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GÝRÝÞ ve AMAÇ: Tüberküloz plörezi ve parapnömonik efüzyon Türkiye’de en sýk görülen plevral efüzyon nedenleridirler. Bu çalýþmanýn amacý enfeksiyöz sývýlarýn ayrýcý tanýsýnda biyokimyasal karakteristiklerini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Bir üniversite hastanesinde torasentez yapýlmýþ 62 konjestif kalp yetmezlikli, 44 parapnömonik efüzyonlu ve 26 tüberküloz plörezili hastanýn serum ve plevra sývýsý biyokimyasal özellikleri retrospektif olarak incelendi. Ýstatistiksel analiz SPSS programýnýn 10.0 versiyonu kullanýlarak yapýldý.
BULGULAR: Hastalarýn ortalama yaþlarý tüberküloz plörezi için 37, parapnömonik efüzyon için 40 ve konjestif kalp yetmezliði için 64 idi. Diðer gruplarla kýyaslandýðýnda tüberküloz plörezi
olgularýnda kilo kaybý anlamlý derecede daha sýktý. Sývýda total lökosit sayýsý transuda grubunda 556/mm3, tüberküloz için 11424/mm3, parapnömonik efüzyon için 8260/mm3 idi.
Tüberküloz plörezi ve parapnömonik efüzyon gruplarý arasýnda plevra sývýsý LDH düzeyi, plevra sývýsý LDH’inin serum LDH’ye oraný, plevra sývýsý total protein ve albümin düzeyi ve
plevra sývýsý total proteininin serum total proteinine oraný açýsýndan anlamlý bir farklýlýk yoktu.

TARTIÞMA ve SONUÇ: Plevra sývýsý veya seruma dayalý biyokimyasal ölçütlerin tüberküloz plörezi ile parapnömonik efüzyonun ayrýcý tanýsýnda faydalý olmadýðýný düþünmekteyiz.

INTRODUCTION: Tuberculous pleurisy and parapneumonic effusion are common causes of pleural effusion in Turkey. The aim of this study was to assess the biochemical characteristics in the differential diagnosis of infectious effusions.
METHODS: The biochemical characteristics of serum and pleural effusion samples of 26 patients with tuberculous pleurisy, 44 patients with parapneumonic pleurisy, and 62 patients with congestive heart failure who had underwent thoracentesis in a university hospital were retrospectively
analyzed. Statistical analysis was done using SPSS 10.0 software.
RESULTS: The mean ages of the patients were 37 for tuberculous pleurisy, 40 for parapneumonic effusion, and 64 for congestive heart failure. Weight loss was significantly frequent in patients with tuberculous pleurisy when compared to other groups. Total leukocyte count in the fluid was 556/mm3 for transudates, 11424/mm3 for tuberculosis, and 8260/mm3 for parapneumonic effusion. There was not a significant difference in pleural fluid LDH levels, ratio of pleural fluid LDH to serum LDH, pleural fluid albumin and total protein levels, and ratio of pleural fluid total protein to serum total protein between tuberculous pleurisy and parapneumonic effusion.
DISCUSSION AND CONCLUSION: We think that biochemical criteria based on the pleural fluid or serum is not helpful in the differential diagnosis between tuberculous pleurisy and parapneumonic effusion.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzda α2 adrenerjik agonisti olan ve premedikan ajan olarak kullanýlan oral klonidinin, sevoþuran anestezisi altýnda orta serebral arter akým hýzý (Vmca) ve serebrovasküler CO2 cevabý üzerine olan etkilerini transkranial doppler ultrasonografi kullanarak incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Hastalar üç gruba ayrýldý. Grup C (n: 12)’de olgulara premedikasyon olarak klonidin tablet (Cateprasan) 75 μg verildi ve sevoþuran anestezisi uygulandý.
Grup S (n: 12)’de olgulara preoperatif plasebo tablet verildi ve sevoþuran anestezisi uygulandý. Grup A (n: 12)’de premedikasyon ve anestezi uygulanmaksýzýn kontrol grubu olarak çalýþýldý. Tüm olgularýn sýrasýyla normokapni, hipokapni ve hiperkapni sýrasýnda transcranial doppler tekniði ile orta serebral arter akým hýzý ölçüldü, eþ zamanlý olarak arter kan gazý alýndý.

BULGULAR: Grup C ve S’deki Vmca deðerleri, PaCO2’nin her aþamasýnda grup A ya göre anlamlý olarak düþük bulundu. Anestezi alan iki grup karþýlaþtýrýldýðýnda yalnýzca hiperkapnide klonidin alan grupta Vmca anlamlý düþük bulundu. CO2 yanýt eðrisi Grup C de A ve S grubuna göre anlamlý olarak daha düþük bulundu.
TARTIÞMA ve SONUÇ: Bu sonuçlar oral premedikan ajan olan klonidinin sevoþuran anestezisi altýnda hiperkapni sýrasýnda Vmca’ý düþürmesi ve serebrovasküler CO2 yanýtý düþürmesi, bu ajanýn cranial cerrahilerde kullanýlabilecek faydalý ve uygun bir ajan olduðunu göstermiþtir.

INTRODUCTION: In this study we aimed to investigate the effects of klonidin, an a2 adrenergic agonist and used as premedication, on middle cerebral arteria flow rate (Vmca) and cerebrovascular CO2 response under sevoflurane anaesthesia by transcranial doppler usg.
METHODS: We had three groups of patients. In Group C (n: 12), sevoflurane anaesthesia and oral clonidin tablet (Cateprasan) 75 μg as premedication were used while preoperative placebo tablet and sevoflurane anaesthesia were used in group S (n: 12). Group A (n: 12) was the control group and no premedication and anaesthesia was applied Middle cerebral arteria flow rate was measured by transcranial doppler usg for all patients in status normocapni, hypocapni and hypercapnia respectively and arterial blood gas was measured
same time.
RESULTS: Vmca values in group C and S were significantly lower than group A in all states of PaCO2. In two anaesthesia applied groups, Vmca was significantly lower in clonidin group only in hypercapnia CO2 response curve was significantly lower in group C when compared with group A and B.
DISCUSSION AND CONCLUSION: According to our results, clonidin as an oral premadicant agent, is an appropriate drug for cranial surgery as it decreases Vmca and cerebrovascular CO2 response under
sevoflurane anaesthesia and hypercapni.

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Sjögren’s syndrome, a chronic autoimmune inflammatory disorder. Hepatic diseases associated with SS occure in 5 % case and usually to result by cirrhosis. We report a case 35 - years- old women presenting SS and primary biliary cirrhosis.

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Benign symmetric lipomatosis, or Launois-Bensaude syndrome is characterized by symmetric and massive fatty deposits, predominantly located in the neck and shoulders.
The disease may be asymptomatic, but in some cases, due to the grotesque disfigurement, can cause significant esthetic or psychologic problems. A 76 year old patient with a history of
subcutaneous masses arising in the arm and leg areas who showed benign symmetric lipomatosis is reported herein.

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Biliary atresia (BA) is the most common and important neonatal hepatobiliary disorder and is seen in 1 in 8.000 to 1 in 18.000. Consequently, 70-80 % of BA patients will eventually
require liver transplantation, approximately half in the first 2y of life. Early diagnosis and therapy is essential especially for the survival of patients with biliary atresia.

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A case of primary chronic sclerosing osteomyelitis of humerus in a 24-year old female is described. Drainaging fistula formation located at the arm differs the case from the Garre’s
defination of “sclerosing form of osteomyelitis”. The patient was treated successfully with the removal of the sclerotic bone and normalization of cortical thickness. Follow-up at 6th
month was satisfactory, with no sign of recurrence.

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Hydatid disease generally caused by Echinococcus granulosus often represented as a slow growing cystic mass; Liver or lung are most commonly affected. However hydatid disease
may also affect the other parts of the body such as the brain, heart, spleen, peritoneal cavity, or bone rarely. Hydatid cysts of the musculoskeletal system are extremely rare. Since the intramuscular hydatid cyst seems like a soft-tissue tumour on clinical examination, the preoperative radiological diagnosis is very important for the identification of the lesion before decision to surgery. We report a rare case of primary hydatidosis
of a 32-year-old man represented as a slow-growing and painful lump on the adductor region of the left upper thigh. A soft, slightly tender, fixed mass, 10 cm., 10 cm. in size was examined and plain radiographs showed only soft-tissue swelling. MRI (magnetic resonaunce imaging)demonstrated a benign soft tissue tumour probably a lipoma. The mass was excised surgically. Sectioning showed a cystic cavity, which contained
clear fluid. The residual cavity was then irrigated with hypertonic saline solution. After the day surgery, abdominal ultrasonography (USG) and thoracal and abdominal computed
tomography and cerebral MRI was performed and all were found to be normal. As far as we know, in rare primary muscle hydatidosis cases in the literature, this is the first case
representing the involvement of the adductor region of the upper thigh. As a conclusion; in endemic regions for hydatidosis, a mass in any part of the body should be considered a
hydatid cyst until proven otherwise.

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Down syndrome (DS) is a genetic disorder with trisomy 21. It has been occured rather frequently because of the increasing maternal age. DS, could be seen together with many anatomic, physiological and biochemical anomalies. Concomitant pulmonary hypoplasia and thoracic wall’s pectus carinatum deformity are rarely seen in DS. Pulmonary hypoplasies diagnosed in newborn period because of the clinical presentation of itself and concomitant disorders. We would like to report present case with DS, left pulmonary hypoplasia and pectus carinatum who was unexpectedly and delayed diagnosed.

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