaktaydý (p=0.007).
Kesin tanýnýn spirometri (SFT) ile konacaðý konusundaki bilgi düzeyi çalýþma süresi arttýkça azalmaktaydý(p=0.0001). Bu konu en fazla göðüs hastalýklarý uzmanlarý, sonra intern doktorlar tarafýndan bilinmekteydi. Branþlar arasýnda fark anlamlý bulundu (p=0.0001). Tanýda SFT’yi gerekli görme, kurumunda SFT olan doktorlarda % 78 iken olmayanlarda % 56 oranýnda saptandý (p=0.0001). SFT’si olan kurumlarýn doktorlarý SFT olmayanlara göre 2.73 (1.51-4.95) kat daha fazla spirometrik incelemeyi gerekli gördü. KOAH geliþiminde risk faktörleri ve alýnacak önlemler, tedavi seçimleri ve kullandýklarý antibiyoterapi yönünden doktorlar arasýnda çalýþma süresi ve branþ yönünden istatistiksel olarak anlamlý bir fark yoktu.
KOAH tanýsýnda bilgi düzeyi doktorluk süresi arttýkça azalmaktadýr ve SFT cihazý bulunmayan kurumlarda doktorlarýn bilgi düzeyi daha kötüdür. Periyodik olarak bu konuda eðitim verilmesi ve birinci basamak saðlýk kuruluþlarýnda SFT cihazý bulundurulmasý bu hastalýkla mücadelede faydalý olacaktýr.

It is known that primary care level doctors make mistakes and use spirometry less for the diagnosis of COPD. In this study, it was aimed to learn the approach of doctors about COPD and precautions that must be taken were discussed.
A questionnaire including 13 questions were applied to 230 doctors from 1.,2. and 3. care levels in Diyarbak›r and Mardin in November 2003. 119 (% 51.7) practitioners, 68 (% 29.6) interns and 43 (%18.7) specialists (9 chest diseases, 23 internal diseases and 11 other) were included. Of the doctors; 157 ( % 68.3) expressed dyspnea, 54 (% 23.5) cough, 15 (%6.5) sputum as a symptom of priority. Comparing the period of being a doctor with knowledge of symptom,the level of knowledge was found to decrease as the period increased and this difference was significantly important (p=0.007). The level
of awareness that spirometry (SFT) is the definite diagnosis method decreased as the period of being a doctor increased (p=0.0001). This subject was best known by chest diseases specialists then intern doctors. Significant difference was found between branches (p=0.0001). Finding SFT necessary for diagnosis was detected as % 78 in doctors having SFT in their institutions and as % 56 in doctors not having PFT (p=0.0001). The doctors having SFT found spirometric investigation necessary 2.73 (1.51-4.95) fold higher than the doctors not having SFT.
Statistically no significant difference was detected among the doctors about period and branch relating the risk factors of COPD, precautions that must be taken the choice of treatment and usage of antibiotics.
The level of information decreases among doctors as the period of being a doctor increases and in the places not having PFT the level of knowledge of doctors is worse. Periodic education and providing PFT in the primary care level will be usefull in the struggle against this disease.

Abstract | Full Text PDF

Bu çalýþmada 81 adet % 10 formalin ile fikse edilmiþ ve herhangi bir makroskobik patoloji içermeyen eriþkin kadavra beyni kullanýlarak ventriculus tertius ile yakýn komþuluklarý bulunan commissura anterior, corpus pineale ve massa intermedia morfometrik olarak incelenmiþtir.
Ölçümlerimizde commissura anterior’un ön-arka mesafesi 2.5±0.56 mm (3.8-1.1 mm.), yüksekliði ise 3.9±0.8 mm (5.8-1.84 mm.) olarak gözlendi.
Massa intermedia’nýn fornix cerebri’ye olan uzaklýðý 5.25±1.78 mm (9.2-1.44 mm.) olarak saptandý. Massa intermedia foramen interventriculare’ye 4±0.91 mm (6.3-2.5 mm.), ven-trikül tabanýna ise 6.26±1.26 mm (8.2-3.1 mm.) uzaklýktaydý. Ayrýca massa intermedia, commissura anterior’a 6.58±1.2 mm (9.04-4.22 mm.), commissura posterior’a ise 9.76±2.08 mm (13-3.1 mm.) mesafede saptandý.
Son aþamada ise corpus pineale’nin ön-arka mesafesi 6.62± 1.5 mm (9.3-1.88 mm.), yüksekliði ise 3.78±0.65 mm (5-2.4 mm) olarak saptandý.

This study used 81 adult cadaver cerebral hemispheres without macroscopic pathology, fixed with 10 % formalin to investigate the morphometry of the anterior commissure, pineal body and massa intermedia which are in close relation with the third ventricle.
We observed the anterior-posterior distance of the anterior commissure as 2.5±0.56 mm (max. 3.8-min. 1.1 mm), and height as 3.9±0.8 mm (max. 5.8-min. 1.84 mm).
The distance of the intermediate mass to the cerebral fornix was measured as 5.25±1.78 mm (max. 9.2-min. 1.44 mm). The distances of massa intermedia to the interventricular foramen and to the lowest point of the ventricle were 4±0.91 mm (max. 6.3-min. 2.5 mm.) and 6.26±1.26 mm (max. 8.2-min. 3.1 mm), consequently. The distance of the massa intermedia to the anterior commissure was 6.58±1.2 mm (max. 9.04-min. 4.22 mm), and the posterior commissure was 9.76±2.08 mm (max. 13-min. 3.1 mm). The anterior-posterior distance of the pineal body was 6.62±1.5 mm (max. 9.3-min. 1.88 mm.) and the height was 3.78±0.65 mm (max. 5-min. 2.4 mm.)

Abstract | Full Text PDF

Bu çalýþmada diyabetik hastalarda geliþen retinopatinin ateroskleroz, yüksek duyarlý C reaktiv protein ile iliþkisinin saptanmasý amaçlandý.
SSK Göztepe Eðitim ve Araþtýrma Hastanesi Diyabet bölümünde takip edilmekte olan retinopati saptanan 27 ve retinopatisi olmayan 27 olmak üzere toplam 54 tip II diyabetik hasta ve kontrol grubu olarak herhangi bir sistemik hastalýðý olmayan 15 olgu çalýþmaya dahil edildi. Tüm olgularda tam oftalmolojik muayene yapýlýp saptanan retinopatiler derecelendirildi. Ateroskleroz varlýðýný saptamak için karotis ve popliteal arterde dopler ultrasonografik inceleme yapýldý. Kan lipid deðerleri ve yüksek duyarlý C reaktiv protein deðerleri ölçüldü ve vücut-kitle indeksleri (BMÝ) hesaplandý. Hipertansiyon varlýðý da araþtýrýldý.
Ateroskleroz ve sistolik hipertansiyonun diyabetik retinopati geliþiminde etkli risk faktörleri olduklarý saptandý. Retinopati geliþimi yaþ, cinsiyet, BMÝ, hiperlipideminin cinsi, diyastolik hipertansiyon, yüksek duyarlý C reaktiv protein ile iliþkilendirilemedi.
Retinopati diyabetik hastalarda gerekli önlemler alýnmadýðý takdirde körlükle sonuçlanabilen çok ciddi bir komplikasyondur. Karotid arterdeki aterosklerozun retinal iskemi yolu ile retinopati geliþim riskini artýrdýðý düþünülmektedir. Bu çalýþmada aterosklerozun diyabetik retinopati geliþiminde etkili risk faktörlerinden biri olduðu sonucuna ulaþýldý.

In this study we aimed to evaluate the relation of atherosclerosis and retinopathy in patients with Diabetes Mellitus.
54 diabetic patients followed by SSK Goztepe Educational Hospital Diabetes Clinic-27 with, and 27 without retinopathywere included in the study. 15 participants without any sistemic disease were chosen for the control group. All the participants underwent complete ocular examination including visual acuity, anterior and posterior segment examinations. Any retinopathy present was graded. Carotid and popliteal Dopler ultrasonografic examinations were performed. The levels of lipids, high sensitiv C Reactive Protein (hsCRP) and BMÝ were assessed.The presence of hypertension were evaluated.
Atherosklerosis and systolic hipertension were associated with an increased risk of diabetic retinopathy. The age of the patient, gender, BM‹, dislipidemia, diastolic hipertension, the level of hsCRP had no significant association with the retinopathy.
Blindness is the severe complication of diabetes occuring in the lack of appropriate treatment. Atherosklerosis of the carotid artery causing ischemia is suspected
to increase the risk of retinopathy In this study we found that aterosklerosis is significantly assosiated with diabetic retinopathy.

Abstract | Full Text PDF

Çalýþmamýzda pulmoner sarkoidozlu hastalarda mediastinoskopiye göre daha az invaziv taný metodu olan fiberoptik bronskoskopinin (FOB) deðerini araþtýrmak istedik. Kliniðimizde sarkoidoz tanýsý konulan 63 olgu incelemeye alýndý. Olgularýn 37’si kadýn olup, yaþlarý 17 ile 66 arasýnda deðiþmekte, yaþ ortalamalarý 45±11 yýl; 26 erkek olgunun yaþlarý 16 ile 53 arasýnda deðiþmekte, yaþ ortalamalarý 36±10 yýl idi. Sarkoidoz tanýsý olgularýn 27’sinde FOB, 23’ünde mediastinoskopi, 4’ünde cilt biyopsisi, 1’inde diþeti biyopsisi, 1’inde skalen biyopsi, 7 olguda klinik radyolojik olarak konuldu. 63 olgudan FOB uygulanan 60 olgunun 27 (% 45)’sinde transbronþial iðne aspirasyon biyopsisi (TB‹AB) ile tanýya varýldý. Radyolojik olarak Evre I 25 olgunun 5 (% 20)’inde, Evre II 35 olgunun 20 (% 57)’sinde, Evre III 3 olgunun 2 (% 67)’sinde TBÝAB ile taný konuldu.
Sonuç olarak; özellikle parankimal tutulumu yaygýn olan Evre II ve Evre III olgularda TBÝAB sarkoidozun morfolojik tanýsýnda etkili ve güvenli bir metod olduðu ve bu sonuçlarýn literatürle uyumlu olduðu bulundu.

In this study, we aimed to assess the diagnostic value of fiberoptic bronchoscopy (FOB) as a less invasive method than mediastinoscopy in patients with pulmonary sarcoidosis 63
patients with pulmonary sarcoidosis were enrolled into study from our clinic. Out of 63, 37 were females, and their ages ranging from 17 to 66 year, with a mean age 45±11 year and 26 male patients had an age ranging from 16 to 53 year with a mean age 36±10 year. 27 of the patients diagnosis is obtained with FOB, 23 of them with mediastinoscopy, 4 of them with skin biopsy, 1 of them with buccal biopsy, 1 of them with
scalen biopsy and 7 of the patients accepted as sarcoidosis clinically and radiologically. We made FOB 60 patients of 63, and out of 60,27 patients (% 45) transbronchial lung biopsies (TBLB) results were revealed the diagnosis. In stage 1: out of 25, 5 cases (% 20), in stage 2: out of 35, 20 cases (% 57), in stage 3: out of 3.2 cases (% 2) diagnosis is obtained with TBLB.
As a conclusion; TBLB is an effective and safer method in diagnosis of pulmonary sarcoidosis especially with parenchymal involvement. We found that, our results coincide with the literatures, recently.

Abstract | Full Text PDF

The prevelance of tuberculosis has been increasing in any age and during perinatal period as well. In this study we presented a case for whom tuberculosis could not be excluded in differential diagnosis despite he was given prophylaxis for gestational
tuberculosis infection: A 3,5-month-old infant was admitted to our clinic with high fever, respiratory distress and failure to thrieve. Thorax and abdominal radiologic imagings
proved multiple hypointense consolidations in spleen and lungs in addition to enlargement of lymph nodes. Cystic fibrosis, malignancy and histiocytosis were excluded in diagnosis
by sweat test, bone marrow aspiration and other laboratory work-up. In the ligh of the history, clinical and radiological evaluation, the patient was considered as perinatal tuberculosis, since his mother was cured for gestational tuberculosis in the second month of her pregnancy. As he had received isoniazid after birth, we concluded that the progression of the disease to disseminated infection was due to inadequate prophylaxis
with single drug.

Abstract | Full Text PDF

Pancreatic cancer remains a highly lethal disease in spite of new developments in early diagnosis and marked improvements in surgical morbidity and mortality. An important goal
in the treatment of patients with pancreatic cancer is to avoid unnecessary prosedures. Staging laparoscopy has been inroduced to prevent patients with advanced tumor disease from unnecessary laparotomy and as a diagnostic tool in neoadjuvant treatment protocols. The results of staging laparoscopy in four patients with pancreatic cancer discussed under the light of literature.

Abstract | Full Text PDF

Traumatic diaphragmatic hernia; is the known result of the blunt or penetrating thoracoabdominal trauma, on the other hand it’s commonly ignored complication. The diagnosis can be delayed even month or years if there are no contributing radiologic findings, signs at physical examination after acute period. The most important point at the diagnosis of diaphragmatic hernia after blunt or penetrating trauma in the remembering
the possibility if a detailed history is not taken the diagnosis and treatment may be delayed. For this reason a detailed history will help the diagnosis. In this article a penetrating
thoracoabdominal trauma which had clinical signs after 2 months has been discussed accompanied with literature.

Abstract | Full Text PDF

Imperforate hymen is a rare occurrence in younger women resulting in hydrocolpos and hydrometrocolpos. Although variations in hymen development occur, complete blockage by the hymen of the vaginal orifice is rare, occuring in approximately 0.05 % to 0.1 % of female newborns. Most commonly, imperforate hymen is not detected until puberty with girls presenting at 13 to 15 years of age, when symptoms begin to appear but menstruation appears not to have begun. The symptoms after the on set of puberty are due to accumulation of menstrual blood within the vaginal outlet tract. We present a case of hematometra due to congenital imperformed hymen in an 18-year-old girl. The syptomps, the diagnostic methods and the treatment of the malformation are reported and discussed.

Abstract | Full Text PDF

The hyper IgM syndrome is a rare, inherited immune deficiency disorder and somatic. The most common form of hyper IgM syndrome is of X-linked inheritance and caused by CD40
ligand gene mutations. Patients usually become symptomatic before the second year of life, with recurrent pyogenic and opportunistic infections such as P. carinii and Cryptosporidium.
In this article, we reported three cases that have recurrent infections and reviewed the clinical features of this rare disease.

Abstract | Full Text PDF

Eagle syndrome, is caused by ossification of stylohyoid ligament and/or elongation of processus styloideus. It is presented by symptoms like recurrent throat pain, foreign body sensation in the throat, dysphagia. Diagnosis can usually be made by means of physical examination by digital palpation of styloid process within the tonsillary fossa. Treatment of the Eagle Syndrome is primarily surgical. Shortening procedures of the styloid process by intraoral or external approach are used. In this study, we aimed to show that patients with Eagle Syndrome can also be presented by assimmetry within the laryngeal structures of the neck during swallowing.

Abstract | Full Text PDF

In literature, uterine anomalies are seen 10-15 times more in infertile cases. Our aim is to point out the importance of evaluation of uterine anomalies, with our case. Special diagnostic
procedures to detect uterine anomalies are not usually performed before reproductive performance is tested. Most patients evaluated for repeated abortion and found to have a uterine anomaly will have a septate uterus. A few will have other anomalies, mostly the bicornuate uterus. Fetal survival rates are higher after septate uterus repair than after other
repairs.

Abstract | Full Text PDF

Acute transverse myelitis is an uncommon disease characterized by abrupt onset of progressive weakness and sensory disturbance in the lower extremities accompanied by bladder and bowel disfunction. It’s course is variable; 50 % of patients make a full recovery, 10 % have no recovery, and 40% recover incompletely. Steroids are used as a treatment model however, it’s effect on the course or prognosis of acute transverse myelitis is controversial.
In this study, four children with acute transverse myelitis are presented. Our aim is to discuss the role of high dose methylprednisolone therapy in children with acute transverse myelitis.

Abstract | Full Text PDF