Bronþiolit, 2 yaþ altý çocuklarda görülen bronþiollerin akut inflamasyonu olup, özellikle 3-6 ay arasý çocuklarda sýk görülür. Sýklýkla viral infeksiyonlar sonucu oluþur ve etken %
50’sinden çoðunda respiratuar sinsisyal virus (RSV)’dur.
Hastanemiz süt çocuðu servisinde 1.12.2003-1.02.2004 tarihleri arasýnda alt solunum yolu infeksiyonu tanýsý alan 100 hasta yaþ, cins, predispozan faktörler, semptomlarýn sýklýðý, fizik muayene ve laboratuvar bulgularý, ortalama yatýþ süreleri, tedavi protokolleri, prognoz açýsýndan deðerlendirildi. 100 hastanýn nazofarengeal sürüntü materyalinde RSV bakýldý. Olgularýn yaþý ortalama 4 ay (33 gün-22 ay), erkek/kýz oraný 1.58 idi. En sýk görülen semptomlar öksürük ve hýrýltý (% 100), burun týkanýklýðý (% 86), ateþ (% 48) olarak bulundu. % 63 hastada RSV pozitifliði saptandý. Olgulara semptomatik tedavi uygulandý. Atopi öyküsü olan hastalara nebulize bronkodilatatör ve nebulize kortikosteroid verildi.
Çalýþmamýzda farmakolojik ajanlarýn akut bronþiolitin doðal seyrini deðiþtirmediði ve özellikle gereksiz antibiyotik kullanýlmamasý vurgulanmýþtýr.

Acute bronchiolitis, the disease of the lower respiratory tract, occurs during the first 2 years of life with a peak incidence at 3-6 months of age.‹t is predominantly a viral illness and the most frequent cause is respiratory syncytial virus (RSV) in more than 50 % of cases.We were investigated hospitalized patients under 2 years of age, because of the lower respiratory tract infectipns between December 2003-December 2004. Patients
were analised in terms of age, sex, predisposed factors, symptoms, physical exam and labratory findings, frequency of length of hospital stay, treatment modalities and prognosis. Nasopharingeal smers of there patients were assesed for RSV. One hundred patients with a mean age of 4 month (range 33 days to 22 month) have a sex ratio of male/female: 1,58. The most common symptoms were a hundred percentage wheezing
and cough, 86 percent nasal stuff and 48 percent fever. Analysis for RSV was pozitive in 63 percent of patients. All patients were treated symptomatically. Patient with a history of atopy avere treated with inhaler bronchodilatator and inhaler corticosteroids. This study was pointed out that; pharmalogical agents did not change natural course of acute bronchiolitis and consumption of antibiotics were completely unnecessary.

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Bu çalýþmanýn amacý, tonsillektomi ve/veya adenotonsillektomi ameliyatý uygulanacak çocuklarda desfluran ile propofo anestezisinin hemodinami ve derlenme üzerine etkilerini karþýlaþtýrmaktýr.
Etik Komite onayý alýndýktan sonra 4-12 yaþ arasý, ASA I-II fizik durumda 40 çocuk çalýþmaya dahil edildi. Tüm hastalara ameliyattan 30 dakika önce 0.5 mg/kg midazolam oral verildikten sonra anestezi indüksiyonu için 0.5 μg/kg remifentanil, 2-2.5 mg/kg propofol ve 0.6 mg/kg rokuronyum verildi. Rasgele iki gruba ayrýlan hastalara anestezi idamesi için oksijen içinde % 60 N2O ve 3 mg/kg/sa propofol (Grup I) veya oksijen içinde % 60 N2O ile % 6 desfluran (Grup II) uygulandý. Hastalarýn kalp atým hýzý ve ortalama arter basýncý, entübasyon öncesi, endotrakeal entübasyon sonrasý, cerrahi insizyon sonrasý ve ameliyat sonuna kadar 5 dakika ara ile ölçülüp kaydedildi.
Anestezi ilaçlarý ameliyat bitiminde kesildi. Ekstübasyon ve sözlü uyaranla göz açma zamanlarý kaydedildi. Aldrete derlenme skoru anestezi sonrasý 5. ve 10. dakikalarda deðerlendirildi.
Çalýþma gruplarýnýn yaþ, cinsiyeti vücut aðýrlýðý daðýlýmlarý ve anestezi süreleri benzer bulundu. Grup II’de kalp atým hýzýnda entübasyon sonrasý artýþ gözlendi. Ameliyatýn 25. Dakikasýna kadar baþlangýç deðerlerinin üzerinde seyretti (p<0.05). Grup I’de ise ortalama arter basýncýnda 10. dakikadan sonra azalma gözlendi (p<0.05). Ameliyatýn 25. dakikasýndaki ölçümde baþlangýç deðerlerine ulaþtý. Grup II’de sözlü uyaranla göz açma zamaný anlamlý olarak kýsa (p<0.01), beþinci dakika Aldrete derlenme skoru anlamlý olarak yüksek bulundu (p<0.05). Sonuç olarak; çocuklarýn anestezi idamesinde desfluranýn propofol gibi hemodinamik deðerleri koruyabildiði, derlenme hýzý yönünden propofolden daha iyi olduðu kanaatine varýldý.

The aim of this study is to assess the hemodynamic and recovery characteristics of desflurane compared with propofol anaesthesia in children scheduled for tonsillectomy and/or adenotonsillectomy.
After the Institutional Ethics Committee approval, 40 ASA I-II status children aged between 4 to 12 years were included in this study. Patients were randomly divided into two groups. After premedication with midazolam (0.5 mg/kg; po) 30 minutes before the operation, anesthesia was induced with 0.5 μg/kg remifentanil, 2-2.5 mg/kg propofol and 0.6 mg/kg rocuronium. Maintenance of anaesthesia was provided either with 60 % nitrouse oxide in oxygen and 3 mg/kg/h propofol infusion Group I or 6 % desflurane and 60 % nitrouse oxide in oxygen in Group II.
Heart rate, mean arterial pressure and O2 saturation were recorded before and after tracheal intubation, followed by the incision and then every 5 minutes until the end of the surgery. Time to extubation and eye opening to verbal command were recorded. Aldrete Recovery Score was assessed for recovery characteristics at 5th minute and 10th minute postoperatively.
The groups did not differ with respect to age, sex, weight and anaesthesia duration. Heart rate increased after tracheal intubation and were significantly high until 20th minute in Group II (p<0.05). Mean arterial pressure decreased significantly after 10th minute and raised to normal values after 25th minute in Group I (p<0.05). The time to eye opening to verbal command were significantly short in Group II (p<0.01). Aldrete Recovery Score was significantly high in Group II at 5th minute (p<0.05). We concluded that desflurane is as good as propofol in maintenance of anaesthesia and even better in recovery
in children.

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Transpediküler vida fiksasyonu omurga instabilitelerinde son zamanlarda sýklýkla kullanýlan bir cerrahi müdahaledir. Bu yöntemle omurgada posterior dekompresyon ve rekonstrüksiyon ayný anda yapýlabilir. Bu anatomik çalýþmada, transpediküler vida fiksasyonunda tekniðe yol gösterici olmasý amacýyla 49 adet insan C7 omurunun pediküllerinin anatomik özelliklerinin belirlenmesi hedeflendi. C7 omurun ortalama uzunluðu 5.84±0.95 mm, yüksekliði 6.82±1.01 mm, pedikül geniþiliði 6.07±1.1 mm olarak bulundu. Massa lateralis’in arka kenarýndan corpus vertebra’nýn ön kenarýna olan mesafe (pedikül eksen uzunluðu) 30.37±2.41 mm, interpediküler mesafe 21.62±1.33 mm ölçüldü. Massa lateralis kalýnlýðý 7.64±1.4 mm idi. Baþarýlý bir vidalama pedikül anatomisinin ayrýntýlý olarak bilinmesi ile mümkün olur. Bu çalýþma gibi morfometrik anatomik çalýþmalardan elde edilen bulgular daha iyi bir cerrahi yaklaþýma ve pedikül komþuluðundaki önemli nörovasküler yapýlarýn korunmasýný amaçlar.

Transpedicular screw fixation is a complicated surgical procedure that has reached substantial popularity in the treatment of spinal instabilities. This procedure is particularly valuable for simultaneous posterior decompression and reconstruction in the cervical spine. This anatomic study was undertaken to provide a set of anatomical data to aid the technique on a large series of human bony C7 cervical vertebrae from 49 individuals. The mean pedicle length was measured as 5.84±0.95 mm, pedicle width as 6.07±1.1 mm, and pedicle height as 6.82±1.01 mm. The distance from the posterior point of the lateral mass to the anterior margin of the vertebral body through the pedicle axis (pedicle axis length) was 30.37±2.41 mm, and the interpedicular distance was 21.62±1.33 mm mm. The lateral mass thickness was measured as 21.99±1.35 mm. Successful placement of the pedicle screw requires a thorough knowledge of cervical spine transpedicle morphometry. The approximate values from the morphometric
studies such as our study can be a guide in choosing the appropriate screw dimensions and to avoid the damage to important neighbouring neurovascular structures.

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Modern diþ hekimliðinin amaçlarýndan bir tanesi diþ çürüðü olmayan çocuklarýn sayýsýnýn artýrýlmasýdýr. Bebeklik, hatta annenin hamileliði sýrasýnda koruyucu uygulamalar baþlanmasý ile ‘önlenebilir hastalýklar’ olarak tanýmlanan bu hastalýklarýn önüne geçilebilmektedir. Erken diþ kayýplarý geliþme geriliði, konuþma bozukluklarý, okulda konsantrasyon bozukluðu, öðrenme zorluðu ve okul devamsýzlýðýnda artýþa sebep olabilir.
Bizim çalýþmamýzýn amacý, kliniðimize yatan hastalarýmýzýn diþ saðlýðýný deðerlendirmek ve diþ saðlýðýný olumsuz yönde etkileyen faktörleri ortaya çýkarmaktý.
Kliniðimizde herhangi bir nedenle yatýrýlan 1 yaþ ve üzerindeki110 hasta diþ çürükleri,diþ fýrçalama alýþkanlýklarý, ebeveynlerin diþ saðlýðý, ailenin sosyoekonomik özellikleri ve flor alým bilgilerini içeren standart bir form oluþturularak deðerlendirildi.
Biberonla beslenme, annesinde diþ çürüðü olan, asgari ücret veya daha düþük maaþ alan ailenin çocuklarýnda, eðitim düzeyi düþük babalarýn çocuklarýnda diþ çürüðü olma oraný anlamlý olarak daha yüksekti.
Çocuk hekimlerinin florür kullanýmý, beslenme ve aðýz temizliði alýþkanlýklarý konusundaki önerileri erken çocukluk ve sonrasýnda görülen çürüklerin korunmasýnda çok önemlidir.
Özellikle sosyoekonomik durumu kötü, eðitim düzeyi düþük babalarýn çocuklarý, diþ çürüðü olan anne çocuklarý diþ çürüðü açýsýndan yakýndan izlenmelidir. Ayrýca hastalar, diþ hekimlerine rutin kontrol ve ileri uygulamalar için desteklenmelidir.

The aim of the modern dentists is to increase the number of children with no dental caries.These diseases are referred as ‘preventable diseases ‘and from the neonatal period they may be prevented. Early tooth loss can result in failure to thrive, impaired speech development, absence from, inability to concentrate and learning problems in school.
The aim of our study is to describe the tooth health of the children who admitted to our clinic with any other diseases, and to find out the negative factors that effect the tooth health.
By using a standart quastionnare we evaluated 110 children over 1 year in our clinic according to tooth brush habit, parents’tooth health, socioeconomic status and fluoride intake.
Bottle feeding,mother with caries, Low of socioeconomic status, or low father’s education level increases significantly the ratio of the children with caries.
The offers of the pediatricians about fluoride intake,nutrition and oral cleaning habit are so important to prevent caries. Especially the children with bad socioeconomic status,who
have low education level fathers,mothers with caries should be followed closely. In addition patients should be supported for rutine dentist examination and further interventions.

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Yakýn temaslýlarda tüberküloz (TB) hastalýðýnýn geliþiminin önlenmesinde ilaçla koruma tedavisi önemlidir. TB hastalarýnýn yakýn temaslýlarý bu açýdan dikkatli þekilde taranmalýdýr. Bu çalýþmamýzda Diyarbakýr 1 nolu Verem Savaþ Dispanseri’nde kayýtlý 360 TB hastasý ve 1986 yakýn temaslýsýnýn kayýtlarýný retrospektif olarak inceledik.
Kaynak olgularýn 218 (% 60.6)’i erkek, 142 (% 39.4)’si kadýn ve ortalama yaþ 31.5±16.1 yýl idi. Kaynak olgularýn taný esnasýnda yaptýklarý ilk baþvuru muayenesinin nedenleri olarak; en sýk 280 (% 77.8) kiþi ferdi muayene talebiyle, ikinci sýrada temaslý muayenesi amacýyla 74 (% 20.6) baþvurduðu saptandý. Kaynak olgularýn 270 (% 75)’inin akciðer tüberküloz, 90 (% 25)’ýnýn akciðer dýþý organ tüberkülozu olduðu saptandý Akciðer tüberkülozlu olgularýn 172 (% 63.7)’sinin yayma pozitif, 98 (% 36.3)’sinin yayma negatif olduðu saptandý. Yayma pozitif akciðer tüberküloz olgularýnda kür oraný % 40.7 olarak saptandý.
Yakýn temaslý olgularýn 948 (% 47.8)’i erkek, 1038 (% 52.2)’i kadýn ve ortalama yaþ 20.2±16.9 yýldý. Kaynak olgu baþýna ortalama 5.51±2.96 adet yakýn temaslý kaydedildiði saptandý. Kaydedilen yakýn temaslýlarýn 596 (% 30)’sýnda tarama muayenesi yapýlmadýðý saptandý. Taramasý yapýlan 1390 temaslýnýn; 264 (% 18.9)’üne ilaçlý koruma verildiði, 32 (% 2.3)’sine tüberküloz tanýsý konulduðu, 92 (% 6.7)’sine BCG yapýldýðý, 14 (% 1.1)’üne ikinci bir kontrol muayenesi önerildiði saptandý. Ulusal tüberküloz kýlavuzunda geçen endikasyonlara göre ilaçlý koruma tedavisi verilmesi gerekirken verilmeyen 631 (% 45.4) yakýn temaslý saptandý. Kaynak olgunun eðitimsiz oluþu ve gelir getirici bir iþte çalýþmamasýnýn muayeneye gelme oranýný anlamlý þekilde düþürdüðü, kaynak olgunun herhangi bir sosyal güvencesinin olmamasýnýn ise bu oraný düþürmede etkili olmadýðýný saptadýk.
Sonuç olarak; VSD hizmetlerinin bir kýsmýnda (özellikle de ilaçlý koruma konusunda) önemli eksiklikler saptandý. Bunlarý n giderilmesinde ulusal programýn tam uygulanmasý ve eðitim çabalarýnýn artýrýlmasýnýn gerektiði düþünüldü.

The preventive chemothreapy is important for preventing of tuberculosis in the close contacts.This regard the close contacts of tuberculosis patients are evaluated carefuly.In this study we investigated retrospectively 1986 close contacts of 360 tuberculosis patients who registered Diyarbak›r No. 1 Tuberculosis Control Dispensary.
In the tuberculosis patients, the mean age 31.5±16.1 years, 218 (% 60.6) cases were male and 142 (% 39.4) cases were female.Examinations reasons of tuberculosis patients were as 280 (% 77.8) and 74 (% 20.6) individual examination and close contact examination,respectively. It was found that index cases were as % 75 of pulmonary tuberculosis and % 25 extra pulmonary tuberculosis. Pulmonary tuberculosis cases were
as % 63.7 of smear positive % 36.3 of smear negative. In the close contacts, the mean age 20.2±16.9 years, 948 (% 47.8) cases were male and 1038 (% 52.2) cases were female.It was found that mean 5.51±2.96 close contacts per a tuberculosis patient were recorded. It was found that examination was not made in the 596 (% 30) cases of close contacts. The number of examinated cases of close contacts was 1390. Examination results in the examinated cases were as fallows respectively: preventive chemothreapy was applied in 264 (% 18.9) of the cases; active tuberculosis disease were determinated in 32 (% 2.3) of the cases; BCG was applied in 92 (% 6.7) of the cases; second control examination was suggested in 14 (% 1.1) of the cases.
Preventive chemothreapy should be applied in 631 (% 45.4) of the examinated close contacts according to National Tuberculosis Guideline. However, it was found that preventive chemothreapy was not applied. It was determinated that the examinated
rate was decreased because of theindex cases were uneducated and unemployed and the examinated rate was not decreased because of the index cases were uninsured.
Conclusion: Some defects were established in the care of tuberculosis control dispensary. It is thought the defects can be corrected by means of the application National Tuberculosis Guideline and the increasing education activities.

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Bu çalýþmamýzda amacýmýz, sürekli ayaktan periton diyalizi (SAPD) uygulanan hastalarda kateter çýkýþ yeri infeksiyonu (KÇÝ) sýklýðýný, etken mikroorganizmalarý ve antibiyotik duyarlýlýklarýný saptamak ve bu sonuçlarý göz önüne alarak verilebilecek en uygun ampirik antibiyotik tedavisinin ne olabileceðini belirlemekti. Çalýþmamýza Ýstanbul Eðitim Hastanesi Nefroloji Kliniðinde Ocak 2002 ile Ocak 2003 tarihleri arasýnda takip edilen 76 hastayý aldýk. Yetmiþaltý SAPD hastasýnýn 13'ünde (% 17) bir yýl süresince toplam 22 KÇÝ ataðý saptandý. Olgularýn dördünde iki, üçünde üç ve beþinde bir KÇÝ ataðý gözlendi. Etken patojen 22 olgudan izole edildi. Bunlarýn 15'inde Stphylococcus aureus (% 62), üçünde koagülaz negatif stafilokok (KNS) (% 13), üçünde Pseudomonas aeruginosa (% 13), ikisinde Klebsiella pneumoniae (% 8) ve birinde difteroid çomak (% 4) izole edildi. Olgularýmýzda üretilen Stafilokoklarýn % 86'sý ve Gram negatif çomaklarýn tümü kinolonlara ve aminoglikozitlere duyarlý bulundu. Stafilokoklarýn % 80'i metisiline duyarlý idi. Bu sonuçlarý göz önüne alacak olursak, ampirik tedavide etkenlerin çoðunluðunun duyarlý olduðu kinolonlarýn veya aminoglikozitlerin ilk tercih olarak kullanýlmasý önerilebilir.

The aim of this study was to investigate the incidence of exit site infections, the antibiotic susceptibility of the microorganism and to recommend the initial choise of antimicrobial therapy in continuous ambulatory peritoneal dialysis (CAPD) patients. For this purpose 76 CAPD patients followed by Nephrology Clinics of ‹stanbul Egitim Hospital during the 2002-
2003 were evaluated. Patients were consisted of % females and % males with a mean age of. The incidence of the exit site infections was found approximately 0,2 episode per year. Microbiologically documented infections were seen in 22 episodes (in all clinically infected cases). Bacterias isolated from these patients were Staphylococcus aureus (62 %), coagulase-negative Staphylococci (13 %), Pseudomonas aeruginosa (13 %), Klebsiella pneumoniae (8 %) and diphteroid bacilles (4 %). 86 % of the Staphylococci and all Enterobacteriaceae isolated from the patients was sensitive to ciprofloxacin and aminoglycosides. 80 % of the Staphylococci was found sensitive to methicillin. In conclusion, we recommend that aminoglycosides or ciprofloxacin have to be used as initial choise of antimicrobial treatment in exit site infections of the CAPD patients.

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Konjestif kalp yetersizliði (KKY), taný ve tedavideki tüm geliþmelere raðmen hala prognozu en kötü kardiyovasküler hastalýktýr. Bu nedenle, kalp yetersizliðinde yaþam kalitesi ve prognozu kötü yönde etkileyen faktörlerin belirlenmesi ve bunlara yönelik tedavi stratejilerinin belirlenmesi çok önemlidir. Anemi, baþlýbaþýna bir kardiyomiyopati nedenidir. Dahasý, hem konjestif kalp yetersizliðini hem de kalp yetersizliðinde nefropatiyi kötüleþtirir. Ayrýca, kalp yetersizliðinde saðkalýmý ve yaþam kalitesini azaltýr. Yaþlý kalp yetersizlikli hastalarda hospitalizasyonlarý artýrýr.
Bu çalýþmada, konjestif kalp yetersizliði tanýsýyla yatarak tedavi edilmiþ 71 hasta retrospektif olarak incelendi. Hastalarýn % 35'inde anemi tespit edildi. Bunlarýn çoðu kronik hastalýk anemisiydi. Anemi, kadýnlarda, yaþlý hastalarda, kreatinin düzeyi yüksek olanlarda, hipertansif hastalarda, iskemik kalp hastalýðý (‹KH) olanlarda anlamlý derecede yüksek saptandý. Hem kadýnlarda, hem erkeklerde anemi ve ejeksiyon fraksiyonu arasýnda herhangi bir iliþki saptanmadý.
Anemi, birçok durumda iyi tanýmlanmýþ bir komorbidite olmasýna raðmen kalp yetersizliðindeki rolü daha yeni dikkat çekmektedir. Sonuç olarak, kalp yetersizliðinde anemi sýktýr. Eþlik eden ek bir hastalýk sýklýðýný artýrýr. Kalp yetersizlikli hastalarda aneminin erken tespiti ve erken tedavi edilmesi çok önemlidir. Aneminin tedavi edilmesiyle, hastalarýn yaþam kalitesi ve prognozu önemli derecede düzelmektedir.

Congestive heart failure, is still cardiovasculer disease having the worst prognosis, in spite of the developments in the diagnosis and the treatment. So, to be defining the factors effecting bad the prognosis and life quality and to be devoloping the new treatment strategies against these factors, is very important. Anemia is the reason for cardiomyopathy in itself. Furthermore, it worsens both heart failure and nephrophaty in heart failure. Also the anemia decreases surviving and life quality. It increases hospitalization at the elderly patients with heart failure.
In this study, 71 patients with heart failure who had hospitalized were analysed retrospective. The anemia was finded % 35 of the patients. Most of these were chronic disease anemia. The anemia ratio was higher in women, in elderly patients, in patients with high creatinin level, hypertension and ischemic heart disease. There was no relation between anemia and ejection fraction both men and women.
Although anemia is a well defined co-morbidity in a lot of conditions, its role in the heart failure is being remarkable currently. In conclusion, the anemia is often in heart failure
and acompaning diseases increase anemia frequancy. To diagnose anemia early and to treat it early is very important in patients with heart failure. Treating anemia improves considerable level the prognosis and life quality of the patients.

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Antiepileptik ilaçlarýn serum lipid konsantrasyonlarýný etkilediði bilinir. Biz de valproik asid (VPA) kullanýmýnýn lipid profiline etkisini araþtýrdýk.
Epilepsi nedeniyle izlenen ve monoterapi olarak VPA kullanan 25 epileptik hasta ve yaþ-cins olarak benzer 25 kontrol grubunda serum lipid profilleri seviyeleri ölçüldü.
VPA kullanan ve kontrol gurubundaki olgular yaþ ve cinsiyet açýsýndan incelendiðinde anlamlý bir fark yoktu. Kontrollerle karþýlaþtýrýldýðýnda, VPA kullanýmýnýn serum lipid profili üzerinde deðiþikliðe neden olmadýðý saptandý. VPA tedavisi alan grupta, TK, HDL-C, LDL-C, VLDL-C, TG, TK/HDL ve LDL/HDL deðerlerinin yaþ, cinsiyet, VPA'in serum düzeyi, dozu ve kullaným süresinden etkilenmediði saptandý.
Epilepsi tedavisinde uzun süreli kullanýlmasý gereken VPA'in, serum lipid profili üzerine etkilerini gösteren farklý sonuçlar bildirildiðinden henüz bir fikir birliði yoktur. Bundan dolayý, VPA kullanan hastalarýn serum lipidlerinin belirli aralýklarla kontrol edilmesi gerektiði kanýsýndayýz.

The effect of antiepileptic drugs on serum lipid concentrations is well known. We investigate the effect of VPA usage on lipid profile.
Serum lipid profiles of 25 epileptic patients followed with the VPA mono treatment and a control group consisting of 25 cases with similar sex ratio and ages were measured.
The age and sex ratio of the cases in VPA using group and control group were not significantly different. According to control group it is detected that VPA usage has no effects on lipid profile. In the group of patients on VPA treatment, TK, HDL-C, LDL-C, VLDL-C, TG, TK/HDL and LDL/HDL levels were not affected from age, gender, serum level of VPA and the dose and duration of VPA treatment.
Conclusion: Because different results were reported in several reports about the effect of VPA on serum lipid profile, which must be used in long term period for the treatment of epilepsy, no consensus has been made. So that we agreed that serum lipid profile must be regularly measured in patients using VPA

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Although lipomas are placed in any localization from hypopharynx to rectum, they are most commonly seen in large bowel, and frequently localized in submucosal areas. Being
usually asymptomatic, this tumors should undergone detailed investigation, since they resemble both benign and malign tumors of large bowel clinically, endoscopically and in gross macroscopic appereance.
A 75-years old woman presented with rectal bleeding was diagnosed as huge lipoma of large bowel and the case is reported because of its low frequency.

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Morquio’s syndrome is an inherited disorder caused by the lack of the enzyme responsible for breakdown of keratan sulfate. The resulting buildup of keratan sulfate in tissues leads
to skeletal dysplasia with other organ systems involvement. A four years old girl brought with the complaints of deformity in legs, abnormal gait, changed shape of chest cage, and short trunk dwarfism was presented to emphasize the clinical and radiological features of the Morquio’s syndrome. Morquio’s syndrome should be also considered in the differential diagnosis of the patients with short trunk dwarfism and skeletal deformities.

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In this report, we presented a case with fever of unknown origin caused by subacute thyroiditis.
A 40-year-old man with diabetes mellitus was admitted to emergency department because of fever, weight loss, fatigue, nervousness and tremulousness. The erythrocyte sedimentation rate and the serum thyroxine and triiodothyronin levels was elevated. The 24-hour radioactive iodine uptake was supressed to 1 %. We made the diagnosis of subacute thyroiditis in this case.
In conclusion, subacute thyroiditis should always be kept in mind for the etiology of the fever of unknown origin.

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A 31-year-old woman presented with massive postpartum hemorrhage eight days after caesarean section. In spite of boom curettage and uterotonic medication, bleeding persisted.
So subtotal hysterectomy was done. Pathologic diagnosis was plasental polyp.

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Nowadays, he number of cancer diagnosis patient is increasing day by day.Chemotherapy and radiotherapy possibilities extend life time of cancerous patients and it is researched the method of increasing of life quality for patientns. Because sometimes
the cancer necessitates long, hard and weaning out treatment process which affects both patient and his family negatively and this situatinon causes mental health problems. It has been emphasized cancer which affects important part of patient life quality, in cancerous patient % 50-60 proportion depressive problems, % 30 proportion anxiety and adaption problems. In addition, It can causes serious problems like suicide. Because cancer, like leukemia diagnosis patients live mental problems which affect negatively their medical treatment, treatment process,and the period of time staying in the hospital. The epidemiological studies indicate that the rate of suicides is higher in the cancerous patients compared to the general population. Consequently, in our study an inpatients
who has attempted to commit suicide is presented The staff working on such cases should be more sensitive about the psychiatric symptoms of the patients.

Abstract | Full Text PDF