GÝRÝÞ ve AMAÇ: Anormal uterin kanamalý premenopozal kadýnlarda intrakaviter patolojilerin saptanmasýnda, transvajinal ultrasonografi, salin infüzyon sonografi ve diagnostik histeroskopinin tanýsal
doðruluklarýnýn karþýlaþtýrýlmasýný amaçladýk.

YÖNTEM ve GEREÇLER: Temmuz 2007- Temmuz 2008 tarihleri arasýnda anormal uterin kanama ile Saðlýk Bakanlýðý Göztepe Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum polikliniðine baþvuran ve histeroskopi yapýlan 35 premenopozal hasta retrospektif araþtýrma kapsamýnda deðerlendirildi. Bu tarihler arasýnda anormal uterin kanama nedeniyle opere olan hastalarýn dosyalarý arþivden çýkarýldý. Tüm hastalara pelvik muayene, transvajinal ultrasonografi, salin infüzyon sonografi, diagnostik histeroskopi ve endometrial biopsi yapýlmýþtý. Transvajinal ultrasonografi,diagnostik histeroskopi ve salin infüzyon sonografi
bulgularý endometrial biopsi tanýlarý ile karþýlaþtýrýldý. Sensitivite, spesifite, PPD ve NPD’ler hesaplandý.

BULGULAR: Anormal uterin kanamasý olan 35 premenopozal hasta deðerlendirildi. Araþtýrma grubunda, ayrýntýlý patoloji sonuçlarýnda premenopozal hastalarýn %51’inde endometrial patoloji bulunmuþtur. TVUSG endometrial biopsi ile karþýlaþtýrýldýðýnda, tüm endometrial patolojileri saptamaktaki sensitivitesi % 61,spesifitesi % 71, PPD % 69, NPD % 63 olarak bulunmuþtur. SIS endometrial biopsi ile karþýlaþtýrýldýðýnda tüm endometrial patolojileri
saptamaktaki sensitivitesi % 78, spesifitesi % 82, PPD %82, NPD % 78 olarak bulunmuþtur. Diagnostik histeroskopi endometrial biopsi ile karþýlaþtýrýldýðýnda tüm endometrial patolojileri saptamadaki sensitivitesi % 89, spesifitesi % 76, PPD %80, NPD % 87 olarak bulunmuþtur. Histeroskopinin ve salin infüzyon sonografinin intrauterin kavitedeki polip ve submüköz myom gibi anormalliklerin saptanmasýnda tanýsal doðruluðu transvajinal ultrasonografiden daha üstün bulundu.

TARTIÞMA ve SONUÇ: Premenopozal hastalarda endometrial polip ve submüköz myomlarýn teþhisinde SIS ve histeroskopi yaklaþýk olarak eþit tanýsal doðruluða sahiptir. Endometrial patolojilerin deðerlendirilmesinde histeroskopi ile endometrial biopsi birlikte yapýldýklarýnda en yüksek tanýsal deðer elde edilmiþ olur.

INTRODUCTION: The aim of this study is to compare the accuracy of transvaginal sonography, saline infusion sonography and diagnostic hysteroscopy in the detection of intracavitary pathologies in premenopausal women with abnormal uterine bleeding.
METHODS: In the period from July 2007 to July 2008, women who were referred for abnormal uterine bleeding to Ministry of Health Goztepe Research and Training Hospital Department of Obstetrics and Gynecology, gynecology outpatient clinic, were evaluated retrospectively. Records of patients who have been operated because of abnormal uterine bleeding
were taken out from the archive. All patients underwent pelvic examination, transvaginal ultrasonography, diagnostic hysteroscopy and endometrial sampling through suction curettage. The findings of transvaginal ultrasonography, saline infusion sonography
and diagnostic hysteroscopy were compared with the findings of endometrial sampling and all findings were compared with the findings of combined hysteroscopy and hystology. Sensitivity, specificity, positive and negative predictive values were
calculated.
RESULTS: A total of 35 premenopausal women with abnormal uterine bleeding were evaluated. Detailed pathology results indicated that 51% of the premenopausal patients in the research group
had endometrial pathology. When TVUSG is compared with endometrial biopsy, its sensitivity, specifity, positive and negative predictive values for detecting endometrial pathologies were found to be 61 %, 71 %, 69 % and 63 %, respectively. When SIS is compared with endometrial biopsy, its sensitivity, specifity, positive and negative predictive values for detecting endometrial pathologies were found to be 78 %, 82 %, 82 % and 78 %, respectively.
When diagnostic hysteroscopy is compared with endometrial biopsy, its sensitivity, specifity, positive and negative predictive values for detecting endometrial pathologies were found to be
89 %, 76 %, 80 % and 87 %, respectively. Diagnostic accuracies of hysteroscopy and SIS were found to be greater than that of TVUSG for the detection of abnormalities like polyps and submucous myomas in the intrauterine cavity.
DISCUSSION AND CONCLUSION: In premenopausal patients, SIS and hysteroscopy have close accuracies in the diagnosis of endometrial polyps and submucous myomas. For the evaluation of endometrial pathology, combination of hysteroscopy and endometrial sampling gives
the best diagnostic accuracy.

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GÝRÝÞ ve AMAÇ: Ýstirahat kalp hýzýnýn hipertansiyon, koroner kalp hastalýðý ve diðer sebeplerden oluþan mortalite açýsýndan bir risk faktörü olduðu bilinmektedir. Çalýþmamýzda, istirahat kalp hýzý
ile koroner arter hastalýðý risk indeksi arasýndaki iliþkiyi saptamak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Ankara Atatürk Eðitim Araþtýrma Hastanesi Ýç Hastalýklarý Kliniði’nde uygulamakta olduðumuz ABPM (Ambulatuar blood pressure management); Haziran 2008
-Kasým 2008 tarihleri arasýnda, endikasyon konularak, yatmakta olan 26 hastada kullanýldý ve hastalarýn 24 saat monitorizasyonlarý saðlandý. Ýstirahat kalp hýzý ortalamalarý ve
laboratuar sonuçlarý kullanýlarak Framingham skorlamasýna göre koroner arter hastalýðý risk indeksleri hesaplandý. Yirmi altý hastanýn yaþ, istirahat kalp hýzý ve koroner arter hastalýðý risk indeksi arasýndaki fark deðerlendirildi.
BULGULAR: Ýstirahat kalp hýzý ile yaþ ve koroner arter hastalýðý risk indeksi arasýnda istatistiksel açýdan anlamlý fark bulunmadý. Hasta yaþlarý ile istirahat kalp hýzý arasýnda istatistiksel olarak bir korelasyon saptanmazken ileri yaþ ile koroner arter hastalýðý risk indeksi arasýndaki fark istatistiksel açýdan anlamlýydý.
TARTIÞMA ve SONUÇ:

INTRODUCTION: It is known that increased resting heart rate is a risk factor for development of hypertension, coronary heart disease and all-cause mortality. We aimed in our study to evaluate the relationship between resting heart rate and coronary artery
disease risk.
METHODS: ABPM (Ambulatory Blood Pressure Management) was used to monitorize arterial blood pressure
of 26 patients hospitalized in Ankara Ataturk Training and Research Hospital Internal Medicine Clinic between June 2008 and November 2008 with any indication of blood pressure
monitorizing. Mean values of resting heart rates were recorded and coronary artery disease score was calculated by Framingham Risk Calculator after laboratory assessment.
Data of 26 patients including resting heart rate, age, sex and coronary heart risk index were compared.
RESULTS: Resting heart rate had no relationship with age and coronary artery disease. Though there was age found to have statistically significant relationship with resting heart rate.
DISCUSSION AND CONCLUSION:

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GÝRÝÞ ve AMAÇ: Duysal ve motor nöropati semptomu bulunmayan tip 2 DM hastalarýnda EMNG kullanarak nöropati varlýðýnýn tespiti ve etkileyen faktörlerin belirlenmesi.
YÖNTEM ve GEREÇLER: Dumlupýnar Üniversitesi Týp Fakültesi Ýç hastalýklarý kliniðine baþvuran tip 2 DM'li ancak nöropati
semptomlarý bulunmayan hastalar çalýþmaya dahil edildi. Hastalardan yaþ, cinsiyet, diyabet yýlý, beden kitle indeksi, bel çevresi elde edildikten sonra 10 saatlik gece açlýðýný takiben HbA1C, total kolesterol, trigliserid, HDL-K ve LDL-K düzeyleri ölçümü için kan alýndý. Elde edilen deðerler ki-kare, Kruskal Wallis Test, pearson korelasyonu ve lojistik regresyon analizi deðerlendirildi.
BULGULAR: Hastalarýn kadýn erkek oraný: 25/14, yaþ ortalamalarý: 49±6 idi. Diyabet yaþlarý 4.4±4.1, beden kitle indeksi: 29.1±3.9, bel çevresi: 96.7±6.8, total kolesterol: 203±29, trigliserid.
171±25, HDL-K: 43±5, LDL-K: 128±25, HbA1C: 7,7±1.4 olarak saptandý.
Otuzdokuz hastanýn 16'sýnda EMNG sonucunda duysal tipte nöropati tespit edildi. Yapýlan korelasyon analizinde EMNG de nöropati saptanmasý ile diyabet yaþý, trigliserid düzeyleri ve
HbA1C arasýnda pozitif bir korelasyon bulunurken, HDL-K ile negatif bir kolerasyon tespit edildi. Lojistik regresyon analizinin bir sonucu olarak, nöropatiyi en fazla öngördüren faktörler
önem sýrasýna göre aþaðýdaki gibidir: 1. Hipertrigliseridemi, 2. Yüksek HbA1C, 3. Uzun diyabet süresi, 4. Düþük HDL-K seviyeleri.
TARTIÞMA ve SONUÇ: Sonuç olarak nöropati ile ilgili semptomlarý bulunmayan tip 2 DM'li hastalarda kolesterol (özellikle trigliserid) düzeylerinin nöropatinin ortaya çýkmasýnda etkili bir faktör olabileceði düþünüldü.

INTRODUCTION: To determine the presence of neuropathy in type 2 diabetic patients without symptoms related to sensorial and motor neuropathy and to establish risk factors affecting occurence of neuropathy.
METHODS: Type 2 diabetic patients without neuropathy symptoms who applied to the internal medicine clinic
of Dumlupýnar University Medical Faculty were included in the study. Informations of age, gender, duration of diabetes were recorded; body mass index (BMI), waist circumference (WC) were measured. In additon, HbA1C, total cholesterol, triglyceride, HDL-C and LDL-C levels were calculated. All data obtained were statistically evaluated with qui-square, Kruskal Wallis Test, pearson’s correlation and logistic regression.
RESULTS: Female/male ratio of patients were 25/17, mean ages were 49±6. Mean of diabetes age was 4.4±4.1 years, BMI was 29.1±3.9, waist circumference was 96.7±6.8. Laboratory measures were follows as: total cholesterol: 203±29, trygliceride: 171±25, HDL-C: 43±5, LDL-C: 128±25, HbA1C: 7.7±1.4.
Sixteen of 39 patients were determined sensorial neuropathy by EMNG. There was positive correlation between neuropathy and duration of diabetes, levels of trygliceride, HbA1c, whereas negative correlation was detected with HDL-C. As a result of logistic regression analyse, statistically significant predicitive factors for neuropathy according to importance were the following: 1. Hypertriglyceridemia, 2. high levels of HbA1C, 3. long duration of diabetes and 4. low levels of HDL-C.
DISCUSSION AND CONCLUSION: In conclusion, in patients with type 2 diabetes mellitus without symptoms related with neuropathy, triglyceride levels may be an effective factor for appearing of neuropathy.

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GÝRÝÞ ve AMAÇ: Bruselloz ülkemizde sýk rastlanan bir zoonoz olup klinikte kendini akut, subakut ve kronik formlarda gösterebilir. Brusellozda komplikasyonlarýn kronik formda daha sýk olduðu görülmüþtür. Bu çalýþmanýn amacý brusellozun akutsubakut veya kronik olma durumu ile standart tüp aglütinasyon (STA) titresi yüksekliði, kan kültüründe üreme ve lokomotor sistem tutulumu durumu arasýnda iliþki olup olmadýðýnýn araþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Kliniðimizde yatýrýlarak tedavi edilen brusellozlu olgularýn dosyalarý retrospektif olarak deðerlendirilerek kan kültürlerinde üreme olup olmadýðý, lokomotor sistem tutulumu olup olmadýðý ve STA titreleri öðrenildi. Olgular STA titresine göre ≥ 1/320 ve < 1/320 olan olgular olarak ikiye ayrýldý. Lomber bölgede aðrýsý olan olgular, herhangi bir
eklemde artrit veya artraljisi olan olgular ve/veya radyolojik olarak lokomotor sistem tutulumu saptanan olgular lokomotor sistem tutulumu olan olgular olarak kabul edildi. Semptom süresi 8 haftadan küçük olan olgular akut, 8-52 hafta olanlar
subakut ve 52 haftadan fazla olanlar kronik bruselloz olarak kabul edildi. Olgularýn Brusellozun akut-subakut veya kronik olma durumu ile standart tüp aglütinasyon titresi yüksekliði, kan kültüründe üreme ve lokomotor sistem tutulumu arasýnda iliþki olup olmadýðý incelendi.
BULGULAR: Çalýþmaya ortalama yaþý 45,5 yýl olan 18’i kadýn 8’i erkek toplam 26 olgu alýndý. Olgularýn 19’u (% 73) akut-subakut ve 7’si (% 27) kronikti. Oniki (% 46,1) olgunun kan kültüründe brusella üredi. Onaltý (% 61,5) olguda lokomotor sistem tutulumu vardý. Olgularýn akut-subakut veya kronik olmasý ile kan kültüründe üreme olmasý ve lokomotor sistem tutulumu olmasý arasýnda anlamlý iliþki bulunmadý. Kronik
olan olgularda akut-subakut olan olgulara göre STA titresi ≥1/320 olan olgu sayýsý daha azdý (p>0,05).
TARTIÞMA ve SONUÇ: Bu çalýþmanýn sonuçlarý kronik olgularda STA titrelerinin akut-subakut olgulara göre daha düþük olduðunu ve semptom baþlangýç süresi ile lokomotor sistem tutulumu ve kan kültüründe üreme arasýnda iliþki olmadýðýný göstermiþtir.

INTRODUCTION: Brucellosis is a common zoonotic infection and manifests in acute, subacute and chronic forms.
Brucellosis complications are more common in chronic form of disease. The aim of this study is to evaluate the relationship between acute-subacute or chronic forms of brucellosis and standart tube agglutination (STA) titer levels, growth on blood culture and locomotor system involvement.
METHODS: Dossiers of brucelosis cases which hospitalized in our clinic are retrospectively evaluated in regard of growth on blood culture, locomotor system involvement and STA titers. Cases were divided into two subgroup as STA titers ≥ 1/320 and < 1/320. Cases with lumbal pain, arthritis or arthralgia in any joint, and/or radiologically proved locomotor system involvement are considered as cases with
locomotor system involvement. Cases with duration of symptoms less than 8 weeks are considered as acute, between 8 and 52 weeks subacute and more than 52 weeks chronic brucellosis. The relationship between acute-subacute or chronic forms of brucellosis and standart tube agglutination titer levels, growth on blood culture and locomotor system involvement were evaluated.
RESULTS: 26 patients (18 female and 8 male) were enrolled to study and their mean age is 45.5 years. 19 of cases (% 73) were acute-subacute and 7 (% 27) were chronic. Brucella grew on blood cultures of twelve cases (% 46.1). Locomotor system involvement was determined in sixteen cases (% 61.5). No significant relationship was seen between acut-subacute and chronic forms of disease and growth on blood culture and locomotor system involvement. In chronic cases, number of patients with STA titers ≥ 1/320 were lower than acutesubacute cases (p>0.05).
DISCUSSION AND CONCLUSION: This study showed that STA titers in chronic cases are lower than acut-subacute cases and there is no relationship between duration of symptoms and locomotor system involvement and growth on blood cultures.

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Tip 2 Diabetes mellitus, toplumda en sýk görülen kronik, metabolik hastalýktýr. Dünyada yaklaþýk 120 milyon diyabetli hasta bulunmaktadýr. Ülkemizde diyabet insidansý % 1,6-2, prevelansý ise % 3,5-5 olarak bildirilmiþtir. Tip 2 Diabetes Mellitus‘da yaþam kalitesi hastalýðýn gidiþinin önemli bir göstergesi olarak kabul edilmektedir. Bu derlemede Diabetes Mellitus’lu hastalarda yaþam kalitesi, epidemiyoloji, klinik sonuçlarý ve komplikasyonlar literatür bulgularý ile tartýþýldý.

Type 2 Diabetes mellitus is the most prevelant chronic endocrine disease in the community. There is nearly 120 million people with diabetes mellitus worldwide. In our country, the
incidence and the prevelance of diabetes mellitus has been reported to be 1,6-2 % and 3,5-5 % respectively. The quality of life has been acceted an important survival indicator of disease in the patients with Type 2 Diabetes Mellitus. In this review, quality of life, epidemiology, clinical outcomes and complications in Type 2 Diabetes patients was discussed in the wiew of literature findings.

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Oreksin A ve oreksin B tekli öncü polipeptit olan ve 130 amino asit içeren pre-pro oreksinden üremektedir. Pre-pro oreksin hipotalamusda ve daha az olmakla birlikte testis ve adrenal bezde bulunmaktadýr. Oreksin-A ve oreksin-B ise merkezi sinir siteminde bulunmasýnýn yaný sýra, adrenal bez ve ince baðýrsak gibi ekstrahipotalamik bölgelerde de bulunmaktadýr. Oreksin-A reseptörü (OX1) hipotalamus ve locus coeruleus ile diðer
beyin bölgeleri ve spinal cord’da, Oreksin-B reseptörü (OX2) ise hipotalamus, korteks, spinal cord ve bazý nükleilerde eksprese olmaktadýr. Ayný zamanda her iki reseptör de barsaklarda ekspire olmabilmektedir. Oreksinler yeme-içme davranýþýnda, enerji homestazýnda, uyku/uyanýklýk regülasyonunda görev almakla birlikte kardiyovasküler ve nöroendokrin sistem üzerine de etki etmektedirler. Bu yazý, oreksinlerin yerleþimi, farmakolojisi ve fizyolojik olaylardaki rollerini özetlemek amacýyla
derlenmiþtir.

Orexin A and orexin B are two peptides derived by proteolytic cleavage from a 130 amino acid precursor prepro-orexin. Prepro orexin is found in the hypothalamus and, to a markedly lesser extent, the testes and adrenals. However orexin-A and orexin-B are found in throught the central neural system, due to extrahypothalamic projectons, as well as in the adrenals and small intestine. The orexin-A receptor (OX1) is exspresses
mainly in the hypothalamus and locus coeruleus, as well as other brain regions and the spinal cord. The orexin-B receptor (OX2) is expressed in the hypothalamus, cortex, spinal cord, and a few discrete bain nuclei. Both receptors are also expressed in the gut. The orexins modulate feding behaviour and energy homeostasis, as well as associated drinking behaviours, and also regulate sleep/ wake cycle. The orexins also have
cardiovascular and neuroendocrine effects. This review is aimed to the pharmacology and localisation of these peptides and summarises the evidence of their role in physiology.

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Brain tumors are the fifth most common reason of cancer related deaths in women between the ages of 20 and 29 (1). However, very rarely do obstetricians and brain
surgeons encounter brain tumors during pregnancy in their daily practice. A diagnosis of brain tumor is a very distressing situation for the patient, especially when this patient is expecting to become a mother. A specific multidisciplinary diagnostic and therapeutic approach is needed for the optimal care of these patients. In this case report, we present
a patient diagnosed with fibrillary astrocytoma of the brain at the 12th gestational week who underwent craniotomy at the 30th gestational week due to a rapid onset hemiplegia
following sudden hemorrhage within the tumor. We also present the successful follow-up of the pregnancy until the 39th week with a discussion of brain tumors during pregnancy.

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Caroli’s disease is a rare congenital disorder characterized by cytic dilatation of the intrahepatic bile ducts. Caroli’s disease is transmitted in autosomal recessive fashion. Chollangitis, liver cirrhosis, and cholangiocarcinoma are its potantial complications. The magnetic resonance cholangiography (MRCG) is the metod with the highest sensitivity in the diagnosis of Caroli’s disease. In this study, we present a case of a fifty year old grill who was diagnosid with Caroli’s disease (Caroli type I).

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Rhinolithis are the stones that are located nasal cavity and exist by accumilation of salt around exogen and endogen nidus. They are seen rarely and if it is not diagnosed for long
time it can expand and result in nasal obstruction. Patinets have rhinolithiasis admitted to hospital with the most common symptoms; bad smell nasal discharge and nasal obstruction. Nasal endoscopy is the most important method in diagnosis. CT (computed tomography) and sinus XR can be used to show size of rhinolithis and and relationships with the adjacent tissues. The main treatment is surgery, excission of rhinolithis. Rhinolithis are commonly reported as case report in literature. In this study we presented 32 years old patient has rhinolithis with his or her history of diagnosis, treatment options, radiolgic
findings.

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Hydatid cyst disease is a parasitic infection mostly involves the liver and the lung. The spleen is one of the rare sites involved in hydatid cyst disease. The clinical presentation of the splenic hydatid cyst disease is often vague. Splenic hydatidosis is a rare site of presentation of hydatid disease and should be suspected on detection of a splenic cyst in endemic areas of
hydatid disease. Computed Tomography is the most sensitive investigation for diagnosis. Mostly splenectomy is the treatment of this rare disease. A 42 year old female patient of
hydatidosis with isolated spleen involvement which were treated surgically are reported. The patients is under control for 24 months without an event.

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