GÝRÝÞ ve AMAÇ: Ankilozan Spondilit’e (AS) özgü ölçüm indeksleri ile demografik veriler arasýndaki iliþkiyi saptamak.
YÖNTEM ve GEREÇLER: Çalýþmaya polikliniðimizde takip edilen, modifiye New York kriterlerine göre AS tanýsý almýþ 83 hasta dahil edildi (29 kadýn, 54 erkek). Egzersiz programlarý, sigara kullanýmlarý, ilaçlarý, ek hastalýklarý, gelir düzeyleri ve hastalýk süreleri sorgulandý. AS’e özgü deðerlendirme indeksleri olan Bath Ankilozan Spondilit Fonksiyonel Ýndeksi (BASFI), Bath Ankilozan Spondilit Hastalýk Aktivite Ýndeksi (BASDAI), Bath Ankilozan Spondilit Metroloji Ýndeksi (BASMI), Bath Ankilozan Spondilit Radyoloji Ýndeksi (BASRI) hesaplandý.

BULGULAR: Hastalarýn yaþ ortalamalarý 41.1±9.7 (24-62 yaþ) yýldý. Ortalama hastalýk süresi 8.2 ± 5.6 yýldý. 28’i (% 33.7) düzenli, 8’i (% 9.6) düzensiz egzersiz yaptýðýný, 47’si (% 56.6) egzersiz yapmadýklarýný belirttiler. 31 (% 37.3) kiþi sigara kullanýyordu. 67 (% 80.7) olguda ek bir hastalýk yoktu. Nonsteroid antiinflamatuar ilaç (NSAI); NSAI+Sulfasalazin ve/veya
Methotrexate; anti tümör nekroz faktör alfa (anti-TNF) alan hastalarýn daðýlýmý sýrayla; 31 (% 37.3), 30 (% 36.1), 17 (% 20.5) idi. Gelir düzeyine göre gruplandýrýldýklarýnda; 550
YTL ve altý 28 (% 33.7) kiþi, 550-1000 YTL arasý 37 (% 44.6) kiþi, 1000 YTL ve üzeri
olanlar 18 (% 21.7) kiþi idi. Egzersizin ve sigara kullanýmýnýn BASFI, BASDAI, BASMI, BASRI ile arasýnda istatistiksel olarak anlamlý bir iliþkisi saptanmadý. Gelir düzeyleri ile BASFI, BASMI, BASRI deðerleri arasýnda anlamlý negatif korelasyon bulundu (p: 0.012, p: 0.0001, p: 0.002). Hastalýk süresi ile BASMI ve BASRI arasýnda istatistiksel olarak anlamlý iliþki bulunurken (p: 0.001, p: 0.005), BASFI ve BASDAI ile bulunmadý.

TARTIÞMA ve SONUÇ: AS’de hastalýk süresi, BASMI ve BASRI ile iliþkili önemli bir parametre olarak saptandý. Gelir düzeyi ise BASMI, BASRI ile birlikte BASFI ile de iliþkili ikinci bir parametre olarak bulundu.

INTRODUCTION: To determine the association between specific measurement indexes of ankylosing spondylitis (AS) and demographic data.
METHODS: 83 patient (29 female, 54 male) who are followed in our outpatient clinic and diagnosed as AS according to modified New York criteria were included into the study. Exercise programs, smoking, medications, comorbidities, income levels, and duration of the diseases were queried. Specific measurement indexes of AS; Bath Ankylosing Spondylitis
Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activation Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis
Radiologic Index (BASRI) were scaled.
RESULTS: Avarage age range of patients were 41.1±9.7 (24-62) years. Avarage disease duration was 8.2±5.6 (1-34) years. 28 (33.7 %), 8 (9.6 %), 47 (56.6 %) of the patients stated that
they were exercising regularly, irregularly and not at all, respectively. 31 (37.3 %) of the patients were smokers. 67 (80.7 %) of the patients has had no comorbidities. Patients using Non-steroidal anti-inflammotory drugs (NSAID); NSAID+Sulfasalazin, and/or Methotrexate; anti-tumor necrosis factor alfa (anti-TNF) were respectively 31 (37.3 %), 30 (36.1 %),17 (20.5 %). Ranged according to the income level; 28 (33.7 %) of the patients were earning 550 YTL and lesser, 37 (44.6%) were earning 550-1000 YTL, 18 (21.7 %) were earning 1000 YTL and more. No relevant statistical relation between exercise & smoking, and BASFI, BASDAI, BASMI, BASRI was detected. Relavant negative correlation (p: 0.012, p: 0.0001,p: 0.002) was detected between income level and BASFI, BASMI,
BASRI. Statistically relevant relation was detected between disease duration and BASMI and BASRI (p: 0.001, p: 0.005)where as no relation between BASFI and BASDAI was detected.
DISCUSSION AND CONCLUSION: Disease duration in AS was detected as an important parameter related with BASMI and BASRI. Income level was found as a second parameter related with BASMI, BASRI and as well with BASFI.

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GÝRÝÞ ve AMAÇ: TOT uygulamalarý sonrasýnda komplikasyon, objektif ve subjektif kür oranlarýný araþtýrmak.
YÖNTEM ve GEREÇLER: Ocak 2006-Mayýs 2007 tarihleri arasýnda stres inkontinansý saptanan TOT prosedürü uygulanan 25 hasta çalýþmaya alýndý. Perioperatif, erken ve geç komplikasyon
oranlarý ile postoperatif 6. ayda objektif ve subjektif kür oranlarý bulundu.

BULGULAR: Perioperatif vajinal yaralanma, sinir, mesane, üretra yaralanmasý kimsede izlenmedi. 1 (% 4) hastada kan transfüzyonu gerektirecek kanama izlendi. Mesh çýkarýlmasýný gerektirecek üriner retansiyon hiçbir hastada izlenmedi. Denova urge semptomlarý 3 (% 12) hastada postoperatif 6. haftada izlendi. 1 (% 4) hastada vajinal erezyon izlendi. Bacak aðrýsý 1
(% 4) hastada izlendi. Preoperatif ped testi ile hafif idrar kaçaðý olan % 16 (4) hasta orta idrar kaçaðý olan % 68 (17) hasta, % 16 (4) aðýr idrar kaçaðý olan % 16 (4) hasta varken postoperatif 6. ayda % 24 (6) hastada hafif idrar kaçaðý izlenirken hiçbir hastada orta-aðýr idrar kaçaðý izlenmedi. (Tablo 3). 6. ayda objektif kür oraný % 84 (21) iken, subjektif kür
oraný % 88 (22) dir.

TARTIÞMA ve SONUÇ: TOT uyguladýgýmýz hastalarýmýzda komplýkasyon oranlarý oldukca dusuk, hospýtalýzasyon suresý oldukca kýsaydý. TOT uygulanmasý kolay ogrenme perýodu oldukca kýsa hasta ve hekým memnunýyetý yuksek býr antý ýnkontýnans operasyonudur.

INTRODUCTION: Assessment of objective and subjective cure rates, and complications after tot procedures.
METHODS: 25 patients were diagnosed to have stress incontinence and applied tot between dates January 2006-May 2007 in our clinic were included in this study. Early and late perioperative complication rates and postoperative objective and subjective cure rates at the sixth month were assessed.
RESULTS: No patient experienced perioperative vagina, nerve, bladder and urethral injury. Bleeding that require blood transfusion was detected only in one patient (4 %). No urinary
retention that require mesh removal was detected in any of the patients. Only three patients (12 %) had de-novo urge symptoms six weeks after the operation. We observed vajinal erosion only in one patient (4 %), and leg pain in one patient (% 4). In preoperative period four patients have mild (% 16), 17 patients have moderate (% 68), and four patients have severe (% 16) urinary leakage with pad test, at the sixth month postoperatively,six patients had mild urinary leakage and no patient had moderate or severe urinary leakage.
DISCUSSION AND CONCLUSION: In patients we applied TOT, our complication rates were very low, and hospitalization period was short. TOT is an easily applied anti incontinance operation with fairly
short learning period and satisfactory results for both patient and the clinician.

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GÝRÝÞ ve AMAÇ: Prediabetik bireylerde diyabetik retinopati sýklýðýnýn tespiti ve etkileyen faktörlerin deðerlendirilmesi.
YÖNTEM ve GEREÇLER: Ýç hastalýklarý kliniðine ocak 2006 ve mart 2008 tarihleri arasýnda baþvuran 20-60 yaþlarý arasýnda toplam 118 birey çalýþmaya alýndý. Bireylerde daha önceden diyabet öyküsü olmasý ve antidiyabetik ilaç kullanmasý çalýþmaya alýnmama kriterleriydi. Açlýk kan glukozunun 100-125 mg/dl arasýnda olmasý Bozulmuþ açlýk glukozu (BAG) ve 75 gram oral glukoz uygulanmasýndan 2 saat sonunda kan glukozunun 140-199 mg/dl olmasý bozulmuþ glukoz toleransý (BGT) olarak tanýmlandý. Bu kriterleri saðlayan bireyler çalýþmaya dahil edildi. Katýlýmcýlara ek olarak diabetik öykü, fizik inceleme (tansiyon, nabýz, kilo boy gibi..) ve laboratuar tetkikleri (kreatinin, ALT, AST, Total kolesterol, HDL- K, trigliserid ve
LDL-K) yapýldý. Takibinde, katýlýmcýlar göz dibi muayenesi için göz kliniðine gönderildi.

BULGULAR: Çalýþmaya katýlan bireylerin % 27.1’inde HT ve % 11.0’inde retinopati vardý. Retinopati sýklýðý sadece IFG’si bulunan hastalarda % 2, sadece IGT’si olanlarda % 9.1 ve IFG ve IGT’nin her ikisine de sahip olanlarda % 22.2 olarak bulundu. HT sýklýðý ise sýrasýyla; % 15.7, % 36.4 ve % 35.6 olarak bulundu. Retinopati ile postglukoz 2. saat kan glukozu
(PG2.Sa. KG) (p: 0,001, r: 296), tek baþýna IGT (p: 0.006, r: 252) olmasý ve birlikte IFG ve IGT olmasý (p: 0.002, r: 281) anlamlý oranda korelasyon gösterdi. Lojistik regresyon analizinde, retinopati için istatistiksel olarak anlamlý parametreler önem sýrasýna göre þöyledir: 1. birlikte IFG ve IGT bulunmasý (p: 0.002), 2. PG2Sa.KG (p: 0.003) ve 3. sadece IGT (p: 0.006) idi. HbA1C retinopati için anlamlý olmamakla birlikte prediktif faktör olarak 4. sýradaydý (p: 0.073). IFG ise retinopatiyi anlamlý olarak öngördürmüyordu (p: 0.752).

TARTIÞMA ve SONUÇ: Bizim çalýþmamýzda prediyabetik bireylerde retinopati sýklýðý en fazla BAG/BGT birlikte olduðu grupta tespit edildi. Retinopatiyi en önemli öngördüren faktör ise PG2.Sa. KG idi.

INTRODUCTION: To determine the frequency of diabetic retinopathy in prediabetik individuals and to evaluate the relevant factors
METHODS: A total of 118 persons between 20-60 years of age attending our internal medicine clinic between january 2006 and march 2008 were recruited for the study. The exclusion criterions were the presence of diabetes mellitus and use of antidiabetic agents. Fasting blood glucose between 100-125 mg/dl was defined as impaired fasting glucose (IFG);
blood glucose after 2 h oral glucose tolerance test between 140-199 mg/dl was defined as impaired glucose tolerance (IGT). The individuals provided these criterions were included
the study. In addition, diabetic history, physical examination (tension arteriale, pulse, fever) and laboratory investigations (creatinine, ALT, AST, Total cholesterole, HDL- C, triglyceride ve LDL-C) were carried out. Subsequently, participants were referred to ophtalmology clinic for fundoscopic examination.
RESULTS: Hypertension was found in 27,1 % of participants and retinopathy was determined in 11 % of them. The frequency of retinopathy in patients with isolated IFG, isolated IGT and both IFG and IGT were 2 %, 9,1 % and 22,2 %, respectively. The frequency of hypertension were found to be 15.7 %, 36.4 % ve 35.6 %, respectively. There are significant correlations between retinopathy and postglucose 2. hour blood glucose (PG2hr BG) (p: 0,001, r: 296), the presence of isolated IGT (p: 0.006, r: 252), coexistence of IFG and IGT (p: 0.002, r: 281). In logistic regression analyse, statistically significant parameters for retinopathy according to impotance are as follows: 1. coexistence of IFG and IGT (p: 0.002), 2. PG2hr BG (p: 0.003), 3. presence of isolated IGT (p: 0.006). Although
HbA1C was no statistically significant for retinopathy, it was in fourth line as predictive (p: 0.073).
DISCUSSION AND CONCLUSION: In our study, frequency of retinopathy among prediabetic subjects were significantly higher in group of coexisting IFG and IGT than other groups. Additionally, PG2hr BG was the most important predictor of retinopathy.

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GÝRÝÞ ve AMAÇ: Laparoskopik tubal sterilizasyon uygulanan hastalarda elektrokoagulasyon ve mekanik klips yöntemlerinin over rezervine etkilerini karþýlaþtýrmak

YÖNTEM ve GEREÇLER: Bu prospektif randomize çalýsmaya tubal sterilizasyon arzusu olan reprodüktif çaðda 80 hasta dahil edildi.Basit randomizasyon ile hastalar elektrokoagulasyon yöntemi ile tubal sterilizasyon yapýlanlar ve mekanik klips yontemiyle tubal sterilizasyon yapýlanlar olmak üzere iki gruba ayrýldý. Preoperatif dönemde ve postoperatif 10. ayda elde edilen 3.
gün bazal serum FSH, LH, estradiol, inhibin-B, antimullerian hormon, total bazal over hacim ölçümü ve antral folikul sayýlarý her bir grup içinde ve gruplar arasýnda karþýlaþtýrýldý.


BULGULAR: Elektrokoagulasyon yöntemiyle tubal sterilizasyon ve mekanik klipsle tubal sterilizasyon gruplarý arasýnda, postoperatif 10. ay total bazal over hacmi ve antral folikul sayýmý
açýsýndan anlamlý farklar izlendi.

TARTIÞMA ve SONUÇ: Elektrokoagulasyon yöntemi ile laparoskopik tubal sterilizasyonun postoperatif dönemde over rezervine olumsuz etkileri olduðu düþünülmektedir.

INTRODUCTION: To compare the effects of laparoscopic tubal sterilization through electrocoagulation and the application of mechanical clips on the ovarian reserve.
METHODS: 80 patients in the reproductive period with the desire of tubal sterilization were included in the prospective, randomized study. The patients were divided into two groups by simple randomization as tubal sterilization through electrocoagulation group and the application of mechanical clips group. Day three serum basal FSH, LH, estradiol, inhibin-B,
antimullerian hormone, total basal ovarian volume measurements and anthral follicle counts of all patients in the preoperative and 10th postoperative months were compared both within and between the two groups.
RESULTS: A significant difference between the postoperative 10th month total basal ovarian volumes and anthral follicle counts were detected between the electrocoagulation and mechanical clips application groups.
DISCUSSION AND CONCLUSION: Laparoscopic tubal sterilization by electrocoagulation is very likely to have an adverse effect on the ovarian reserve in the postoperative period.

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Hipertansiyon en önemli saðlýk sorunlarýndan biridir. Tüm dünyada hipertansiyon tedavisi ve kan basýncýnýn kontrol altýna alýnma oranlarý genel olarak düþük seyretmekle birlikte ülkeler arasýnda önemli farklýlýklar vardýr.
Son yýllarda tüm dünyada, çok çeþitli bitkisel ilaç, beslenme desteði, vitamin ve mineraller bilinen týbbi ilaçlarýn yanýnda yoðun bir þekilde kullanýma girmiþtir. Ýnsanlýk tarihinden itibaren bir çok bitkisel ilaçtan tedavide faydalanýlmýþ, son 40 yýldýr Amerika’da 8-10 yýldýr da Türkiye’de bitkisel ilaç pazarý büyüyerek bir sektör halini almýþtýr. ‘Doðalsa mutlaka güvenilirdir‘ sloganýyla sunulan bu ilaçlar, hastalar tarafýndan çoðunlukla doktor bilgisi ve kontrolü dýþýnda kullanýlmakta, yan etki ve toksisitelerinin olmadýðýna inanýlmaktadýr.
Günümüzde; hipertansif hastalarýmýzýn en sýk kullandýðý bitkisel preparatlar arasýnda sarýmsak (allium sativum) ve limon suyunu görmekteyiz.

Hypertension is one of the most important health problems. Hypertension’s cure and getting’s rates under blood pressure are generally low also there are important diffrences among countries.
Recently, many kinds of herbal drugs, nutritional supports, vitamins and minerals are used besides medical drugs. Many herbal drugs are used for therapy since early human history.
For the last 40 years in the USA and the last 8-10 years in Türkiye, herbal drug marketing has become a sector. These drugs are presented with the slogan “If it is natural, then it is
absolutely reliable”. They are usually used without doctor control since they are believed not to have any side effects and toxicity.
In the day; Hypertension patients frequently uses vegetable between factory-made pharmaceutical be seen garlic (allium sativum) and lemon juice.

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Perimenopozal dönemin en önemli yakýnmalarýndan biri sýcak basmasýdýr. Sýcak basmasý tekrarlayan, özellikle yüzde kýzarmaya neden olan, terleme oluþturan, vücudun üst bölümlerinde ve yüzde yoðun ýsý hissi yaratan ve ardýndan üþüme ile sonlanan bir durumdur. Sýcak basmasýnýn nedeni tam olarak belirlenememekle birlikte; endojen östrojen hormonunun konsantrasyonundaki deðþiminin rolü olabileceði düþünülmektedir. Kadýnlarda sýcak basmasýnýn görülme sýklýðý ve oluþma zamaný kadýndan kadýna deðiþiklik göstermektedir. Bu farklýlýk yaþanýlan ülke, beden kitle indeksi, yaþam stili, sigara kullanma durumu gibi birçok faktöre baðlýdýr. Sýcak basmalarýnýn çoðu tedavi edilmeksizin þiddeti azalarak zamanla geçmesine raðmen; kadýnlarda bu yakýnmaya iliþkin tedavi arayýþlarý yüksek oranlardadýr. Bu makalede sýcak basmasý için önerilen, düzenli egzersiz yapma, bitkisel kaynaklý destekler, vitamin E takviyesi, topikal progesteron, akupunktur ve mýknatýs tedavisine yer verilmiþtir.

Hot flashes are one of the most important signs of perimenopause.Hot flashes are recurrent, transient episodes of flushing, perspiration, and a sensation ranging from warmth to intense heat on the upper body and face, sometimes followed by chills. The exact cause of hot flashes has not been determined, although it seems that the changing endogenous estrogen concentrations associated with menopause may play a role.
The incidence and occurence time of hot flash differs in every women. Various lifestyle, country, body mass index, cigarette smoking, and social factors also seem to be related to hot flash frequency. Most hot flashes are mild to moderate in intensity and typically stop over time without therapy, nevertheless, many women experience hot flashes severe enough to seek treatment. The main focus of this review is on treatment regular
exercise, herbal and vitamin E supplement, topical progesterone, acupuncture, magnet therapy for hot flash symptoms.

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Okülokütanöz albinizm (OKA) göz, deri ve saçýn pigmentasyonunda yaygýn bir azalmayla karakterize melanin biyosentezi dozukluklarýnýn herediter bir grubudur. Albinizmin bütün formlarýnýn prevalansý dünya genelinde önemli ölçüde deðiþiklik gösterir ve yaklaþýk 17000’de bir oranýnda tahmin edilmektedir. OKA’nin klinik spektrumu deðiþiklikler gösterir. Orta derecedeki formlarda (OKA1B, OKA2, OKA3 ve OKA4) uzun sürede bir miktar pigment birikimi görülürken, OKA1A formunda yaþam boyu melanin üretiminin komple yokluðu ile en þiddetli tipi olduðu görülür. Klinik manifestasyonlarý deðiþik derecelerde konjenital nistagmus, iris hipopigmentasyonu ve yarý saydamlýk, retinal pigment epitelyumunda azalmýþ pigmentasyon, foveal hipoplazi, genellikle azalmýþ görme keskinliði (20/60’dan 20/400’e) ve kýrma kusurlarý, renkli görmede bozulma ve göze çarpan fotofobi. Optik sinirlerin yanlýþ seyri azalmýþ steroskopik görme ve þaþýlýkla sonuçlanan karakteristik bir bulgudur. Deri ve saçýn hipopigmentasyon derecesiOKA’nýn tipine göre deðiþiklik gösterir. OKA’nin 4 tipinin hepsi otozomal resesif hastalýklar olarak kalýtsal geçiþlidir. En az 4 gen hastalarýn farklý tiplerinde (TYR, OCA2, TYRPl ve MATP) sorumludur. Teþhis karakteristik oküler semptomlara ilaveten deri ve saçýn hipopigmentasyonunun klinik bulgularýna dayanýr. OKA formlarý arasýndaki klinik karýþmadan dolayý moleküler teþhis gen defektini ve OKA subtipini tesbit etmek için genelde gereklidir.

Oculocutaneous albinism (OCA) is a group of inherited disorders of melanin biosynthesis characterized by a generalized reduction in pigmentation of hair, skin and eyes. The prevalence of all forms of albinism varies considerably worldwide and has been estimated at approximately 1/ 17,000. The clinical spectrum of OCA ranges, with OCA1A being the most severe type with a complete lack of melanin production throughout life, while the milder forms OCA1B, OCA2, OCA3 and OCA4 show some pigment accumulation over time. Clinical manifestations include various degrees of congenital nystagmus, iris hypopigmentation and translucency, reduced pigmentation of the retinal pigment epithelium, foveal hypoplasia, reduced visual acuity usually (20/60 to 20/400) and refractive errors, color vision impairment and prominent photophobia. Misrouting of the optic nerves is a characteristic finding, resulting in strabismus and reduced stereoscopic vision. The degree of skin and hair hypopigmentation varies with the type of OCA. All four types of OCA are inherited as autosomal recessive disorders. At least four genes are responsible for the different types of the disease (TYR, OCA2, TYRP1 and
MATP). Diagnosis is based on clinical findings of hypopigmentation of the skin and hair, in addition to the characteristic ocular symptoms. Due to the clinical overlap between the
OCA forms, molecular diagnosis is necessary to establish the gene defect and OCA subtype.

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Cystic subchondral bone deficiencies which are not extended to the joint are named intraosseous ganglion cyst. These kinds of cysts are rarely seen in triquetrum. Magnetic rezonance imagine of the wrist was obtained for the rule out of the dequervain
tenosynovitis in a 54 years-old woman and a triquetrum intraosseous ganglion was diagnosed. In this case report, a rare intraosseous ganglion of triquertum with a dequervain
tenosynovitis was presented.

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Trichoepithelioma is a benign hamartomatous tumor of the pilosebaceous follicle that may occur either as a nonhereditary solitary lesion or as multiple lesions that are often dominantly inherited. The gene for multiple trichoepitheliomas has been mapped to a locus 9p21. The exact prevalence is unknown. They most commonly appear in early childhood or at puberty. We report a case of multiple familial trichoepithelioma occurring
in four members of a family.

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Perianal abscess is a common condition encountered in childhood. It is particular when happening in infants under 6 months of age. Here, a 2-month-old infant with perianal abscess is reported.
A 2-month-old infant admitted to hospital with a complaint of painful, swollen perianal lesion suggesting the presence of perianal abscess. Laboratory tests did not reveal any neutropenia nor inflammatory disease. The infant underwent a perianal abscess drainage. No fistula was found during the operation and no recurrence was observed, either.
Perianal abscess is not uncommon in childhood, but the precise incidence is unknown. In contrast to adults, the pattern of presentation in children strongly indicates a congenital predisposition. The gender ratio in adults is (M: F) 2: 1, whereas in infants it is almost an exclusively male disease. Systemic signs of sepsis are not common in infants. The classical treatment of perianal abscess is incision and drainage. The identification
and treatment of corresponding fistula is important to avoid recurrence

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