GÝRÝÞ ve AMAÇ: Bu çalýþma Öðrenci Seçme Sýnavý’na (ÖSS) hazýrlanan öðrencilerdeki umutsuzluk ve sýnav kaygýsýnýn beslenmeyle olan iliþkisini saptamak amacýyla planlanmýþtýr.
YÖNTEM ve GEREÇLER: 2004-2005 eðitim-öðretim döneminde Yalova ilinde lise son sýnýfta olup ÖSS’ye girecek 100 öðrenci (50 kýz, 50 erkek) ile girmeyecek 100 öðrenci (50 kýz, 50 erkek) çalýþmaya dahil edilmiþtir. Öðrencilerle ilgili genel özellikler (yaþ, sigara-alkol kullanýmý), vücut aðýrlýklarýndaki deðiþimler, sýnav öncesi-sýrasý-sonrasýndaki fizyolojik-psikolojik durum deðiþiklikleri ve beslenme öyküsüne iliþkin bilgilerle psikolojik testler anket yöntemiyle doðrudan kendilerine sorarak elde edilmiþtir.
BULGULAR: ÖSS’ye girecek ve girmeyecek öðrenciler arasýnda yaþadýklarý kaygý ve umutsuzluk arasýnda istatistiksel açýdan önemli bir fark bulunmamýþtýr (p>0.05). Bununla birlikte sýnav döneminde, iki gruptaki öðrenciler karþýlaþtýrýldýklarýnda, kaygýlý iken beslenme durumlarýnýn deðiþimi istatistiksel açýdan önemli bulunmuþtur (p<0.05). Standartlara göre öðrencilerin enerji, makro ve mikro besin alým durumlarý incelendiðinde ÖSS’ye girecek ve girmeyecek öðrencilerin enerjiden gelen protein ve karbonhidrat yüzdesi, B6 vitamini, B12 vitamini, C vitamini, kalsiyum ve demir alýmlarýnda istatistiksel açýdan önemli fark görülmüþtür (p<0.05).
TARTIÞMA ve SONUÇ: Merkezi öðrenci yerleþtirme sýnavlarý ile ortaya çýkan bu sistem öðrenciler üzerinde sýnav kaygýsý yaratmakta ve psikolojik sorunlara neden olabilmektedir. Bu çalýþmada ÖSS’ye girmeyecek öðrencilerin sýnava girecek olan öðrenciler kadar kaygýlý ve umutsuz olduklarý görülmüþtür.

INTRODUCTION: This study was planned to determine the relationship between nutrition and hopelessness and anxiety of students who get riding for the student selective examination (SSE).
METHODS: This study was carried on 100 students (50 male, 50 female) who get riding the SSE and 100 students (50 male, 50 female) who didn’t get riding SSE in 2004-2005 education term in Yalova. The general features of students (age, cigarette-alcohol usage), weight changes, psychological changes before-during-after exam, information about nutritional story and physiological tests were taken by using a questionnaire directly asked to the students themselves.
RESULTS: We could not find a statistical important difference about having hopelessness and anxiety between the students who were going to get riding SSE and the students who were not (p<0.05). Nonetheless, when comparing the two groups of students, a significant difference is found in the nutritional status while they have hopelessness and anxiety (p<0.05). When evaluating the students’ energy, micro and macro nutrient intake according to the standards, a statistical important difference is found in protein and carbohydrate percent coming from energy, vitamin B6, vitamin B12, vitamin C, calcium and iron intake between the students who were get riding SSE and the students who were not (p<0.05).
DISCUSSION AND CONCLUSION: Resulting from the centralized student selection and placement examination creates anxiety on students and causes psychological problems. This study shows that the students who didn’t get riding SSE had anxiety as much as the students who get riding the SSE.

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GÝRÝÞ ve AMAÇ: Son yýllarda Helicobacter Pylori (Hp)’nin ITP’li hastalarda daha yüksek oranda bulunduðu ve eradikasyon tedavisinini trombosit sayýsýný yükselttiðini gösteren bir çok çalýþma literatürde mevcuttur. Bu çalýþmada Kr ITP’li hastalarda Hp pozitifliðinin saðlýklý bireylere göre daha sýk görülüp görülmediðinin araþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Çalýþmaya Dicle Üniversitesi çocuk saðlýðý ve hastalýklarý hematoloji polikliniðinde kronik ITP tanýsýsyla düzenli takiplere gelen izlenmekte olan 19 hasta ve kontrol grubu olarak çocuk polikliniðine baþvuran saðlýklý 24 çocuk çalýþmaya dahil edildi.
BULGULAR: Hasta grubunda 19 hastanýn 11’inde (% 57.8), kontrol grubunda is 24 hastanýn 12’sinde (% 50), toplamda çalýþmaya alýnan 43 hastanýn 23 ünde (% 53.4) Hp IgG pozitif saptandý. Kr. ÝTP’li hastalarda Hp sýklýðýnýn artmadýðý görüldü.
TARTIÞMA ve SONUÇ: ÝTP’ li hastalarda ve kontrol grubunda Helicobacter IgG seroprevelansý ülkemizde benzer yaþ gruplarýnda yapýlan çalýþmalarla uyumlu idi. Kr. ÝTP hastalarýnda da benzer oranda bulundu ve kontrol grubuyla arasýnda anlamlý bir fark bulunamadý. Buradan yola çýkarak steroid ve immünglobulin tedavisine yanýt vermeyen veya tedavi sonrasý trombositleri hýzla düþen Kr. ÝTP olgularýnda Hp araþtýrýlmasý ve sonucun müspet olduðu durumlarda eradikasyon tedavisinin verilmesini önerilmektedir.

INTRODUCTION: The role of Helicobacter pylori (Hp) infection in relation to the development and/or persistence of ITP in infected patients still remains controversial. The aim of this study was to determine the prevalence of Hp in chronic ITP and compare the incidence of Hp positivity with healthy control group.
METHODS: For this purpose, 19 patients with chronic ITP were followed at department of Pediatric Hematology of Dicle University Hospital and were evaluated for Hp IgG antibody positivity and hematological parameters. Control group consisted of 24 healthy children followed up at the outpatient clinic.
RESULTS: Hp IgG was positive in 11 of 19 cases in the study group (57.8 %) and 12 of 24 cases in control group (53.4 %). In terms of Hp positivity, means there was no statistically significant difference between the two groups (p>0.005).
DISCUSSION AND CONCLUSION: Hp IgG seroprevalance in study and control groups were similar with other age matched studies reported from our country. In chronic ITP cases, the results were similar, and no significant difference was present between study and control groups. Steroid or IVIG therapy resistant or frequent relapsing chronic ITP patients, investigation for Hp and eradication therapy for Hp positive patients may be recommended.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada, ayak bileði travmasý olan hastalarýn Ottowa ayak bileði deðerlendirme kriterleri ve radyolojik olarak incelenerek bu kriterlerin klinik yararlýlýðýnýn deðerlendirilmesi amaçlanmaktadýr.
YÖNTEM ve GEREÇLER: Acil servise baþvuran ayak bileði travmasý olan 124 hasta Ottowa ayak bileði deðerlendirme kriterlerine göre ve radyolojik olarak incelendi. Hastalara ayak bileði ön-arka, yan ve ankle mortise radyografileri istendi. Kriterlere uyulmasýna, radyolojik bulgulara göre hastalar deðerlendirildi.
BULGULAR: Ottowa kriterleri bir bütün olarak deðerlendirildiðinde sensitivitesi % 100; spesivitesi % 10.5; negatif kestirim deðeri % 100 ve pozitif kestirim deðerleri % 41.4 olarak tesbit edilmiþtir.
TARTIÞMA ve SONUÇ: Acil servise baþvuran hastalarýn Ottowa ayak bileði deðerlendirme kriterlerine göre incelenmesi neticesinde istenen radyolojik tetkiklerde sýnýrlama getirilebilir. Sensitivitesi yüksek olan bu kriterlerin acil serviste kullanýmý, hastanýn hastanede kalýþ süresini azaltmasý açýsýndan uygundur. Yapýlan bu klinik çalýþmada % 10.5 civarýnda hasta harcamalarýnda tasarruf yapýlabileceði gösterilmiþtir.

INTRODUCTION: The aim of this study is to evaluate the effectiveness of the Ottowa Ankle Rules by considering the patients who had ankle traumas with the rules and radiography.
METHODS: 124 patients with ankle traumas are evaluated at the emergency room according to the Ottowa Ankle Rules and radiologic findings. Anteroposterior,lateral and ankle mortise radiographs were performed to the patients.
RESULTS: As all the Ottowa Ankle Rules are evaluated, the following results were gained: The sensitivity is 100 %, specifivity is 10.5 %, negative predictive value is 100 % and positive predictive value is 41.4 %.
DISCUSSION AND CONCLUSION: We can reduce the radiologic tests and total time of staying at the hospital for the patients at the emergency rooms who suffer about ankle traumas by using sensitive Ottowa Ankle rules. This study showed us that we can reduce the costs of the patients about 10.5 percent.

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GÝRÝÞ ve AMAÇ: Bu çalýþmamýzda single lead VDD (tek odacýklý, atriyal ve ventriküler sensing, ventriküler pacing özellikli) pacemaker ile VVIR (tek odacýklý, yalnýzca ventriküler sensing ve pacing özellikli, hýz cevaplý) pacemaker modlarýnýn serum atriyal natriüretik peptid (ANP) ve efor kapasitesi üzerine etkilerini araþtýrdýk. Hangi modun hemodinami ve yaþam kalitesi açýsýndan daha uygun olduðunu tayin etmek istedik.
YÖNTEM ve GEREÇLER: Çalýþmaya semptomatik AV Tam Blok veya 2. derece AV blok nedeniyle single lead VDDR pacemaker takýlmýþ 21 hasta (13 erkek, 8 kadýn) alýndý. Önce pacemaker VDD modunda iken ANP için kan örneði alýndý, hemen arkasýndan efor testi uygulandý. Daha sonra pacemaker VVIR moduna çevrildi ve 1 ay süreyle VVIR modunda kaldý. Bir ayýn sonunda ANP için kan örneði alýnýp VVIR modunda efor testi yapýldý.
BULGULAR: VDD modunda ANP seviyeleri normal iken VVIR modunda yüksek bulundu (57.14±22.01 ve 117.85±48.25 pg/ml, p<0.001). Efor süresi VDD modunda VVIR moduna göre daha uzundu (275.00±113.08 ve 266.24±103.97 sn, p<0.05)
TARTIÞMA ve SONUÇ: Atriyoventriküler senkronizasyonun saðlandýðý single lead VDD pacemaker, atriyoventriküler senkronizasyonun olmadýðý hýz cevaplý VVIR pacemakera oranla daha fizyolojik ve daha üstündür. Hastaya daha kaliteli bir yaþam sunmaktadýr. DDD pacemakera oranla daha ucuzdur ve implantasyon süresi daha kýsadýr. Sinus düðüm fonksiyonlarý normal olan semptomatik AV Tam Bloklu hastalara birincil seçenek olarak deðerlendirildi.

INTRODUCTION: The aim of this study was to evaluate the effects of single lead VDD pacing and VVIR pacing on plasma atrial natriuretic peptide (ANP) concentration and exercise performance.
METHODS: We evaluated ANP concentration and exercise performance in single lead VDD pacing versus VVIR pacing in 21 patiens (13 men and 8 women,) previously implanted single lead VDDR pacemakers. For ANP blood sample was taken during VDD modality, then exercise test was applied. Then pacemaker mode turned to VVIR mode, with this mode it worked for a month. At the end, blood sample was taken and exercise test was applied.
RESULTS: Blood levels of ANP were normal in the VDD group, and increased in the VVIR group (from 57.14±22.01 to 117.85±48.25 pg/ml, p<0.001). Exercise duration was longer in the patients with VDD pacemaker than VVIR pacemaker group (275.00±113.08 sec vs 266.24±103.97 sec, p<0.05).
DISCUSSION AND CONCLUSION: ANP level increases and exercise duration decreases in the VVIR mode. This finding suggests an improvement a cardiac performance with atrioventricular syncronisation. Assesment of ANP may be useful in selection of pacing mode.

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GÝRÝÞ ve AMAÇ: Bu çalýþmamýzda kronik kalp yetersizlikli anemik hastalarda tek baþýna intravenöz demir tedavisinin egzersiz kapasitesi ve kardiyak fonksiyonlar üzerine etkisini araþtýrdýk.
YÖNTEM ve GEREÇLER: Çalýþmamýza kronik kalp yetersizliði (KY) ve demir eksikliði tanýsý almýþ, sol ventrikül ejeksiyon fraksiyonu (LVEF) < % 40, Hb< 12 g/dl ve ferritin < 400 ng/dl olan 39 hasta (21 kadýn, 18 erkek) alýndý.Hastalara tedavi öncesi ekokardiyografi, 6 dakika yürüme testi ( 6DYT) metre cinsinden yapýldý. Toplam 6 kez (1, 3, 5, 13, 15 ve 17. günlerde) 200 mg (2 ampul) i.v. ferrik hidroksil sükroz verildikten sonra 21. gün tekrar ekokardiyografi, 6DYT ve kan deðerleri ölçümleri alýndý.
BULGULAR: Tedavi öncesi ortalama 9.43±1.15 g/dl olan Hb düzeyi tedavi sonrasý 11.53±g/dl (p<0.001), Fe düzeyi 16.64±10.94 mcg/dl’den 84.77±30.08 mcg/dl’ye (p<0.001), transferin satürasyonu % 5.02±3.07’den % 21.87±6.83’e (p<0.001), ferritin 12.10±7.67 ng/ml’den 92.05±37.48 ng/dl’ye (p<0.001), 6DYT 181.77±54.39 m’den 289.84±74.27 m’ye ( p<0.001) yükseldi. Hastalarýn fonksiyonel kapasiteleri NYHA 2.20±0.47’den 1.33±0.48’e geriledi (p<0.001). LVEF ölçümleri tedavi öncesi ve sonrasý deðiþmedi.
TARTIÞMA ve SONUÇ: KY olan hastalarda anemi prevalansý oldukça yüksek olup bu hastalarda mortalite ve morbidite oranlarýný ciddi düzeyde yükseltmektedir. KY ve demir eksikliði anemisi olan hastalarda tek baþýna i.v. demir sükroz tedavisi hemoglobini yükseltmekte güvenlidir, semptomlarý geriletmiþ ve egzersiz kapasitesini arttýrmýþtýr.

INTRODUCTION: The aim of this study was to evaluate the effect of intravenous iron sucrose on execise tolerance and cardiac function in anemic patients with chronic heart failure.
METHODS: We evaluated 39 anemic patients (21 women, 18 men) with chronic heart failure which left ventricular ejection fraction (LVEF) < % 40, Hb< 12 g/dl and ferritin < 400 ng/dl. Echocardiographic examination and six minute walk test (6MWT) were conducted at the begining and end (21st day) of intravenous iron therapy. Intravenous 200 mg ferric hydroxyl sucrose infusion was given total six times (1., 3., 5., 13., 15., and 17. days).
RESULTS: The mean Hb increased from 9.43±1.15 g/dl to 11.53±1.04 g/dl (p<0.001), iron from 16.64±10.94 to 84.77±30.08 mcg/dl (p<0.001), transferrin from 5.02±3.07 to % 21.87±6.83 (p<0.001), ferritin from 12.10±7.67 to 92.05±37.48 ng/ml (p<0.001), 6MWT from 181.77±54.39 to 289.84±74.27 m (p<0.001). NYHA functional class (FC) improved from FC II to FC I (p<0.001). No differences were found in LVEF measurements.
DISCUSSION AND CONCLUSION: Anemia is common in patients with chronic heart failure and an independent predictor of poor prognosis. Intravenous ýron sucrose therapy is effective and safe in these patients. Functional capacity and exercise tolerance improved with i.v. iron sucrose therapy.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý multipl skleroz hastalarýnda yaþam kalitesi ile fiziksel özürlülük arasýndaki iliþkiyi deðerlendirmekti.
YÖNTEM ve GEREÇLER: Çalýþmaya 60 MS’li (38 kadýn, 22 erkek) hasta alýndý. Hastalarýn demografik özellikleri, hastalýk süreleri ve MS tipleri kaydedildi. Fiziksel özürlüðü deðerlendirmek için Geniþletilmiþ Özürlülük Durum Skalasý (EDSS=Expanded Disability Status Scale), yaþam kalitesinin ölçümü için Multipl Skleroz Yaþam Kalitesi Enstrümaný (MSQOL-54=Multiple Sclerosis Quality of Life-54) kullanýldý.
BULGULAR: Hastalarýn yaþ ortalamasý 42,15±9,75 yýl, ortalama hastalýk süresi 9,29±4,85 yýl idi. Hastalýk süresi 10 yýlýn üzerinde olan 23; 10 yýl ve daha az olan 37 hasta vardý. Hastalarýn 34’ü (% 56,67) relapsing-remitting (nükseden-remisyona giren), 14’ü (% 23,33) sekonder progresif, 12’si (% 20) ise relapsing (nükseden) progresif ve primer progresif tip olarak sýnýflandýrýldý. MS tipi ile fiziksel ve mental saðlýk toplamý ortalamalarý arasýnda anlamlý iliþki saptanmadý (p=0,061 ve p=0,764). EDSS skoru 5 ve daha altýnda olan hastalarýn fiziksel saðlýk toplamý ortalamalarý, EDSS skoru 5’in üzerinde olanlardan istatistiksel olarak anlamlý dercede yüksek bulundu (p=0,001). EDSS skoru ile mental saðlýk toplamý ortalamalarý arasýnda iliþki saptanmadý (p=0,244). Hastalýk süresi 10 yýl ve daha altýnda olan hastalarýn fiziksel saðlýk toplamý ortalamalarý, hastalýk süresi 10 yýlýn üzerinde olanlardan istatistiksel olarak anlamlý dercede yüksek bulundu (p=0,04). Hastalýk süresi ile mental saðlýk toplamý ortalamalarý arasýnda iliþki saptanmadý (p=0,169).
TARTIÞMA ve SONUÇ: MS hastalarýnda EDSS ile belirlenen artmýþ fiziksel özürlülük skorunun ve uzun hastalýk süresinin, yaþam kalitesinin fiziksel saðlýk bölümünü olumsuz yönde etkilediði bulundu.

INTRODUCTION: The aim of this study was to evaluate the relation between quality of life and physical disability in patients with multiple sclerosis (MS).
METHODS: Sixty MS patients (38 women, 22 men) were included into the study. Their demographic characteristics, duration of illness and MS types were noted. Expanded Disability Status Scale (EDSS) was used to asses the physical disability, Multiple Sclerosis Quality of Life-54 (MSQOL-54) was used to assess the quality of life.
RESULTS: The mean age of the patients and mean duration of the illness were 42,15±9,75 years and 9,29±4,85 years, respectively. 34 patients (56,67 %) was classified as relapsing remittent form, 14 patients (23,33 %) as secondary progressive form, and 12 patients (20 %) as primary progressive form and relapsing progressive form of MS. We didn’t detect any significant relationship between MS type and means of physical and mental health composite scores (p=0,061 and p=0,764). Mean physical health composite score of the patients with 5 and below EDSS score were found significantly higher than those whose EDSS scores were above 5 (p=0,001). There were no relationship between EDSS score and mean mental health composite score (p=0,244). Mean physical health composite score of the patients with 10 years and above disease duration were found to be statistically significant higher than those with above 10 years disease duration (p=0,04). There were no relationship between disease duration and mean mental health composite score.
DISCUSSION AND CONCLUSION: It was found that both physical disability score assessed with EDSS and long disease duration affects physical health division of quality of life negatively.

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Non-sendromik dudak ve/veya damak yarýðý(NSDDY) çoklu genetik ve cevresel faktörlerin sonucu komplex doðumsal bir defekttir. Son zamanlarda NSDDY sebebi olan birçok gen bulunmuþtur. Onlarýn bazýlarý Methylenetetrahydrofolate reductase(MTHFR), B-Cell leukemia/lymphoma 3(BCL3), T-box transcription factor-22(TBX22), Poliovirus receptor like-1, 2 (PVRL1,2) ve Ýnterferon regulatory factor-6 (IRF6) genlerin sebep olduðu NSDDY, baþ-boyun bölgesinin sýk görülen konjenital anomalilerinden biridir. Bu derlemedeki amaç, NSDDY etiyolojisindeki önemli genetik ve çevresel faktörlerden bazýlarýný özetlemekdi.

Non-syndromic cleft lip and/or palate (NSCLP) is a complex birth defect resulting from multiple genetic and environmental factors. Recently several genes causing NSCLP have been discovered. Some of them-namely Methylenetetrahydrofolate reductase (MTHFR), B-Cell leukemia/lymphoma 3(BCL3), Poliovirus receptor like-1, 2 (PVRL1 and PVRL2), T-box transcription factor-22 (TBX22), and Interferon regulatory factor-6 (IRF6) are responsible for causing NSCLP is one of the common congenital anomalies of the head and neck. This review aim to summarize some of important genetic and environmental factors in the aetiology of NSCLP.

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Spinal deformities may cause difficulties with both tracheal intubation and regional anesthesia. This report describes the anesthetic management that was performed in 48 years old patient with extremely severe thoracolumbar kyphoscoliosis and mallampati class IV. After examining the risk factors, spinal block by injecting single dose 12,5 mg bupivacaine solution to the intratechal space was chosen to provide anaesthesia. Motor and sensory blockade at the level of Th12 was achieved.

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Meralgia paresthetica is a painful mononeuropathy of lateral cutaneal femoral nerve. Many factors have been accused in etiology. In this case report, 63 year old female complaining of hypoesthesia and paresthesia on lateral and anterior sides of the right thigh, diagnosed with electroneuromyography, a case of idiopathic meralgia paraesthetica is presented.

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Amniotic fluid embolism is a clinical pathology which is rare and maternal mortality is high. A case of 23 year-old ASE was presented in this case report. At the patient who doesn’t have any risk factor and has been made caesarean section because of the bad obstetric history, suddenly dyspnea, cyanosis, blood loss and unexplained hypotension occurred after the thirty minutes,postoperatively. The respiration and circulation was supported with urgent resuscitation, then the patient was taken intensive care, monitorized and coagulopathy treatment was performed. The diagnosis of the ASE was made with the clinical and laboratory symptoms. We aimed to discuss the epidemiology, clinical findings, pathophysiology, risk factors, diagnosis, differential diagnosis and treatment of the ASE with this case.

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