Diabetus mellitus, insulin fonksiyon ve sekrasyonu bozukluðuna baðlý, karbonhidrat, lipid ve protein metabolizmasýnýn kronik hiperglisemik metabolik hastalýðýdýr. Dünya Saðlýk Örgütüne göre 2025 yýlýnda dünyada 300 milyon olgu olacaktýr. Dibetus mellitus kardiyovasküler hastalýklar için baðýmsýz risk faktörü olup dislipedemiye baðlý olarak risk artar. Diabetik dislipidemi trigiliserid yüksekliðiyle karekterizedir, HDL seviyesi düþük ve LDL seviyesi yüksektir. Bu lipid profili “toksik üçlü” olarakta adlandýrýlýr ve diabet teþhisinden çok önce ortaya çýkar.
Çalýþmamýzda, 2006 Aðustos- 2007 Mayýs aylarý arasýnda dahiliye kliniðimize baþvuran 30745 hastanýn diabet prevalansý ve plazma lipid deðerleri ile iliþkisini araþtýrdýk. Kan glukoz ve total kolesterol, triglisetid, HDL-kolesterol konsantrasyonlarý arasýnda istatistiksel baðýntý olduðunu tespit ettik. Total kolesterol, triglisetid yükselirken, HDL-kolesterol seviyesi düþmektedir, diðer yandan kan glukoz seviyesi artmaktadýr. Hba1c ve total kolesterol, triglisetid, HDL-kolesterol seviyeleri arasýndada istatistiksel iliþki tespit edilmiþtir.
Tip 2 diabetli hastalar dislipidemiktir. Hastalarýn lipid seviyelerini normal sýnýra çekmek kardiyovasküler morbidite ve mortaliteyi azaltýlabilir ve koroner hastalýklara baðlý ölüm, mitokart infarktüsü, inme riskini azaltýr.

Diabetes Mellitus is a chronic hyperglycemic metabolic disease leading to disorders of carbohydrate, lipid and protein metabolism due to deficiency of insulin function and insulin hormon secretion. By the year 2025, the World Health Organization projects more than 300 million cases worldwide. Diabetes mellitus is an independent risk factor for cardiovascular disease and this risk increases further with accompanying dyslipidemia. Diabetic dyslipidemia is characterized by hypertriglyseridemia, decreased levels of HDL-cholesterol particles and increased small and dense LDL-cholesterol particles. This lipid profile, also named as toxic triad, coexists in the patient long before diabetes can be diagnosed.
In our study, we investigated diabetes prevalence and its relationship with plasma lipids and other related parameters in 30745 patients attending to our internal medicine clinic between August 2006 and May 2007. We detected high statistical correlation between fasting blood glucose and total cholesterol, triglyseride, HDL- cholesterol concentrations. Total cholesterol, TG levels were increased whereas HDL-cholesterol levels were decreased, on the other hand, blood glucose concentrations were elevated. We found out that relationships between Hba1c levels and total cholesterol, TG, HDL-cholesterol levels were statistically significant too.
The majority of type 2 diabetic patients are dyslipidemic. Optimization of lipid profile in these patients is the most important intervention needed for the improvement of cardiovascular mortality/morbidity and for the reduction of risks related to the procedures of coronary death, MI, stroke and revascularization.

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GÝRÝÞ ve AMAÇ: Nütrisyon desteði altýndaki yoðun bakým hastalarýnda, biyokimyasal veriler ve antropometrik ölçümler deðerlendirilerek enteral ve kombine enteral-parenteral nütrisyonun etkileri karþýlaþtýrýldý.
YÖNTEM ve GEREÇLER: Yoðun bakýmda ventilatör desteði gereksinimi olan 30 hasta iki gruba ayrýldý. Enteral grubu: Günlük kalori gereksiniminin tamamý enteral nutrisyon ile; Enteral-Parenteral grubu: Günlük kalori gereksiniminin % 50’si enteral, % 50’si parenteral nutrisyon ile karþýlandý. Tüm hastalardan, 1., 7. ve 14. günlerde total protein, prealbumin, albumin, globulin, glukoz, BUN, kreatinin, trigliserid, kolesterol, ALT, AST, elektrolit, CRP serum düzeyleri için kan örnekleri alýndý, orta kol çevresi (MAC) ve triseps deri kývrým kalýnlýðý (TSF) ölçüldü, günlük kalori ve protein alýmlarý, insülin gereksinimleri kaydedildi.
BULGULAR: Total protein, globulin ve trigliserid 14. gün düzeyleri grup içi karþýlaþtýrmalarda her iki grupta da 1. gün düzeylerine göre anlamlý derecede yüksek, enteral grupta 14. gün BUN deðerleri 1. güne göre ve enteral-parenteral gruba göre anlamlý derecede yüksek, CRP deðerleri her iki grupta da anlamlý düþüþ gösterdi. Gruplar arasý ve grup içi karþýlaþtýrmalarda MAC ve TSF ölçümleri açýsýndan farklýlýk yoktu
TARTIÞMA ve SONUÇ: Günlük kalori ve protein alýmlarý, biyokimyasal veriler ve antropometrik ölçümler karþýlaþtýrýldýðýnda, enteral ve kombine enteral-parenteral nütrisyon alan kritik hastalar arasýnda anlamlý bir fark olmadýðý kanýsýna varýldý.

INTRODUCTION: In this study the influences of enteral versus combined enteral-parenteral nutrition with biochemical and antropometric parameters in intensive care patients were compared.
METHODS: 30 cases who required ventilatory support in the intensive care unit were randomized into two groups. Daily calorie requirement of enteral group is supplied with enteral nutrition products entirely and daily calorie requirement of combined group is supplied with 50 % enteral and 50 % parenteral solutions. On days; 1, 7 and 14, all cases were tested for prealbumin, albumin, globulin, glucose, urea, creatinin, triglyceride, cholesterol, ALT, AST, electrolytes (sodium, potassium, chlorine, calcium, magnesium, phosphorus) and CRP serum levels and mid-arm circumference (MAC) and triceps skinfold (TSF) measurements were recorded. Daily calorie and protein intake and insulin requirement were recorded on days 1, 7 and 14 also.
RESULTS: On day 14, total protein, globulin and triglyceride levels were significantly higher when compared to baseline levels in both groups; and BUN levels were significantly higher versus day 1 in enteral group significantly higher when compared to the combined group; CRP levels declined significantly in the two groups. There wasn’t any difference in MAC and TSF measurements between the groups.
DISCUSSION AND CONCLUSION: When daily calorie and protein intake; blood glucose levels; glucose intolerance and insulin infusion requirement; laboratory measurements and antropometric measurements were compared, no difference was observed between the critical patients fed with enteral versus combined enteral-parenteral nutrition.

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Vertebral fraktürler sýrt aðrýsý, fonksiyonel kýsýtlýlýklar ve iþ gücü kayýplarýna baðlý olarak yaþam kalitesini olumsuz etkileyebilir. Bu nedenle vertebral fraktürlerin yaþam kalitesi üzerine etkisi önemli bir klinik durumdur. Çalýþmamýzda, osteoporoz tedavisi alan hastalarda vertebra kýrýðý sýklýðýnýn ve vertebral kýrýðýn yaþam kalitesi üzerine etkisinin araþtýrýlmasý amaçlandý. Polikliniðimizde osteoporoz tanýsýyla takip ve tedavi edilen 70 hasta çalýþmaya alýndý. Dual enerji X-ray absorbsiyometri ile kemik mineral yoðunluðu, direkt grafiler ile vertebra kompresyon kýrýðý varlýðý ve Kýsa Form-36 (SF-36) ölçeðiyle yaþam kalitesi deðerlendirildi. Primer osteoporoz (PO) 37 (% 52.9) ve sekonder osteoporoz (SO) 33 (% 47.1) hastada tespit edildi. PO’lu 7 (% 18.9), SO’lu 6 (% 18,2) hastada vertebra kýrýðý saptandý. Vertebra fraktürü olan ve olmayan PO’lu hastalar karþýlaþtýrýldýðýnda SF-36 ölçeðinin alt gruplarý arasýnda fark bulunmadý. Sonuç olarak, bu çalýþmada vertebral fraktürlerin yaþam kalitesi üzerine etkisi saptanmamýþtýr.

Vertebral fractures cause poor quality of life due to the back pain, functional limitations, and loss of utility. Therefore, the effects of vertebral fractures on quality of life is an important clinical issue. This study aimed to evaluate the prevalence and the effects of vertebral fractures on quality of life in seventy patients with osteoporosis. Bone mineral density were performed by dual-energy x-ray absorptiometry. Ouality of life was assessed by Short-Form 36 (SF-36). Spine radiographs were used to evaluate the existence of vertebral fracture. Primary and secondary osteoporosis were determined in 52.9 % and 47.1 % of the patients, respectively. Vertebral fractures were determined in 7 (18.9 %) patients with primary osteoporosis and in 6 (18.2 %) patients with secondary osteoporosis. When scores of SF-36 subgroups were compared, there was no statistically significant difference between the patients with and without vertebral fractures in primary osteoporosis. In conclusion, any meaningful relationship was found between vertebral fracture and quality of life in patients with primary osteoporosis with the instrument of SF-36.

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GÝRÝÞ ve AMAÇ: Psöriyazis anormal epidermal hiperproliferasyon ve diferansiyasyon ile karakterize inflamatuvar ve immün aracýlý bir deri hastalýðýdýr. Son çalýþmalarda psöriyazisli hastalarda mikrovasküler tutulumun arttýðý ve renal fonksiyon deðiþikliklerinin görüldüðü bildirilmiþtir. Bu çalýþmada psöriyazis vulgarisli hastalarda subklinik böbrek tutulumunun varlýðý araþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya klinik ve histopatolojik olarak plak tip psöriyazis vulgaris tanýsý konulan 60 hasta ile 60 saðlýklý kiþi alýndý. Hasta ve kontrol grubunun tam idrar tahlilleri yapýldý, üre, kreatinin ve 24 saatlik idrarda mikroalbüminüri deðerleri ölçüldü. Verileri deðerlendirirken Student-t testi, Mann Whitney-U testi, Spearsman’s Rho testi ve ki-kare testi kullanýldý. Ýstatiksel analizler için SPSS for Windows 15.0 programý kullanldý. p<0.05 anlamlý kabul edildi.
BULGULAR: Çalýþmaya alýnan hastalarýn % 58.3’ü kadýn, % 41.7’si erkek, kontrol grubunun % 55’i kadýn, % 45’i erkekdi. Ortalama hastalýk süresi 13.1 yýl, ortalama PASI deðerleri ise 19.5 olarak saptandý. Psöriyazisli hastalarýn 24 saatlik idrar volümü ortalamasý kontrol grubuna göre yüksek bulundu (p<0.05). Hastalarýn 15’inde (% 25), kontrol grubunun 8’inde (% 13.3) mikroalbüminüri görüldü ve iki grup arasýnda anlamlý fark bulunmadý (p>0.05). Gruplarýn idrarda atýlan ortalama mikroalbümin deðerleri arasýnda da anlamlý fark saptanmadý (p>0.05). Mikroalbüminüri varlýðý ile cinsiyet arasýnda iliþki görülmezken (p>0.05), mikroalbüminüri kontrol grubunda kadýnlarda daha fazla görüldü (p<0.05). Hastalýk süresi ve þiddeti ile mikroalbüminüri arasýnda anlamlý bir iliþki bulunmadý (p>0.05),
TARTIÞMA ve SONUÇ: Çalýþmamýzda psöriyazisli hastalarda subklinik böbrek tutulumunun göstergesi olan mikroalbüminüri anlamlý derecede yüksek bulunmadý, mikroalbüminüri ile hastalýk þiddeti ve hastalýk süresi arasýnda iliþki saptanmadý.

INTRODUCTION: Psoriasis is an immune mediated inflammatory disease which is characterised with abnormal hyperproliferation and differentiation. Latest studies have indiacated an increase in microvascular involvement and alterations in renal functions in patients with psoriasis. In this study, we have investigated subclinical renal involvement in patients with psoriasis vulgaris.
METHODS: Sixty psoriasis vulgaris patients who are clinically and histopathologically diagnosed and sixty healthy individuals are contributed to the study. Both the patients and control groups are examined for their urine tests, urea, creatinine and 24-hours microalbuminuria levels. Student-t Test, Mann-Whitney-U Test, Spearsman’s Rho test and Ki-Square test are used to evaluate the results. SSPS Windows 15.0 programme is used to evaluate the statistical data and accepted as statistically significant (p<0.05).
RESULTS: In patients group, 58.3 % of patients were female, 41.75 % were male; and in control group 55 % of patients were female and 45 % were male. The mean duration of disease was obtained as 13.1 years and the means levels of PASI were calculated as 19.5 years.The mean level of 24-hours urine volume were higher in patients with psoriasis compare to the control group (p>0.05). Fifteen patintes (25 %) in patients group, 8 (13.3 %) in control group had showed microalbuminuria and no significant differences are found between two groups (p>0.05). The mean output of microalbumine in urine between two groups had showed no significant difference (p<0.05). No dissimilarities are found in microalbuminuria between sexes, however, microalbuminuria was found higher in women in control group (p>0.05). There was no significant relation between the microalbuminuria and with both the severity and the duration of the disease (p>0.05).
DISCUSSION AND CONCLUSION: In our study, levels of microalbuminuria which is an indicator of subclinical renal involvement in psoriasis were not significantly high, no relation between the microalbuminuria levels with the duration and the severity of the disease.

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GÝRÝÞ ve AMAÇ: Alt konka hipertrofisine baðlý burun týkanýklýðý yakýnmasý olan hastalarda radyofrekans uygulamasýnýn etkinliði araþtýrýldý. Bu çalýþmadaki amacýmýz, burun týkanýklýðýna sahip eriþkin hastalarda radyofrekans tedavisi sonrasý hastalýk spesifik hayat kalitesi sonuçlarýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Bu çalýþma Ýstanbul Haseki Eðitim ve Araþtýrma Hastanesi Kulak Burun Boðaz Klininde, Ocak 2005 ile Mayýs 2006 tarihleri arasýnda gerçekleþtirildi. Alt konka hipertrofisi nedeni ile burun týkanýklýðý þikayeti olan 45 hastaya (24 erkek, 21 kadýn) radyofrekans uygulamasý yapýldý. Hastalar 15-59 yaþlarý arasýnda olup yaþ ortalamasý 32,5 di.Bir çok hasta daha önce medikal tedavi almýþ ve þikayetleri hala devam etmekteydi. Preoperatif ve postop 2. ve 6. aylarda NOSE skalasý ile burun týkanýklýðý þikayeti deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 45 hastanýn, ortalama NOSE skorlarý post op 2. ayda preoperatif duruma göre istatiksel olarak anlamalý derecede iyileþme gösterdi. Bu iyileþme postop 6. ayda hala devam etmekteydi ve istatiksel olarak anlamlýydý. Hasta memnuniyeti ve hayat kalitesi sonuçlarý yüksekti. Postop dönemde anlamlý bir kanama epizodu görülmedi.
TARTIÞMA ve SONUÇ: Alt konka hipertrofisi tedavisinde uygulanan radyofrekans; minimal invaziv, lokal anestezi altýnda gerçekleþtirilebilen, çok düþük komplikasyon oranlarý olan cerrahi tekniktir. Postop dönemde hastanýn sosyal hayatýný etkilememesi ve hasta memnuniyetinin yüksek olduðu bir yöntemdir.

INTRODUCTION: The efficacy of the radiofrequency application was evaluated in patients with nasal airway obstruction due to inferior turbinate hypertrophy. Our goal was to assess disease-specific quality of life outcomes after radiofrequency in adults with nasal obstruction.
METHODS: This study was made in Department of Otorhinolaryngology of Ýstanbul Haseki Training and Research Hospital, in the period, between October 2005 and May 2006. Ablation radiofrequency was performed in 45 patients (24 male and 21 female) which had been presented with chronic nasal obstruction because of the inferior concha hyperthrophy. The patients were between 15 and 59 years of age, with average age of 32,5 years. Most of the patients had taken medical treatment but their compliance were still exist. Nasal obstruction compliance of the patients were evaluated via the NOSE scale, preoperatively and at 2-6. months postoperatively.
RESULTS: Fourty-five patients underwent surgery; there was a significant improvement in mean NOSE score at 2 months after radiofrequency (p<0.05 t=26,496), and this improvement was higher at 6 months. Patient satisfaction was very high, and patients quality of life outcomes significantly high. No significant episodes of epistaxis were observed postoperatively.
DISCUSSION AND CONCLUSION: The application of inferior concha radiofrequency is a minimally invasive with very low complication rates, surgical technique, which can be performed under local anaesthesia. It does not prevent social activity of the patients in postoperative period and this technique can satisfy the patients.

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Ýlaçlarýn en çok görülen yan etkilerinden biri olan ilaç döküntüleri sýklýkla antibiyotikler, antikonvülsanlar ve non-steroid antiinflamatuvar ilaçlara baðlý olarak geliþir. Ýlaç döküntüleri ekzantamatöz, ürtikeryal, büllöz ya da püstüler olabilir. Büllöz ilaç döküntüleri çeþitli klinik tablolar ve mekanizmalarla oluþur. Bu döküntüler fiks ilaç erüpsiyonu, Stevens-Johnson Sendromu, toksik epidermal nekrolizis, ilaca baðlý pemfigus, ilaca baðlý büllöz pemfigoid, ilaca baðlý lineer IgA dermatozu, ilaca baðlý psödoporfirya, akut jeneralize ekzantematöz püstüloz, fototoksik ilaç reaksiyonlarý, bromoderma, iyoderma ve akral eritemi içerir. Büllöz ilaç döküntüleri hayatý tehdit etmeleri açýsýndan büyük önem taþýr. Özellikle Stevens-Johnson Sendromu ve toksik epidermal nekrolizis zamanýnda müdahale edilmediðinde fatal seyredebilir. Bu nedenle hastalarda tedavi sýrasýnda aniden ortaya çýkan büllöz lezyonlar ciddiye alýnmalý ve ilaca baðlý bir reaksiyon olabileceði akýlda bulundurulmalýdýr.

Drug eruptions are among the most common adverse events which are frequently associated with antibiotics, anticonvulsants and non-steroidal antiinflammatory drugs. Drug eruptions may be exanthematous, urticarial, blistering or pustular. Bullous drug eruptions encompass many different clinical reactions and pathomechanisms. These eruptions include fixed drug eruptions, Stevens-Johnson Syndrome, toxic epidermal necrolysis, drug-induced variants of pemphigus, bullous pemphigoid and linear IgA dermatosis, pseudoporphyria, acute generalized exanthematous pustulosis, phototoxic drug eruptions, bromoderma, iododerma and acral erythema. Bullous drug eruptions are critical since they can be life-threatening. Especially Stevens-Johnson Syndrome and toxic epidermal necrolysis may be fatal when not treated earlier. Therefore spontaneous blisters arising suddenly must draw attention to the possibility of a bullous drug reaction which would require early intervention.

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Objectives: We aimed to present a case diagnosed as Harlequin fetus in early neonatal period.
Case: 38 year-old, gravida 2, parity 2 patient delivered in our clinic. The diagnosis is made according to the clinical findings of the neonate and treatment performed.
Discussion: Harlequin fetus is one of the most serious forms of ichthyosis. It is difficult to diagnose the disease prenatally.

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The most frequent complications after thyroid surgery are recurrent laryngeal nerve and superior laryngeal nerve injury, hypoparathyroidism, bleeding, hematoma, wound infection and flap edema. These complications may influence the life quality of the patient. Reason-result relations of psychiatric disorders and vitamin D, bone, calcium metabolism are important, but in reality, it is less emphasized subject in the clinical settings. In this study a patient, hypoparathyroidism.after thyroid surgery for a half year, at the age of 23, high school.graduate, having one children and housewife, is presented.

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High grade gliomas need serious follow up in post operative period. It might be necessary to re-operate due to tumor progression in this period. In addition, some changes because of radiotherapy and chemotherapy might act like tumor progression. This condition is called pseudoprogression and its management is different. Therefore pseudoprogression is a new condition that should be known and considered via following up high grade gliomas. Studies for this subject increase in literature. We aimed to explain this new condition with a case that we assumed as pseudoprogression having high degree glioma.

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