Derinin yapýsý ve fonksiyonlarý çevresel ve endojen faktörlerden etkilenerek fotoyaþlanmaya, inflamasyona, immun disfonksiyona, epidermal homeostazýn bozulmasýna ve deri hastalýklarýna neden olur. Bazý yiyeceklerin ve ek besinlerin diyetle
alýnmasýnýn ultraviyole ýþýnlarýna, immun yapýya ve bazý hastalýklara karþý koruyucu etki saðladýðý gösterilmiþtir. Bu derlemede vitaminlerin, karotenoidlerin, doymamýþ yað asitlerinin
ve bitkisel antioksidanlarýn deri deðiþikliklerini önlemedeki etkileri özetlenmiþtir.

Skin condition and functioning are affected by environmental and endogenous factors leading to photoaging, inflammation, immune dysfunction, imbalanced epidermal homeostasis and skin disorders. Dietary consumption of specific foods and supplements was shown to provide protection against ultraviolet light, immune status and some skin disorders. In this review, we summarize the effects of vitamins, carotenoids, polyunsaturated fatty acids and botanical antioxidants in the prevention of skin alterations.

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Uyku, oldukça kompleks ve mekanizmasý net olarak çözülmemiþ karmaþýk bir durumdur. Gece/gündüz uyunmasýna ve yaþamýn 1/3’ünün uykuyla geçmesine raðmen hala uykunun moleküler mekanizmasýyla ve uyku/uyanýklýk regülasyonuyla ilgili bilinmeyenler vardýr. Uyku zamanlamasýnýn, süresinin ve yoðunluðunun belirlenmesinde çeþitli etkenler söz konusudur. Bu etkenler arasýnda; nöropeptitler ve beslenme yer almaktadýr. Yapýlan çalýþmalarda diyetle alýnan karbonhidrat, protein ve bazý elzem yað asitlerinin uyku regülasyonunda etkisi olduðu kanýtlanmýþtýr.

Sleep is a highly complex state that remains as one of the great mysteries in neuroscience. Althought sleep/wake cycles are repeated every day and night and almost one-third of our lifetime is spent sleeping, the molecular mechanisms of sleep wake regulation have remained little understood. There are some factors for determining the time, duration and intensity of sleep. Among these factors; neuropeptides and nutrition intensified recently. Some experimental evidence indicates dietary intake of carbohydrate, protein and some essential fatty acids are probably sleep regulating substances.

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GÝRÝÞ ve AMAÇ: Glenohumeral instabilite teþhisi konularak, açýk cerrahi ile bankart tamiri yapýlan hastalarýn cerrahi yöntem ve klinik sonuçlarýnýn deðerlendirilmesi amaçlanmýþtýr.


YÖNTEM ve GEREÇLER: Omuz instabilite tanýsý ile 92 hastaya GATA ortopedi kliniðinde, sütur ankorlar kullanýlarak açýk Bankart tamiri uyguladýk. Altý aylýk rehablitasyonunu tamamlamýþ ve takipleri tam olarak yapýlabilen toplam 68 hastanýn fizik muayeneleri yapýlmýþ ve son radyografileri deðerlendirilmiþtir. Hastalarýn hepsi erkekti. Hastalarýn cerrahi sýrasýndaki ortalama yaþý 24.55 (19-35) di. Ýlk çýkýk yaþý deðerlendirildiðinde 68 hastanýn 42'sinde 20 yaþýn altýnda, 25'inde 20 ile 30 yaþ arasýnda, 1'inde ise 30 ile 40 yaþlan arasýnda ilk çýkýk öyküsü vardý. Ýlk çýkýk yaþý ortalama 19.5, çýkýk sayýsý ortalama 20.7 idi. Cerrahi sonrasý ortalama takip süresi 30.7 (6-52) aydý.
BULGULAR: Hiç bir hastada rekürrens görülmedi. Olgularýn ortalama Rowe skoru 95.5 ti (80-100). Rowe’un bankart skorlamasýna göre 60 hastada (% 88.2) mükemmel sonuç, 8 hastada (% 11.8) iyi sonuç elde edildi. Hiç bir hastada rekürrens ve baþarýsýz sonuç yoktu. 13 hastamýzda ortalama dýþ rotasyon kaybýmýz 7.46 0 idi.
TARTIÞMA ve SONUÇ: Glenohumeral instabilite tedavisinde amaç glenohumeral eklem hareketini kýsýtlamadan instabilitenin önlenmesidir. Bu açýdan bakýldýðýnda Bankart tekniði uygun bir tekniktir.

INTRODUCTION: The aim of this study was to evaluate the open surgical technique and clinical outcomes of the bankart repair for glenohumeral instability.
METHODS: Open Bancard repair by suture anchore tecnique was performed to 92 patients having glenohumeral instability. The patients who had completed the rehabilitation
lasting 6 months have been included in this study. Twenty-four of the 92 patients were excluded because of various reasons like inadequate follow up etc. Sixty-eight patients
who have completed the six weeks physiotherapy programme made the study group. All patients were male with a mean-age 24.55 at the time of surgery. The mean age of the
first dislocation was 19.5, and the mean number of the dislocation was 20.7. The mean follow-up time was 30.7 (6-52) month.
RESULTS: There was no recurrence in any patients. The mean Rowe score of the cases were 95.5 (80-100). By means of the Rowe score, excellent results in 60 patients (88.2 %) and good
results in 8 (11.8 %) patients were obtained. We faced no failure as there was no recurrence in any patients.The mean external rotation decrease was 7.46 0.
DISCUSSION AND CONCLUSION: The aim at the treatment of the glenohumeral instability is that the instabilitation is prevented without limiting the motion of the glenohumeral joint. From this point of view, Bankart technique is one of the most appropriate technique.

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GÝRÝÞ ve AMAÇ: Ýstanbul Eðitim Araþtýrma Hastanesi Koroner Yoðun Bakým Ünitesinde Ocak 2003-Aralýk 2003 arasýnda Akut miyokard infarktüsü tanýsýyla yatýrýlarak tedavi edilen 92 hastanýn klinik, demografik özellikleri, uygulanan tedaviler, komplikasyonlar ve hastane içi mortalite oranlarýnýn deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: 92 hastanýn kayýtlarý geriye dönük incelendi.
BULGULAR: 92 hastanýn yaþ ortalamasý 58.1±10.14 idi. Hastalarýn 73 (% 79.3)‘ü erkek, 19 (% 20.6)’u bayan idi. 8 (% 9) hastada ST elevasyonsuz miyokard infarktüsü, 84 (% 91) hastada ST elevasyonlu miyokard infarktüsü tespit edildi. 17 (%18.4) hastada yatýþý sýrasýnda ölüm gerçekleþmiþ, bunlarýn 11 (% 64.7)’i ilk 24 saatte, 6 (% 35.3) taneside 24 saatten sonra gerçekleþmiþtir. Hastane için mortalite 65 yaþ üstünde daha fazladýr (p=0,01). 41 hastaya (% 45) trombolitik tedavi uygulanmýþ, 51 (% 65)’ine hastaneye geç ulaþmalarý yada kontrendikasyon bulunmasý nedeniyle trombolitik uygulanmamýþtýr. Trombolitik uygulanan hastalarda mortalite anlamlý derecede düþüktür (p: 0.045). 75 hasta kardiyoloji poliklinik kontrolü önerilerek taburcu edilmiþtir.

TARTIÞMA ve SONUÇ: Kardiyovasküler ölümler mortalitenin en sýk sebebi olmasýna karþýn, ülkemizde akut koroner sendromlarda giriþim yapabilecek merkez sayýsý azdýr. Bu durum merkezimiz gibi trombolitik tedavi yapan merkezlerin önemini arttýrmaktadýr. Çalýþmamýzda hastalarýn önemli bir kýsmýna hastaneye
geç baþvurmalarý nedeniyle trombolitik uygulanamamýþtýr. Hastane içi mortalite trombolitik uygulananlarda anlamlý derecede düþüktür. Bu nedenle toplumun doðru bilgilendirilerek hastaneye erken baþvurulmasý saðlanmalýdýr.

INTRODUCTION: The study was aimed to examine clinical and demographic characteristics, therapeutic interventions, complications, in-hospital mortality of 92 patients hospitalized for
acute myocardial infarction between January 2003-December 2003 in Coronary Intensive Care Unit of Istanbul Education Research Hospital.
METHODS: Records of 92 patients were reviewed retrospectively.
RESULTS: Mean age of 92 patients was 58.1±10.14 years. Seventy-three (79.3 %) of the patients were male and 19 (20.6%) were female. Non-ST elevation myocard infarction was found
in 8 (9 %) patients and ST-elevation myocard infarction in 84 (91 %). Seventeen patients (18.4 %) died at admission, with 11 of them (64.7 %) dying within 24 hours and 6 dying later than the first 24 hours. In-hospital mortality was higher among those elder than 65 years old (P=0.01). Forty one (4
%) patients received thrombolytic treatment and 51 (65 %) did not due to reaching to the hospital lately or several counter indication. In-hospital mortality rate is significantly lower
in patients receiving thrombolitic (p=0.045). Seventy-five patients were discharged, with a recommendation of cardiologic outpatient follow-up.
DISCUSSION AND CONCLUSION: Although cardiovascular death is the most common cause of death, a few centers in our country are able to
perform interventions in acute coronary syndromes. This increases the importance of centers performing thrombolytic treatment such as our one. In the current study, a substantial proportion of patients did not receive thrombolytic treatment due to delayed admission to the hospital. Although no significant difference existed between groups receiving and not receiving thrombolytic treatment in our center, in-hospital mortality was significantly lower among those receiving thrombolytic treatment. Hence, the community should be appropriately informed to allow the early admission to the hospital

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GÝRÝÞ ve AMAÇ: Ýdiyopatik skolyozlu hastalarda transpediküler vida yöntemi ile tedavi sonuçlarýnýn geriye dönük olarak incelenmesi.

YÖNTEM ve GEREÇLER: Ýdiyopatik skolyoz nedeniyle transpediküler vida yöntemi tedavi edilen 25 hastanýn (13 kýz, ortalama yaþ 14.2 yýl, daðýlým 10-21: 12 erkek, ortalama yaþ 16.7 yýl, daðýlým 11-30) korreksiyon sonuçlarý geriye dönük olarak deðerlendirildi. Hastalarýn postoperatif birinci, üçüncü, altýncý ve 12. aylarda ve takip eden sürelerde yýllýk kontrolleri yapýldý. Klinik gözlemin yaný sýra, hastalar ameliyat öncesi ve sonrasý cobb açýlarý ve korreksiyon oranlarý belirlenerek radyolojik
olarak deðerlendirildi. Radyolojik olarak iskelet sisteminin matüritesi risser sýnýþamasýna göre yapýldý. Hastalar ortalama 20.6 ay (daðýlým 3-50 ay) takip edildi.

BULGULAR: Baþvuru anýndaki eðriliklere göre yedi vakanýn jüvenil idiyopatik skolyoz, 18 vakanýn adolesan idiyopatik skolyoz olduðu tespit edildi. Olgularýmýz arasýnda infantil idiyopatik skolyoza rastlanmadý. Matürite açýsýndan yapýlan klinik deðerlendirmede 20 vakanýn sekonder seks karaktelerinin belirmiþ olduðu görüldü. Olgularýn ameliyat öncesi ortalama Risser sýnýþamasý 2.9 olarak bulundu. Ameliyattan önce frontal planda cobb yöntemine göre ölçülen eðrilikler ortalama 55.5 derece (daðýlým 15-90 derece), lateral bending grafilerinde cobb açýlarý ortalama 28 derece (daðýlým 8-60 derece) ve fleksibilite oranlarý % 51 (daðýlým % 20-80) olarak tespit edildi. Ameliyat sonrasý ise cobb açýsý 18.4 derece (daðýlým 3-50 derece), korreksiyon oraný % 69 (daðýlým % 33.3-94) olarak
bulundu. Son kontrollerde yapýlan ölçümlerde ise cobb açýsý 19.2 derece (daðýlým 3-52 derece), korreksiyon kaybý ise % 1.2 (% 1-3) olarak tespit edildi.

TARTIÞMA ve SONUÇ: Ýdiyopatik skolyoz tedavisinde pedikül vidasý kullanýlarak yapýlan düzeltme, klinik ve radyolojik olarak iyi sonuçlara sahiptir. Pedikül vidasý ile düzeltmelerde komplikasyon oranýnýn düþük olmasý güvenilir bir metod olduðunu düþündürmektedir.

INTRODUCTION: To evaluate the results of treatment in patients with idiopathic scoliosis treated by transpedicular screw tecnique retrospectively.
METHODS: The correction results of 25 patients (13 female, mean age 14,2 years range 10-21; 12 males, mean
age 16.7 years, range: 11-30) who were treated with transpedicular screw due to idiopathic scoliosis were evaluated retrospectively. Patients were controlled in 1st, 3rd, 6th and 12th month postoperatively and clinical and radiological findings were recorded. Preoperative and postoperative cobb angles were measured for calculating the correction rates.
RESULTS: Seven of patients had juvenile idiopathic scoliosis while 18 had adolescent idiopathic scoliosis. There was no infantile idiopathic scoliosis among our patients. Regarding maturity, 20 patients had evident secondary sex characteristics. Skeletal maturity was evaluated by Risser classification.
DISCUSSION AND CONCLUSION: Preoperatively, the mean deformity angle in frontal plane according to cobb tecnique was 55.50 (150-900), 280 (80-600) in lateral bending graphies and rates of flexibility was 51 % (20-80 %). Postoperatively, the mean cobb angle was 18.40 (30-500), the correction rate was 69 % (33.3-94%). In the controls, the cobb angle was 19.20 (30-520) and the loss of correction was 1.2 % (1-3 %)

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Urinary tract infections are one of the most common infections in outpatient. Acute pyelonephritis is an upper urinary tract infection. Infections of the biliary tract are most often associated with obstruction to the flow of bile. Twenty-four years old female patient admitted to emergency clinic with complaints of fever, chill, shivering, myalgia, arthralgia, nausea, vomitting and right sided abdominal pain. In her past medical history, there was no disease other than nephrolithiasis. In her vital signs, body temperature was 39.8°C. In physical examination, there were pain at deep palpation of right upper quadrant of abdomen and right costovertebral angle.Also, there was Murphy sign. Other system examination was normal. At the admission time, in laboratory examination;
white blood count was 15.270/mm3 with 90 % of neutrophile. Microscobic examination of urine showed puyuria. Abdominal ultrasound revealed edema and thickening of fundus (5.3 mm) of gall bladder and dilatation of right proximal urether and mucosal edema of right renal pelvis and proximal urether. Abdominal computerize tomography showed 2x2.5x5 cm hypodense lesion with irregular border at the cortical region of the middle zone of right kidney and hypodense effussion around the gall bladder. With the diagnosis of pyelonephritis, renal abscess and acute cholecystitis treatment of ceftriaxone
2x1 gr/day and ornidasole 2x500 mg/day was given for 3 weeks. There were no other complaints in 6 months of follow.

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This is a case report of a patient with a transverse colon volvulus and acute obstruction of the large intestine. A case is presented with emphasis on incidence, predisposing factors,
clinical presentation and radiologic examination. Volvulus of the transverse colon continues to be relatively rare medical problem and is infrequently included in the differential diagnosis
of the acute abdomene.

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GÝRÝÞ ve AMAÇ:
YÖNTEM ve GEREÇLER:
BULGULAR:
TARTIÞMA ve SONUÇ:

INTRODUCTION: We aimed a patient whose detected Osteogenezis Ýmperfekta Tip 2 in antenatal period, to discuss a case report.
METHODS: A patient who is 24 years old and whose pregnancy is detected, osteogenezis Ýmperfekta Tip 2 in 30. pregnancy weeks had amniosynthesis and after the completion of the molecular tests the patient is included the study.
RESULTS: Aðrý Maternity and Children Hospital.
DISCUSSION AND CONCLUSION: Osteogenezis Ýmperfekta Tip 2 is diagnosed that diminishing of calvarium mineralisation, flattening profile and fractures of the long bones since the 20. Pregnancy weeks
and because of pairing chromosomal abnormalities and structural deformities this event results exitus intrauterin or neonatally.

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We aimed a patient whose detected fetal megasistis in antenatal period,to discuss a case report. A patient who is 39 years old and whose pregnancy is detected fetal megasistis in
28.pregnancy weeks did not accept amniosynthesis and her pregnancy is resulted intrauterin exitus in 30. pregnancy weeks. Fetal Megasistis is diagnosed that fetal bladder longitudinal
diameter>7 mm between 10-14 pregnancy weeks and because of pairing chromosomal abnormalities and structural deformities this event results exitus intrauterin or neonatally.

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Evans syndrome is rare and characterized with autoimmun thrombocytopenia and hemolytic anemia. Etiology is unknown. The patients may apply with different clinical findings. Seven years old boy was refered for fever, abdominal pain and epistaxis. In physical examination pallor and hepatosplenomegaly were detected. In laboratory anemia, thrombocytopenia, insufficient of thrombocytes and hemolysis in periferic blood smear, high lactic dehydrogenase, low haptoglobulin, increased reticulocyte count were found and Direct Coombs test were positive. Hypercellularity, increased erytroid series and megacaryocytes were determined in bone marrow examination. Erythrocyte suspension and intravenous immunglobulin were used for treatment. In 12 days follow-up hemoglobine level and platelet count were in normal limits and patient was discharged
succesfully. The patient had no symptoms and normal laboratory findings two months later. The aim of this case report is evaluation of clinical and laboratory features of Evans
syndrome.

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Hydatid cyst is a zoonosis caused by echinococcos granulosis. Incidence of the disease varies between 5 to 20 in 100 000 in most countries. Cardiac hydatid cysts are rare and comprise 0,5 to 2 % of all hydatid cyst cases. The most frequent location is the free wall of left ventricle and interventriculer septum. A hydatid cyst localized at the apex of left ventricle is an extremely rare occasion. Most of the patients with cardiac hydati-dosis are asymptomatic. We present a case of cardiac hydatid cyst localized at the left ventriculer apex who presented
with atrial fibrillation (AF) and symptoms of heart failure(HF). Hydatid cyst must be considered absolutely in the differantial diagnosis of cardiac cysts.

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