ST segment deðiþikliklerinin miyokardial doku perfüzyonunun derecesiyle yakýn iliþkide olduðu gösterilmiþtir. Akut miyokard infarktüsünde trombolitik sonrasý komplet ST segment rezolüsyonu, düþük mortalite ve daha iyi sol ventriküler fonksiyonlarla birliktedir. Biz çalýþmamýzda, akut ST elevasyonlu MÝ tanýsý alýp trombolitik (streptokinaz) veya birincil perkütan giriþim tedavi yöntemlerinden biri uygulanan hastalarda, bu iki tedavi yönteminin, miyokardial doku reperfüzyonunun iyi bir göstergesi olan ST segment rezolüsyon derecesine etkilerini karþýlaþtýrdýk.
Çalýþmaya ST elevasyonlu miyokard infarktüsü ile baþvuran 113 hasta alýndý. Birincil perkütan giriþim veya trombolitik uygulanan hastalarýn iþlem öncesi ve sonrasý 180. dakikada çekilen EKG’lerinde toplam ST segmentleri her hasta için hesaplanarak farklarý alýndý (delta). Bu delta deðerleri her iki grup için karþýlaþtýrýldý.
Birincil PCÝ grubunda ortalama delta deðeri 5.44±2.2 mV iken, trombolitik grubunda bu deðer 3.88±1.9 idi. Ýki deðer arasýndaki istatistiksel fark belirgin derecede anlamlý idi
(p<0.0001).
Akut miyokard infarktüslü hastalarýn tedavisinde perkütan koroner giriþimin, miyokardiyal doku perfüzyonunun bir göstergesi olan ST segment rezolüsyonunu, trombolitik tedaviden
daha fazla saðladýðýný gördük.

ST-segment changes have been shown to correlate with myocardial tissue perfusion. Complete ST-segment resolution after thrombolysis in acute myocardial infarction is associated with lower mortality and better left ventricular function. The main
goal of this study was to determine whether PCI and thrombolytic therapy achieve comparable reperfusion rates, as evidenced by ST-segment resolution.
We were analyzed 113 patients diagnosed MI with ST segment elevation. Patients managed with both percutan intervention and thrombolytic approach were evaluated according to their EKG premanaged and EKG postmanaged 180. second. The difference of ST segment elevation on premanagement EKG and postmanagement 180. second EKG called “delta”.
Delta was compared in both managed group. Delta was 5.44±2.2 mV in managed with primer percutan approach, 3.88±1.9 mV in managed with thrombolytic approach. The
difference in these two groups was significant istatistically (p<0.0001).
We concluded that percutan coroner approach was better than thrombolytic approach in management of patients diagnosed with MI.

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Hastanemiz Çocuk Kliniðinde Ocak 1997-Aralýk 2003 tarihleri arasýnda yatýrýlarak izlenen, yaþlarý ortalama 4.67 olan 367 zehirlenme olgusu retrospektif olarak deðerlendirildi. Olgularýn % 47.4’ü 2-6 yaþ grubundaydý. Tüm olgularda zehirlenme etkeni belirlendi. En sýk farmakolojik etken santral sinir sistemi ilaçlarý % 23.38 olarak saptanýrken, farmakolojik
olmayan etkenlerde kostik-korozif madde alýmý (% 70) ilk sýrayý almaktaydý. Zehirlenmelerin % 89.9’u kaza, % 10.08’i intihar amaçlý gerçekleþmiþti. Zehirlenme nedeniyle baþvurular
en sýk ilkbahar ve kýþ aylarýnda yapýlmýþtý. Olgularýn % 1.6’sý exitus ile sonuçlandý. Exitus olgularýnýn hepsi mantar zehirlenmesiydi.

During the period of January1997-December 2003, 367 cases of poisoning, avarage age is 4.67, who were hospitalized in the department of pediatrics in our hospital were evaluated
retrospectively. 47.4 % of the cases were seen in the age group of 2-6 years. All the cases of poisonings were found. Most of the intoxications occured with central nervous system drugs (23.38 %) among the pharmaceutical products. Accidental corrosive ingestion (70 %) was the first among the nonpharmaceutical products. Accidental causes were 89.9 % of the cases. 10.08 % of the cases were exposed to the poisoning because of suicide. Most frequently, poisoning cases were taken to the emergency room on Spring and Winter. 1.6 %
of the cases were died. All the causes of the death were mushroom intoxications.

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Bu çalýþmada, günübirlik anestezi uygulanan hastalarda, desfluran ve sevofluranýn anestezi idamesi ve erken derlenme dönemindeki özelliklerini karþýlaþtýrmayý amaçladýk.
Çalýþmaya jinekolojik habaset nedeniyle intrakaviter radyoterapi uygulanacak 46 hasta alýndý. Bir mg/kg fentanil, 0.05 mg/kg mivakuryum ve 2 mg/kg propofol ile anestezi indüksiyonu yapýldýktan sonra LMA yerleþtirilerek, idamede Grup I’de % 3-6 desfluran, Grup II’de % 1-2 sevofluran kullanýldý. Yeterli anestezi derinliði, volatil ajan titrasyonu ve 0.5 mg/kg fentanil uygulamasýyla saðlandý. Anestezi sonrasýnda LMA çýkarýlma zamaný, spontan soluma, sözel uyarýlara yanýt, oryantasyon ve modifiye Aldrete skorunun 9 deðerine ulaþtýðý süre kaydedildi. Hemodinamik parametreler anlamlý olmamakla beraber Grup I’de daha yüksekti. Göz açma, sözel uyarýlara yanýt, oryantasyon ve modifiye Aldrete skorunun 9 olma zamaný Grup I’de daha kýsa bulundu (p<0.05). Yan etkiler arasýnda anlamlý farklýlýk gözlenmedi.
Sonuç olarak, günübirlik anestezi uygulamalarýnda kullanýlan desfluran ve sevofluranýn, intraoperatif dönemdeki özelliklerinin benzer olduðu, ancak desfluran ile daha hýzlý erken derlenme saðlandýðý sonucuna varýldý.

The aim of this study was to compare the characteristics of desflurane and sevoflurane during maintenance of anaesthesia and early recovery.
Forty-six patients with gynaecologic malignancy scheduled for intracaviter radiotherapy were included in the study. After induction of anaesthesia with fentanyl 1 mg/kg, mivacurium 0.05 mg/kg and propofol 2 mg/kg, a laryngeal mask was placed. During maintenance, desfurane 3-6 % was used in Group I, and sevoflurane 1-2 % in Group II. The necessary level of anaesthesia was obtained by titration of the concentrations of
volatile agents used and fentanyl 0.5 mg/kg. Times to spontaneous respiration, response to verbal command, LMA removal, orientation and modified Aldrete score to be 9 were recorded. Although it was not significant, hemodynamic variables were higher in Group I. Times to spontaneous respiration, response to verbal command, orientation and Aldrete score to be 9 were shorter in Group I (p<0.05). There was not any statistically
significant difference between side effects.
We concluded that desflurane and sevoflurane have similar characteristics during intraoperative period of outpatient anaesthesia but desflurane provides more rapid early recovery.

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Birincil immün yetersizlik sendromlarý özellikle çocukluk döneminde karþýlaþýlan önemli bir hastalýk grubudur. Klinikte tekrarlayan ve çoðu kez tedaviye güç yanýt veren infeksiyonlar þeklinde belirir.
Çalýþmamýzda, Ocak 1997-Aðustos 2004 tarihleri arasýnda kliniðimizde birincil immün yetersizlik tanýsý alan 103 hasta semptomlarýn baþlangýç yaþý, cinsiyet daðýlýmý, baþvuru þikayetleri, soygeçmiþ, tespit edilen immün yetersizlik tipi, infeksiyon odaklarý, ek patolojiler ve komplikasyonlar yönünden retrospektif olarak deðerlendirildi. Bu çalýþmada amacýmýz özellikle hangi koþullarda veya hangi hastalarda PIYs düþünülmesi ve ileri tetkiklerin yapýlmasý gerektiðini belirlemekti.
Takip edilen toplam 103 hastanýn 37’si kýz (% 35.9), 66’sý erkek (% 64.1), ortalama taný yaþý 30.4 aydý. Olgularýn % 81.2’sinde humoral immün yetersizlik tespit edilirken, en sýk gözlenen birincil immün yetersizlik sendromu % 42.7 ile IgA eksikliðiydi. Baþvuru þikayetleri tekrarlayan öksürük ataklarý (% 59.2), ateþ (% 45.6), tekrarlayan hýrýltý ataklarý (% 36.9), sýk orta kulak infeksiyonu (% 34.9), tekrarlayan veya kronik ishal (% 28.2) ve tekrarlayan cilt infeksiyonlarýydý (% 8.8). En sýk tespit edilen infeksiyonlar pnömoni (% 48.5), üst solunum yolu infeksiyonu (% 46.6), bronþiolit (% 33.0), otit media (% 35.0), gastroenterit (% 28.2) ve sinüzitti (% 27.2).
Çalýþma sonucunda tekrarlayan ve veya komplike sinopulmoner infeksiyonlarda; uzamýþ veya tekrarlayan gastroenteritlerde; etkeni belirlenemeyen tekrarlayan üriner sistem infeksiyonlarýnda; fýrsatçý veya alýþýlmadýk organizmalarla olan infeksiyonlarda; alýþýlmadýk lokalizasyonlardaki infeksiyonlarda; tekrarlayan cilt veya organ derin abselerinde; aþý reaksiyonlarýnýn veya döküntülü hastalýklarýn çok aðýr seyretmesi durumunda; aile öyküsünde atopi, erken sütçocuðu ölümleri, otoimmün hastalýk gibi bulgularý olan çocuklarda immün yetersizlik yönünden araþtýrýlmaya gidilmesi gerektiði sonucuna vardýk.

Primary immunodeficiencies which is diagnosed especially in childhood period are important group of the disorders. Clinically they appear as recurrent infections. In our study, 103 patients with primary immunodeficiency syndromes followed in our clinic between January 1997-August 2004 are analyzed retrospectively in terms of age at diagnosis, gender, symptoms at admission, family history, type of immunodeficiency, origin of infections, type of infections, accompanying diseases and complications. The aim was to evaluate in which group of patients primary immunodeficiency syndromes should be suspected and more detailed investigations must be carried out.
In this study 37 of 103 patients with primary immunodeficiency were girls, while 66 of them were boys. The average age of patients at diagnosis was 30.4 months. While % 81.2 of all grup is humoral immune deficienc, most frequent diagnosed type of primary immüne deficiencies was selective IgA deficiency (% 42.7). The main observed complaints were: recurrent cough episodes (% 59.2), fever (% 45.6), recurrent wheezing attacks (% 36.9), frequent otitis media (% 34.9), prolonged diarrhea (% 28.2), and recurrent skin infections (8.8 %). Most frequently encountered infections were pneumonia (% 48.5), upper respiratory tract infections (% 46.6), bronchiolitis (% 33.0), otitis media (% 35.0), gastroenteritis (% 28.2) and sinüsitis (% 27.2).
In conclusion in a case with recurrent and or complicated sinopulmonary infections; urinary tract infections without an identified cause; chronic diarrhea or recurrent gastroenteritis; infections with unusual or opportunistic organisms; infections in unusual locations; recurrent deep skin or organ absess; extremely serious vaccine reactions; if there were atopy, early infant death or autoimmune disease present in family
history of child we should investigate for immune deficiencies.

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Çalýþmamýzýn amacý, intertrokanterik femur kýrýklarýnda medial desteði olan ve olmayan olgularda, 6 derece açýlý proksimal femur çivilerinin sonuçlarýný karþýlaþtýrmaktýr.
Ýntertrokanterik femur kýrýðý olan 33 olgu çalýþmaya alýndý. Medial desteði olan 15 olgu, medial desteði olmayan 18 olgu sonuçlarý istatistiksel olarak karþýlaþtýrýldý.
Medial desteði olan grubun Sanders travmatik kalça skalasý sonuçlarý, medial desteði olmayan gruba göre istatistiksel olarak ileri derecede anlamlý farklý bulundu.
Sonuç olarak, medial desteði olmayan intertrokanterik femur kýrýklarýnda aðrý, yürüme, fonksiyon, kas kuvveti, günlük aktiviteler ve radyolojik sonuçlarý medial desteði olan kýrýklara
göre daha kötüdür.

In this study our aim is to identify the results of the intertrocanteric femur fractures. We want to compare the facts which have medial support with the facts which have no medial support.
We receipt 33 intertrocanteric femur fracture patients. We compare the 15 medial supported patients with the 18 nonsupported, statistically.
There are statistical difference with the medial supported group and the non-supported group. In this comparison, we use Sanders traumatic hip scale.
In conclusion, the medial supported group’s results are better than the non-supported group. In this scale, comparison elements are pain, walking, function, muscle force, daily activity
and radiology results.

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Subakut sklerozan panensefalit (SSPE), kýzamýk infeksiyonu geçirildikten yýllar sonra geliþen, ilerleyici inflamasyon ve sklerozla karakterize yavaþ seyirli bir viral infeksiyondur. Olgularýn çoðunda baþlangýç yaþý 5-15 yaþ arasýndadýr ve erkeklerde kýzlardan 2 kat fazla görülür. Hastalýk tipik olarak kiþilik deðiþikliði, ilerleyici miyoklonik aktiviteyle baþlayan ve yaygýn nörolojik bozukluklara yol açan, nörodejeneratif bir bozukluktur. Hastalýk hýzlý seyirli olup, semptomlar ortaya çýktýktan sonra 6-24 ay içinde ölüm görülür.
Bu çalýþmada, 1998-2003 yýllarý arasýnda kliniðimizde taný konularak tedavileri düzenlenen toplam 19 SSPE olgusunu sunduk. Olgularýmýz 14 erkek, 5 kýz olup, ortalama yaþ 6.3± 2.5 yýl (2-10 yýl), kýzamýk infeksiyonunu geçirme yaþý 1.3±0.9 yýl (3 ay-2.5 yýl) olarak bulundu. Altý olguya aþý yapýlmamýþtý. Ýki olgunun ise aþý yapýlýp yapýlmadýðý bilinmiyordu. Özellikle evre II’de gelen hastalarýmýzda; yürüyememe ve denge bozukluðu % 46, kiþilik deðiþikliði ve konuþma bozukluðu % 38, unutkanlýk ve baþýn öne düþmesi % 30, halsizlik, konvülziyon, baþ aðrýsý ve istemsiz hareket % 23, idrar kaçýrma, sýçrama, bilinç kaybý % 15, yutma güçlüðü % 7.6 tesbit edildi. Oniki olguya isoprinosin ve interferon, 5 olguya isoprinosin, 2 olguya interferon tedavisi yapýldý. Dört olgu taný aldýktan ortalama 7 ay sonra kaybedildi.
SSPE’li olgularýmýzý literatür bilgisi altýnda deðerlendirmek için bu çalýþmayý sunduk.

Subacute sclerosing panencephalitis(SSPE) is a slow infection with measles virus that causes progressive inflammation and sclerosis of the brain. It is the rarely seen late complication of measles, mostly occuring at 5-15 years of age. The incidence in males is twice as much as females. SSPE is neurodegenerative diseae which presents typically with changes in behaviour and progressive myoclonic activitiy followed by diffuse neurological
disorsers. The disease is rapidly progressive and the survival time is approximately 6-24 months after the occurence of firts symptoms.
In this study, 19 cases of SSPE, diagnosed and treated in our clinic between 1998-2003, are presented. 14 of the patients were male and 5 were female. Average was 6.3±2.5 years (2-10 years) and the mean age of measles infection was 1.3±0.9 years (3 months-2.5 years). 6 of the patients were unvaccinated. Most of the patients presented at stage 2. On admission, ataxia and gait disorder was seen in 46 %, behavioral changes and disarthria 38 %, amnesia and head-drop 30 %, weakness, convulsions, headache and involuntary movements 23 %, urinary incontinence, myoclonic jerks, loss of consciousness 15 % and dysphagia 7.6 %.12 of the patients were treated with Isoprinosin and Interferon, 5 patients only Isoprinosin and 2 patients Interferon. 4 of them died approximately 7 months after diagnosis.
This study is done to evaluate the clinical course of SSPE and to compare the results with literature knowledge.

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Tüberküloz plörezi, tüberküloz infeksiyonunun herhangi bir döneminde meydana gelebilmesine raðmen sýklýkla birincil infeksiyonun geç bir komplikasyonudur. Bu çalýþmada, 2001-2004 yýllarý arasýnda SSK Süreyyapaþa Göðüs Kalp ve Damar Hastalýklarý Eðitim Hastanesinde tedavi edilen 95 tüberküloz plörezi olgusunun klinik, radyolojik ve laboratuvar özellikleri retrospektif olarak incelendi
Tüberküloz plörezi tanýsý almýþ hastalarýn 38 (% 40)’i kadýn, 57 (% 60)’si erkekti. Yaþlarý 15-79 arasýnda deðiþmekte olup, yaþ ortalamasý 32.98±14.09 idi. Plevra sývýsý, 55 (% 53.7) hastada saðda, 39 (% 41.1) hastada solda yerleþmiþ, 5 (% 5.3) hastada ise bilateral sývý tespit edildi. En sýk görülen semptom göðüs aðrýsý, en az görülen semptom ise balgamdý. P-A grafisinde 37 (% 39.9) hastada parankim lezyonu mevcuttu ve bu hastalarýn üçünde kavite tespit edildi. Taný, olgularýn % 50.5 (n=48)’inde plevra biyopsisi, % 3.2 (n=3)’sinde eksuda niteliðinde sývý ve balgam yayma pozitifliði, % 4.2 (n=4)’sinde sývýda basil saptanmasý ile ve % 42.1 (n=40)’inde de klinik radyolojik olarak konulmuþtu.
Sonuç olarak, tüberküloz plörezi ülkemizde genç hastalarda görülmektedir ve plevra biyopsisi, tüberküloz plörezi tanýsýnda en etkili metotdur. Ancak, plevral biyopsiyle taný konulamayan hastalarda, plevral sývýda lenfosit hakimiyeti, adenozindeaminaz (ADA) düzeyi yüksekliði ve balgam ARB pozitifliði tüberküloz plörezi tanýsý için önemli parametrelerdir.

Although pleuritis can occur at any time after infection with M.tuberculosis, it is classically considered a relatively late manifestation of primary tuberculosis. In this study 95 cases with tuberculous pleurisy were determined clinical, radiological and laboratory features retrospectively in SSK Süreyyapaþa Center for Chest Disease and thoracic surgery between 2001 and 2004
38 (40 %) patients were female, 57 (60 %) were male. Agerange was between 15 and 79 years, the mean age of the patients was 32.98±14.09. The effusion on the right side was in 55 % (53.7) of patients, on the left side in 39 (41.1 %) of patients, and on both sides in 5 (5.3 %) of patients. The commonest symptom was chest pain, the least symptom was sputum. Parenchymal lesion was found 37 (39.9 %) by chest radiograph and cavity was found three of these patients. Tuberculous pleurisy was diagnosed in 50.5 % (n=48) cases by pleural biopsy, in 3.2 % (n=3) cases positive smear of sputum and exudative effusions, in 4.2 % (n=4) cases by positive smear of effusion and in 42.1 % (n=40) cases clinic and radiological.
As a conclusion, tuberculous pleurisy was seen in young patients in our country and pleural biopsy was the most effective method for the diagnosis. On the other hand, for the patients not diagnosed by the pleural biopsy, the presence of lymphocytic predominance, ADA levels and positive smear of sputum are significant parameters for the diagnosis of the tuberculous pleurisy.

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Plevral alanda sývý toplanmalarý plevral efüzyon, parapnömonik efüzyon, ampiyem, transuda, eksüda, komplike ampiyem þeklinde olabilir. Akciðer infeksiyonuna ikincil oluþan plevral efüzyon, predispozan faktörlerle ya da yetersiz tedavi sonucu ampiyeme dönüþmektedir.
1998 ile 2003 yýllarý arasýnda SSK Göztepe Eðitim Hastanesi Çocuk Kliniði Dahiliye servisinden takipli parapnömonik plevral efüzyon ve ampiyem tanýsý alan toplam 63 olgu klinik, labaratuvar ve radyolojik bulgularý ile retroprospektif olarak deðerlendirildi. Olgularýn yaþ ortalamasý 6.01 yýl olup, % 61.9’u erkek % 38.0’i kýz cinsiyet oluþturmaktaydý. E/K = 39/24’dü. Olgularýn 39’unda ampiyem (% 61.9), 24’ünde plevral efüzyon (% 38.1) tespit edildi. Olgularýmýzýn 17’sinde (% 26.9) daha önceden antibiyotik kullaným öyküsü mevcuttu.
Ponksiyon sývýsýnda 9 olguda Streptococcus pneumoniae, 3 olguda metisiline duyarlý Staphylococcus aureus, 1 olguda Haemophylus influenzae, 1 olguda Gram (+) kok üredi. Otuzbeþ ampiyemli ve 10 plörezili olguya tüp drenajý+parenteral antibiyotik, 15 plörezili olguya parenteral antibiyotik, iki komplike ampiyemli olguya fibrinolitik tedavi, ankiste ampiyem geliþen 2 olguya cerrahi tedavi (dekortikayon) uygulandý. Hastanede ortalama kalýþ süresi 30.3±9.9 gün klinik iyileþme süresi 12.9±6.7 gün olarak bulundu.

Kliniðimizde parapnömonik olgulara yaklaþýmda; erken taný konulmasý, uygun antibiyoterapi, ponksiyon sývýsýnýn analizi sonucu ampiyemi destekleyen olgularda etkin antibiyoterapi yanýnda erken tüp drenajý yapýlmasý mortalite ve morbiditeyi azaltmaktadýr. Etkin tedaviye raðmen yanýt alýnamayan olgularda drenaj yetersizliði deðerlendirilerek fibrinolitik tedavi ve dekortikasyon düþünülmelidir.

Collection of fluid in pleural space can be in the form of pleural effusion, parapneumonic effusion, ampyema, transudate, exudate and complicated empyema. Pleural effusion secondary to pneumonia can cause emyema as a result of predisposing factors or inadequate treatment.
63 cases with the diagnosis of parapneumonic effusion and empyema that have been followed up in our pediatrics clinic, between 1998-2003, are analyzed retrospectively with their laboratory and radiologic findings. Mean age of the patients was 6.01 years. 61.9 % of them were male and 38 % were female. 39 of the cases (61.9 %) had empyema and 24 of them (38.1 %) had pleural effusion. 17 of the cases (26.9 %) had history of antibiotherapy. In 9 of the cases S.pneumonia, in 3 cases Methisiline sensitive Staphylococcus Aureus, in 1 case Haemophilus influenza and in 1 case gram (+) coccus was detected in pleural fluid culture. 35 patients with empyema and 10 patients with pleural effusion were treated with chest tube drainage and parenteral antibiotics. 15 patients with pleuresia were treated only with parenteral antibiotics. Fibrinolytic therapy was performed in 2 patients with complicated empyema and 2 patients with empyema underwent decortication. The average duration of hospital stay was 30.3±9.9 days and
clinical improvement was seen in 12.94±6.7 days.
In conclusions; early diagnosis, appropriate antibiotherapy, early chest tube drainage together with effective antibiotherapy in cases with empyema decrease the morbidity and mortality. Fibrinolytic therapy and decortication must be considered if there is poor response to therapy.

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GÝRÝÞ ve AMAÇ: Ailesel Akdeniz atefli akut krizi esnasýnda Q-T segmenti ve Q-T dispersiyonunun incelenmesi.
YÖNTEM ve GEREÇLER: Ailesel Akdeniz ateþi (AAA) akut krizi tanýsý konan 34 erkek hasta çalýþma grubunu, 30 saðlýklý erkek de kontrol grubunu oluþturdu. Q-T mesafesini etkileyen herhangi bir ilaç alanlar çalýþma dýþý býrakýldý. Çalýþma grubunda tedavi öncesi alýnan EKG’de Q-T mesafesi ölçüldü. Ölçümlerde 12 derivasyonlu yüzey EKG kayýtlarý yüksek çözünürlükte taranarak bilgisayar ortamýnda elektronik cetvel kullanýldý. RR mesafesi, Bazett formülüne göre düzeltilmiþ maksimal ve minimal Q-T mesafesi gruplar arasýnda t testi ile karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda yaþ daðýlýmý farklý deðildi (çalýþma grubu 21±1, kontrol grubu ise 21±2 yýl). Ortalama hastalýk süresi 10±5 yýl ve hastalýðýn ailesel görülme oraný % 26 olarak saptandý. Kontrol ve çalýþma gruplarýnda düzeltilmiþ maksimum Q-T süresi sýrasýyla 425±37 ms ve 447±27 ms (p=0.045), düzeltilmiþ minimum Q-T ölçümleri 361±24 ms ve 396±17 ms (p<0.0005), düzeltilmiþ Q-T dispersiyon süresi 65±33 ms ve 51±15 ms (p=0.09) olarak bulundu.
TARTIÞMA ve SONUÇ: Ailesel Akdeniz ateþi akut krizi, Q-T deðerlerinde uzamaya yol açmýþ, ancak Q-T dispersiyonunu anlamlý olarak etkilememiþtir. Bu uzamanýn klinik olarak önemi tam olarak bilinmemekle beraber, tedavide kullanýlan ilaçlarýn Q-T süresini uzatarak potansiyel aritmilere neden olabileceði ve Q-T mesafesini etkileyen ilaçlarýn proaritmik özelliklerinin belirgin olarak ortaya çýkabileceði göz önünde bulundurulmalýdýr.

INTRODUCTION: To investigate the Q-T interval and Q-T dispersion in acute crisis of familial Mediterranean fever.
METHODS: Thirty-four patients during their acute crisis of familial Mediterranean fever (FMF) constituted the study group, while 30 healthy men were included in the control group. Any case taking medications known to effect Q-T interval was excluded from the study. Q-T interval was measured from the EKG before therapy in the study group. Electronic calipers were utilized after obtaining the 12-lead surface ECG recordings, which were scanned at a high resolution and transferred to computer. R-R intervals, maximum and minimum Q-T intervals, which were corrected according to Bazett formula were compared by t test.
RESULTS: The age distribution of FMF didn’t differ in both groups (study group 21±1, control group 21±2 years). The average duration of the illness were 10±5 years and the familial incidence of this disease was found 26 %. The corrected QTmax was measured as 425±37 msec and 447±27 msec (p=0.045), the corrected Q-Tmin was 361±24 msec and
396±17 msec (p<0.0005), corrected Q-T (Q-Tc) dispersion was 65±33 msec and 51±15 msec (p=0.09).
DISCUSSION AND CONCLUSION: Acute FMF crisis prolongs Q-T interval but did not differ Q-T dispersion. Although we don’t know the clinical significance of this prolongation, the drugs using for the treatment
can prolong Q-T interval and cause potential arrhythmias and the proarrhytmic properties of these drugs become evident.

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GÝRÝÞ ve AMAÇ: Multipl sklerozlu (MS) hastalarda tutulan sistemlerin ve hastalýk seyrinin yaþam kalitesine etkilerini araþtýrmak.
YÖNTEM ve GEREÇLER: Kesin MS tanýsý almýþ 45 hasta (27 kadýn, 18 erkek) çalýþmaya alýndý. Hastalar eðitim düzeylerine, çalýþýp çalýþmadýklarýna, hastalýk tipine (relapsing remitting, birincil progresif ve ikincil progresif), tutulan sisteme (piramidal, serebellar, vizüel, sensoriyel, sfinkter tutulumu) ve spastisite olup olmamasýna göre gruplandýrýldý. Nörolojik bozukluk düzeyleri Geniþletilmiþ Özürlülük Durum Skalasý (EDSS=Expanded Disability Status Scale), yaþam kaliteleri Modifiye Farmer Yaþam Kalitesi (QOL=Quality of Life) ile, spastisite ise Modifiye Ashworth Skalasý ile deðerlendirildi.

BULGULAR: Hastalarýn yaþ ortalamasý 37.15±10.49 (22-37), ortalama hastalýk süresi 6.00±3.34 yýl idi. Kadýn ve erkek hastalar arasýnda EDSS ve QOL skorlarýnda farklýlýk bulunmadý. Düþük eðitim düzeyi olan hastalarda EDSS skoru daha yüksekti (p<0.01). Eðitim düzeyi ile toplam QOL arasýnda korelasyon bulunamadý, QOL-MP (MP=týbbi sorunlar) alt skoru arasýnda ise pozitif korelasyon bulundu (p<0.05). Çalýþmayan hastalarda toplam QOL, QOL-FE (FE=fonksiyonel ve ekonomik altölçeði) ve QOL-MP alt skorlarý çalýþan gruba göre anlamlý olarak düþüktü. Spastisite olan grupta toplam QOL ve QOL-MP skorlarý spastisite olmayan gruba göre anlamlý düþük, EDSS ise yüksekti (p<0.05).
Hastalýk tipine göre EDSS skoru ikincil progresif grupta (p<0.01), QOL-MP skoru ise relapsing remitting grupta daha yüksek (p<0.05) bulundu. Sistem tutulumlarýna göre deðerlendirildiðinde ise serebellar tutulum olan grupta toplam QOL, QOL-SR ve QOL-FE alt skala puanlarý serebellar tutulum olmayan gruba göre düþüktü, fark istatistiksel olarak anlamlý idi (p<0.05). Diðer sistemlerin tutulumu ise EDSS ve QOL skorlarýnda anlamlý farklýlýða neden olmadý.

TARTIÞMA ve SONUÇ: Serebellar tutulum ve spastisite hastalarýn yaþam kalitesini olumsuz yönde etkilemektedir.

INTRODUCTION: To examine the effects of the disease course and involvement of functional systems to the quality of life in multiple sclerosis (MS).
METHODS: 45 patients (27 females, 18 males) with definite MS were included in the study. Patients were grouped according to their educational levels, employment status, disease course (primary progresive, secondary progressive and relepsing remitting), involvement of functional systems (pyramidal, sensorial, visual, sphincter, cerebellar) and spasticity (with/without spasticity). Neurological impairment, quality of life and spasticity were assessed by expanded Kurtzke disability status scale (EDSS), quality of life scale (QOL) and modified Ashworth scale, respectively.
RESULTS: The mean age of the patients was 37.15±10.49(22-37), and the mean disease duration was 6.00±3.34. No statistically significant diffference were found in EDSS and QOL scores between male and female patients. EDSS scores were higher in patients with lower educational levels (p<0.01). A positive correlation was noticed between higher educational
levels and QOL-MP(QOL-medical problems), but not with other QOL subscales and total QOL. Total QOL, QOL-FE (QOL- functional and economic) and QOL-MP (QOL-medical
problems) scores were significantly lower in unemployed patients compared to employed ones. In the spasticity group total QOL and QOL-MP scores were significantly lower and EDSS scores were significantly higher than the nonspasticity group (p<0.05). EDSS scores were higher in the secondary progressive group. QOL-MP scores were higher in relapsing remitting group. Assessment of patients due to disease course showed that total QOL, QOL-SR (QOL-social and recreational) and QOL-FE scores were significantly lower in cerebellar disease group (p<0.05). No other statistically significant difference was found between the other functional systems groups.
DISCUSSION AND CONCLUSION: Cerebellar disease and spasticity effects quality of life in MS patients.

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Prolonged hypothyroidism results in hiperplasia of the thyrotropin secreting cells of the hypophysis. The symptoms of the hypothyroidism may accompany the symptoms of hyperprolactinomia and visual loss. ‹t is not easy to distinguish hypophyseal hyperplasia from TSH secreting hypophsis adenomas.

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In 5 %-10 % of patients with acute cholecystitis, calculi obstructing the cystic duct are not found at surgery. Brucellosis is a rare cause of acute acalculous cholecystitis. We report a 52 year-old, previously healthy, man with brucellosis who presented with abdominal pain due to cholecystitis and empyema of gallbladder.
A 52 year-old man presented with fever and abdominal pain for 3 days. The fever ranged from 37.5°C to 39°C. The abdomen was tender in the right upper quadrant regions. Complete blood count revealed a white blood cell count of 6200/mm3. The other laboratory tests were normal. Sonography revealed enlargement of spleen, thickening of the gallbladder wall and empyema of gallbladder. The blood culture grew a Gram negative
rod, wich was subsequently identified as brucella. The standard tube agglutinin titer was 1: 160. After rifampin and doxycycline treatment started, symptoms and signs recovered
without surgical operation at the end of third day. Gall bladder empyema disappeared in control ultrasonographic examination at the end of the first week.

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Ovarian cyst torsion is an emergent mostly seen in adolesance and reproductive period of life. It’s rarely seen in postmenopausal period and also in geriatric population. Color Doppler
Sonography is an excellent tool for the evaluation of ovarian torsion. Torsion results in disruption of the blood supply to the ovary. This should result in a devascularized structure. We report a case of torsioned ovarian cyst in a 84 years old woman.

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In this paper we presented a case with tuberculosis presenting as multiple pulmonary nodules. He was 30 years old. He had no symptom. His chest x-ray showed multiple pulmonary nodules on left lung fields. Physical examination was normal. VATS revealed diagnosis of pulmonary tuberculosis.

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We reported one patient who was have superior sagittal sinüs thrombosis immediately occurred after a minör head injury. This case raise the question, whether endothelial damage due to a sudden rise in intracranial pressure and acceleration trauma may be an under-recognized precipitating factor for cerebral venos sinus thrombosis.

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By means of acute dystonic reaction associated with dehydrobenzperydol administration in one case and metoclopramid administration in other case, we discussed about the general
properties of the treatment protocol of acute dystonic reaction and the side effects of dehydrobenzperydol and metoclopramid.

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Occurance of true primary mediastinal ectopic thyroid is extremely rare. It is seen in less than 1 % of all goiters. Mediastinal mass is typically asymptomatic. It can cause venous obstruction and and tracheal compression if enlarges enough. Ectopic mediastinal goiter generally locates in anterior or middle mediastinum. Occasional location in posterior mediastinum, paravertebrally, is rarely presented. We present this case because of very unusual location.

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Ectopic ACTH production is one of the etiological causes of Cushing’s syndrome due to increased cortisol production. Bronchial carcinoid tumors can also secrete ACTH and cause
Cushing’s syndrome.
Cushing syndrome diagnosed in patient who admitted our clinic with high blood pressure, swelling and flushing on face and neck, weight gain, weakness. After investigations toward
etiology bronchial carcinoid tumor secreting ectopic ACTH was detected in patient. In this report, Cushing syndrome associated with bronchial carcinoid tumor was discussed accompained with literature.

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Fahr disease is a disorder that is characterised with the massive calcification in cerebral basal ganglions or cerebellum. Clinical findings vary from minimal motional disorders to
convulsions and may be sporadic, familial or idiopatic. Also this disease may be related with hypoparathyroidism or defect of free radical production or iron transportion.
13 year old boy patient who has unvoluntary contractions in his hands, feet and face during the last month attended to a private hospital. Bilateral symetric widespread calcification in subcortical area and basal ganglions has been seen in CCT and the patient has been sent to our unit. In physical examination; his coreatetoic motions has been seen. Laboratory findings; Ca: 7.2 mg/dl, P: 6.8 mg/dl, ALP: 499 U/l, Serum PTH: 381 pg/ml (N: 12-72 pg/ml).
In his cranial MRI investigation: T1 hyperintention in bilateral dental nucleus, putamen and caudat nucleus and symetric signal increase especially in basal ganglions has been seen.
The patient has been accepted as pseudohypoparathyroid and treated with calsitriol and calsium lactate. This case is presented in order to discuss the relationship between intracerebral calsifications and endocrinopathies.

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