GÝRÝÞ ve AMAÇ: Çalýþmamýzda anestezi indüksiyonunda uygulanan remifentanil ile deksmedetomidinin, trakeal entübasyonda oluþan hemodinamik yanýtýn kontrolü ve entübasyon kalitesi üzerine etkilerinin karþýlaþtýrýlmasý amaçlandý.

YÖNTEM ve GEREÇLER: ASA I-II sýnýfýnda normotansif 60 olgu çalýþmaya alýndý. Baþlangýç sistolik, diyastolik, ortalama arter basýncý (SAB, DAB,OAB), kalp atým hýzý (KAH) ve periferik oksijen satürasyonu (SpO2) deðerleri (t0) kaydedildi. Grup R’de remifentanil 2 μg kg-1 dozunda 2 dk. içinde, Grup D’de deksmedetomidin 1 μg kg-1 dozunda 10 dk. içinde infüze edildi. Ajanlarýn uygulamasýndan 90 sn sonra 5 mg kg-1 tiyopental sodyum, 0.1 mg kg-1 vekuronyum iv bolus olarak uygulandý, olgularda 90 sn sonra endotrakeal entübasyon gerçekleþtirildi. Entübasyon þartlarý modifiye McNeil ve ark. skorlama sistemine göre deðerlendirildi. Anestezi idamesi % 1 sevoþuran ve N2O-O2 (% 66-34) karýþýmý ile saðlandý. SAB, DAB, OAB, KAH ve SpO2 ölçümleri, Remifentanil veya deksmedetomidin uygulamasýndan 60 sn sonra (t1), indüksiyon uygulamasýndan 60 sn sonra (t2), entübasyondan iþleminden 60 sn sonra (t3), entübasyondan 5 dk sonra (t4) olarak tekrarlandý.

BULGULAR: Gruplar arasýnda demografik verilerde farklýlýk yoktu. Ýstatistiksel olarak Grup D’nin t2 ve t3 SAB, DAB ve OAB deðerleri Grup R’den anlamlý yüksek (p<0.001), Grup D’nin t1 KAH deðeri Grup R’den düþük bulundu (p<0.05), Grup R ve Grup D arasýnda SpO2 ölçümlerinde farklýlýk saptanmadý (p>0.05). Grup R’de maske ventilasyonunda zorluk oraný Grup D’den,Grup D’de entübasyona reþeks harekette 1-2 öksürük görülme
oraný Grup R’den anlamlý yüksek bulundu (p<0.05), Grup R ve Grup D arasýnda çene gevþemesi ve vokal kord pozisyonu oranlarý açýsýndan farklýlýk saptanmadý (p>0.05). Grup R’nin toplam entübasyon kalite skorlarý Grup D’ye göre daha yüksek bulundu (p<0.05).

TARTIÞMA ve SONUÇ: Sonuç olarak, entübasyon sýrasýnda oluþan hemodinamik yanýtýn kontrolünde ve entübasyon kalitesi deðerlendirmesinde 2 μg kg-1 remifentanil, 1 μg kg-1 deksmedetomidine göre daha etkili bulundu.

INTRODUCTION: In our study, the aim was to compare the effects of remifentanile and dexmedetomidine to controle the cardiovascular response to tracheal entubation and the quality of tracheal intubation.
METHODS: Sixty ASA I-II patients were included into the study. The baseline values of systolic, diastolic and mean arterial pressures (SAP, DAP, MAP), heart rate (HR) and peripheric O2 saturation (SpO2) (t0) were recorded. Infusion of remifentanile 2 μg kg-1 was administered in 2 minutes in Group R and dexmedetomidine 1 μg kg-1 was administered in 10 minutes in Group D. After infusions of the agents, tiyopentale sodyum 5 mg kg-1,
vecuronium 0.1 mg kg-1 given iv. Intubation was performed ninety seconds after the induction. The quality of tracheal intubation was evaluated by using McNeil systeme score. Anaesthesia was maintained with sevoflurane % 1 and N2O-O2 (% 66-34). SAP, DAP, MAP, HR and SpO2 were measured at the following times: 60 s. after the infusions of remifentanile and dexmedetomidine (t1), 60 s. after induction (t2), 60 s. after intubation (t3), and after 5 min. after induction (t3).
RESULTS: There were no difference in the demographical data between the groups. SAP, DAP, MAP values was significantly higher at t2 and t3 in Group D, compared to Group R. HR value at t1 was lower in Group D, there was no difference in SpO2 values. The ratio of difficult mask ventilation was higher in Group R, the ratio of cough during intubation was higher in Group D. There were no differences in jaw relaxation and vocal cord position between groups. The quality of tracheal intubation score was higher in Group R.
DISCUSSION AND CONCLUSION: As a result, remifentanile 2 μg kg-1 was more effective to controlle the cardiovascular response associated with intubation and to the quality of tracheal intubation.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý febril nötropenili olgularda mortaliteyi belirleyen baþvurudaki risk faktörlerini deðerlendirmektir.

YÖNTEM ve GEREÇLER: Bu geriye dönük çalýþmaya 2005 ve 2006 yýllarý arasýnda hastanemize baþvuran ateþ ve nötropenisi olan (nötrofil <500/mm3 ve vücut ýsýsý > 38,5°C) 22 hasta alýndý. Bu çalýþmada yaþ, cinsiyet, ateþin baþlangýcýndan baþvuruya kadar geçen süre, altta yatan malignite varlýðý, baþlangýç mutlak nötrofil sayýsý, renal fonksiyon bozukluðu, aminotransferaz
düzeylerinde yükselme, etken mikroorganizmanýn izole edilmiþ olmasý, infeksiyon yerinin lokalize edilmiþ olmasý, hipotansiyon varlýðý ve baþlangýçta seçilen antibiyotik rejimi
türünün febril nötropenik olgularda mortalite üzerindeki belirleyici etkisini inceledik.

BULGULAR: Olgularýn % 86'sýnda solid tümör ve kemoterapi öyküsü vardý ve % 14 olgu kemoterapi ile iliþkili deðildi. Febril nötropenide mortalite % 13'dü. Renal fonksiyon bozukluðu tek yönlü analizde mortalite ile iliþkiliydi. Ancak çok deðiþkenli analizde mortaliteyi belirleyen baðýmsýz deðiþken bulunamadý.

TARTIÞMA ve SONUÇ: Her ne kadar febril nötropenik olup ölümle sonuçlanan olgularda renal fonksiyon bozukluðu hayatta kalanlara göre daha sýk olsa da mortaliteyi belirleyen baðýmsýz deðiþken bulunamamýþtýr.

INTRODUCTION: The goal of this study was to identify prognostic risk factors present at the beginning of the episode in patients with neutropenia and fever admitted to our hospital.
METHODS: Twentytwo patients with neutropenia and fever (neutrophils < 500/mm3 and temperatures > 38,5°C) admitted to our hospital between the years 2005 and 2006 were included in a retrospective study. We investigated the predictive value of age, gender, the time from the beginning of fever to admission,
the presence of malignity as a underlying comorbidity,baseline neutrophil count, the presence of renal dysfunction,elevation in aminotransferase levels, isolation of etiologic organism,the presence of a clinical site of infection, the presence of hypotension, and initial antibiotic preference on mortality
in patients with neutropenia and fever.
RESULTS: Eightysix per cent of patients had solid tumors and 14 % of patients were not associated with chemotherapy. Overal mortality was 13 %. In univariate analysis, renal dysfunction were associated with mortality in patients with neutropenia and fever. From multivariate logistic regression analysis
of patients, we didn' t found independent predictors for mortality.
DISCUSSION AND CONCLUSION: Although renal dysfunction is more frequent in patients with neutropenia and fever who have died than survived,nonindependent predictor for mortality was found.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada toplumumuzda giderek daha sýk görülen bir saðlýk sorunu olan metabolik sendromun çocukluk çaðýndaki bazý klinik ve laboratuvar bulgularýnýn belirlenmesi amaçlanmýþtýr.

YÖNTEM ve GEREÇLER: Çalýþmaya Ocak 2006-Ocak 2007 tarihleri arasýnda obesite,hipertansiyon ve hiperlipidemi nedeniyle fiiþli Etfal Eðitim ve Araþtýrma Hastanesi Çocuk Polikliniðine ve Çocuk Endokrinoloji
Polikliniðine baþvuran çocuklar alýnmýþtýr. Olgular NCEP ATP III kriterlerine göre metabolik sendrom (MS) varlýðý açýsýndan deðerlendirilmiþ ve MS(+) (n: 29) ve MS(-) (n: 23) olarak iki gruba ayrýlmýþtýr. Çalýþmaya alýnan olgular metabolik sendromun klinik ve laboratuvar özellikleri açýsýndan deðerlendirilmiþtir

BULGULAR: Çalýþmaya yaþlarý 0-14 yýl (11.1±3.4) arasýnda deðiþen 26’sý erkek ve 26’sý kýz olmak üzere 52 çocuk alýnmýþtýr. Çalýþmaya alýnan olgularýn % 86’sý obes olarak deðerlendirilmiþ ve obes olgularýn % 60’ýnda metabolik sendrom saptanmýþtr. MS(+) grupta ailede inme öyküsü, annede gestasyonel diabetes mellitus istatistiksel olarak anlamlý olmamakla birlikte MS(-) gruba göre yüksek bulunmuþtur. MS(+) ve MS(-) gruplarýnda Creaktif protein düzeyleri arasýnda istatistiksel anlamlý fark bulunmamý
þtýr. MS(+) grupta ferritin ve fibrinojen deðerleri MS(-) gruba göre istatistiksel olarak anlamlý yüksek bulunmuþtur (p=0.038, p=0.001). Bu çalýþmada metabolik sendromla ilgili bilinen risk faktörlerine ek olarak, ailesinde inme anamnezi olan çocuklarda göreceli risk 6,2 olarak bulunmuþtur.

TARTIÞMA ve SONUÇ: Ýnsülin direnci ve metabolik sendrom çocuklarý da tehdit eden ve giderek önem kazanan bir saðlýk sorunudur. Elde ettiðimiz sonuçlarýn daha geniþ çaplý araþtýrmalarla desteklenmesi gerekir.

INTRODUCTION: The aim of this study to identify clinical and laboratory findings of children with metabolic syndrome as the metabolic syndrome is becomig an important health problem in our population.
METHODS: This study was conducted in the Outpatient Clinics of Pediatrics and Pediatric Endocrinology in fiiflli Etfal Training and Research Hospital. A total of 52 patients attended for obesity, hypertension and dislipidemia from January 2006 to January 2007 were included. Clinical and laboratory findings were evaluated. Partcipants were divided into two groups according
to NCEP ATP III criteria for metabolic syndrome [MS(+) group n: 29 & MS(-) group n: 23].
RESULTS: There were 26 girls and 26 boys with an age range of 0 to 14 years. 86% of participants were obese and 60% of obese patients had metabolic syndrome. Although not statistically significant,
family history of stroke and gestational diabetes mellitus were encountered more frequently in the MS(+) group compared to MS(-) group. CRP levels were not different, but ferritin and fibrinogen levels were higher in MS(+) group than in MS(-) group (p=0.038 and p=0.001 respectively). Additional to known risk factors relative risk for metabolic syndrome was 6.2 for children with a family history of stroke.
DISCUSSION AND CONCLUSION: Insuin resistance and metabolic syndrome has been a health problem threatening children. Our results should be supported with larger population based studies.

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Ýnguinal kord, round ligament lipomlarý ve yaðlý dokularý sýklýkla inguinal hernilerle birlikte olan ve dolayýsýyla inguinal herni cerrahisinde görülen lezyonlardýr. Bu çalýþmada prospektif olarak Ocak-2006 ve Ocak-2007 tarihleri arasýnda Göztepe Eðitim ve Araþtýrma Hastanesinde
açýk yöntemle opere edilen 100 hastada yapýlan 110 onarým incelendi. 3 vakada herni olmaksýzýn sadece lipom saptandý. Vücud kitle indeksi lipom olmayanlarda % 25.6, lipom olanlarda % 25.9 olarak saptandý.

Lipomas of the inguinal cord, round ligament and adipose tissue are usually coincidence together so all of them can see at inguinal herni surgery. In this study, we explored 110 patients which was operated in Göztepe Training and Research Hospital at January 2006-January 2007. We detected 3 patients have only lipoma without inguinal herni. Body mass indeks detected 25.6 % who has lipoma and 25.9 % without lipoma.

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Parçalý patella kýrýklarýna total veya parsiyel patellektomi önerilir. Biz patellektomi yapmadan tansiyon-bant tekniði ile rekonstrükte ettiðimiz olgularýmýzýn sonuçlarýný tartýþmayý amaçladýk.
2000-2005 yýllarýnda acil servisimize baþvuran 47 patella kýrýðýndan, parçalý patella kýrýðý nedeniyle tansiyon-bant tekniði ile ameliyat edilen 11 hastanýn sonuçlarý deðerlendirildi. Deðerlendirme eklem hareket açýklýðý, radyolojik artroz ve Cincinati Diz Skorlama Sistemi kullanýlarak yapýldý.
On bir hastanýn hepsinde kaynama oldu. Ortalama takip süresi 20 (18-24) aydý. Hastalarýn ortalama Cincinati Diz Skorlama Sistemi puaný 352 (310-420) idi. Tüm dizlerin ekstansiyonu tam; fleksiyon ortalamasý 132 (120-140) idi.
Parçalý patella kýrýklarýnda tansiyon-bant tekniði sonuçlarý iyidir. Çok ender durumlarda parsiyel veya total patellektomiye ihtiyaç vardýr.

Total or partial patellectomy was recommended in comminuted patellar fractures. Our aim was to discuss the cases that had used tension-band technique in order to use patellectomy.
Eleven comminuted patellar fractures were evaluated. These cases were selected from the cases that had applied to our emergency room. Total numbers of the patellar fractures were 47 between the years 2000-2005. The evaluation was done with range of motion of the knee, radiological arthrosis, Cincinati Knee Scoring System.
All patellar fractures of eleven patients fused. Mean follow-up time was 20 (18-24) moons. Mean score of Cincinati Knee Scoring System was 352 (310-420). All knees had full extension. Mean flexion was 132 (120-140).
Outcomes of the tension-band technique in comminuted patellar fractures are excellent. Partial or total patellectomy rarely use for comminuted patellar fractures.

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Spinal muscular atrophy is a neurodegenerative disease accompanied by loss of motor neurons. Our case who has spinal muscular atrophy diagnosis was operated for sectio and bilateral tube ligation. In this case report the spinal muscular atrophy disease which is rarely seen is described. Dissociative anesthesia is performed as an alternative technique.

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Appendiceal mucoceles are rare lesions of appendix and the incidance in literature is 0.1-0.4 of all appendectomies. Mucocele is characterized by a gross enlargement of appendix from accumulation of mucoid substance within the lumen. There is a female predominance (female/male: 7/1) and an avarage age of diagnosis over 50s. Preoperative diagnosis of appendiceal mucocele is rare. Their clinical presentation is not specific and they are incidentally detected on imaging. USG confirms appendiceal involvement, but differential diagnosis with acute inflammation, abscess or localized peritonitis is to be made. CT is more specific and more accurate for diagnosis of mucocele. Mucocele can result from a simple mucous membrane hyperplasia with extreme mucous formation; or an adenoma; or an adenocarcinoma. Rupture of mucocele results in pseudomyxoma peritonei which significantly decreases survival of patients with appendiceal mucocele.

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The aim of this report is to describe a rare case of hepatic abscess causing by brucellosis. The hepatic involvement of brusella is rare and asymptomatic. Its diagnosis may be difficult
because the isolation of the microorganism is unusual, serological agglutinating titers are low and the initial detection of liver abscess may be misleading. The imaging findings can offer important diagnostic clues but not specific for brucella. Therefore serologic confirmation is necessary to reach the correct diagnosis.

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Intoxications of calcium channel blocker which is used in lots of conditions such as hypertension, supraventriculer arrhythmias, angina pectoris; are more fatal than other cardiac drugs. In this study, we aimed to review the intoxications of calcium channel blockers because of a case. 34 years old male case was brought to emergency un›t, after three hours taking 120 diltiazem tablets( each of them is 60 miligram) for suicide. Acut renal failure occured after 24 hours in the patient having complete atrioventriculer block at the beginning. Cardiac rythm of the patient was normal in 27th hour. The patient who was taken hemodylasis twice in coronary care unit, was transported to the internal medicine service because of renal failure. Vasodilatation that occured because of the effects
in smooth muscle cells in calcium channel blockers overdose, gives rise to decreasing in cardiac output, hypotension and shock. Decreasing in organ perfusion can be concluded
with multi-organ disfunction. We wanted to point because of a case developing complete atrioventriculer block and renal failure,intoxications of calcium channel blocker is a condition having high mortality and morbidity, and it must be treated
fastly and aggresively.

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Carcinoma of the anal canal is a relatively uncommon tumor of digestive-system cancers. Most of these carcinomas develop from squamous epithelium, but some arise from the transitional zone between the columnar epithelium of the rectum and the squamous epithelium of the anal canal. The latter type is called cloacogenic or transitional carcinoma. A 46 year-old male who presented with purulan discharge and bleeding from anus had anal tumoral mass. The mass was completely resected and shown to be transisyonaal carcinoma of anus by histopathologic examination. We reported a case of cloacogenic or transitional carcinoma because of rarity.

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Pleural effusion due to hepatitis A virus infection is a rare complication during childhood and occur during early period of the disease. Here a 9-year-old girl with pleural effusion during hepatitis A infection is reported. A 9-year-old girl admitted to hospital with complaints of fever, jaundice, nausea and lack of appetite. Physical examination
revealed abdominal tenderness, hepatomegaly and scleral icterus. A clinical diagnosis of viral hepatitis was made. Laboratory data revealed normal complete blood count and
serum bilirubin of 8.5 mg/dl (direct 3.5 mg/dl). Alanine aminotransferase was 555 IU/L and aspartate aminotransferase was 331 IU/L. Serum proteins and prothrombin time was normal. Positive anti hepatitis A virus (HAV) IgM antibody titres confirmed the diagnosis of hepatitis A. Other viral hepatitis markers were negative. Abdominal sonography revealed mild hepatomegaly with increased echogenicity. Mild ascites with right sided pleural effusion was also noticed. With this case we want to emphasize that pleural effusion and
ascites can be seen during hepatitis A virus infection and this complication usually resolves spontaneously.

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Bardet-Biedl syndrome (BBS) is a genetically heterogeneous disorder characterised by obesity, retinal dystrophy, polydactyly, renal malformations, mental retardation, and hypogonadism. To date, 12 BBS genes have been cloned (BBS1-BBS12). Eighteen-year-old girl with BBS was admitted to genetics department with complaint of amenore. Initial evaluation revealed polydactily, brachydactyly, and obesity. Detailed investigation revealed classical finding of retinopathy, mental retardation, and hypogonadism. Here in we discussed a patient with BBS who had primer amenore.

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