GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, miadýna ulaþmýþ (40 hafta) gebelerin takibinde human plasental laktojenin önemi ve serbest östriol ile birlikte fetusun iyilik halini belirlemek için deðerlendirilmeleridir.
YÖNTEM ve GEREÇLER: Göztepe Eðitim Hastanesi Kadýn Hastalýk-larý ve Doðum Kliniði, Gebe polikliniðine kontrol ve takip amaçlý baþvuran 40 miadýndaki gebe çalýþmaya alýndý. 40 gebe riskli ve risksiz olarak 20 þerli iki gruba ayrýldý. Bütün gebeler takibe alýndýklarý ilk günden doðumlarýna kadar USG, NST, CST, Free östriol ve HPL plazma deðerleri ile takip süreleri amniotik indeksleri HPL, free östriol ve NST sonuçlarý, doðum þekli, mekonyumlu olup olmadýklarý, apgar skorlarý kaydedildi
BULGULAR: Free östriol deðerlerindeki düþme fetal prognozu belirlemede anlamlý bulunmuþ olup bu diðer prognoz belirleyicileri NST, CST, USG ile koreledir. Bu açýdan deðerlendirildiðinde ardýþýk alýnmasý gereken ve biokimyasal iþlemleri gerektirmesi nedeni ile free östriolun diðer prognoz belirleyicileri kadar pratik olmadýðý düþünülmüþtür.
HPL deðerleri riskli ve risksiz gruplar arasýnda karþýlaþtýrýldýðýnda istatiksel fark bulunmamýþtýr. Maternal patolojisi olmayan gebelerde fetal prognozu belirlemede HPL’nin anlamlý rolü yoktur.
TARTIÞMA ve SONUÇ: Gebelikte fetal prognozu deðerlendirmekte USG, NST, CST ve free östriol deðerleri korele ve aralarýnda anlamlý bir fark bulunmadý. Buna göre HPL’nin fetal prognozu belirlemede etkin bir parametre olarak kullanýlamayacaðý vurgulandý.

INTRODUCTION: The aim of this study is the impact of human plasental lactogen and to determine the fetal well being with free estriol in 40 weeks gestation pregnancies.
METHODS: A total of 40 pregnant women with a gestational age of 40 weeks applied to Göztepe Training Hospital Obstetrics and Gynecology clinic were enrolled in this study. 40 pregnant women were divided into two equal groups as high risk and no risk. All pregnant women were followed from the first day to the end of labor and obstetric ultrasonography, NST, CST were performed. Serum free estriol and HPL levels, the duration they are followed up, amniotic fluid indexes, the way of parturation, if the fetus painted with meconium or not and the apgar scores were all noted.
RESULTS: The decline at the levels of free estriol is a good prognostic factor to determine the fetal well being and is correlated with the other prognostic markers as NST, CST and USG. From another view determining levels of free estriol is not as practical as the other prognostic markers because sequential and biochemical analyses are required.
When serum HPL levels were compared, there is no statistical differance with high risk or no risk groups. At pregnant women without any maternal patology, there is not any expressive role of HPL for determining the fetal well being.
DISCUSSION AND CONCLUSION: For determining the fetal prognose USG, NST, CST and serum free estriol levels are correlated with each other and none of them is superior to another and HPL is not a prognostic marker to determine the fetal well being.

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GÝRÝÞ ve AMAÇ: Psoriasis tip I sitokinlerin baskýn olduðu T-hücre iliþkili immunolojik bir deri hastalýðýdýr. Leptin T hücre üzerindeki Th1 sitokin sentezini uyarýcý ve Th 2 sitokin sentezini baskýlayýcý etkileri ile psoriasis immunopatogenezinde rolü olabilecek vücut aðýrlýðýný düzenleyen bir hormondur. Bu çalýþmada leptinin psoriasisli hastalarda serum düzeyini, vücut kitle indeksleri [body mass index (BMI)] ve hastalýk þiddeti ile iliþkisini araþtýrdýk.
YÖNTEM ve GEREÇLER: Psoriasisli 80 hasta (31 erkek, 49 kadýn; yaþ 43.13±13.13 yýl/SD) ve yaþ, cinsiyet uyumlu saðlýklý 80 kiþi (32 erkek, 48 kadýn; yaþ 42.91±12.97 yýl/SD) dahil edildi. Çalýþmaya katýlan bütün bireylerin BMI’leri hesaplandý. Serum leptin düzeyleri ELISA yöntemi ile ölçüldü.
BULGULAR: Psoriasisli hastalarýn ortalama serum leptin düzeyleri (9.48 ng/ml) ile saðlýklý kontrol grubunun serum leptin düzeyleri (5.94 ng/ml) karþýlaþtýrýldýðýnda istatistiksel olarak aradaki fark anlamlý bulundu (p<0.05). Psoriasisli kadýn hastalarýn leptin düzeyleri kontrol grubuna göre yüksek bulunurken (p<0.01), erkeklerde anlamlý yükseklik görülmedi (p>0.05). Psoriasisli kadýn hastalarýn baþlangýç yaþlarý ile serum leptin düzeyleri arasýnda pozitif yönde anlamlý bir iliþki görülürken (p<0.05), erkeklerde görülmedi (p>0.05). Her iki grupta da serum leptin düzeyleri ile BMI arasýnda ileri derecede anlamlý iliþki saptandý (p<0.01). Psoriasisli hastalarda her iki cinste de serum leptin düzeyleri ile aile hikayesinin pozitifliði ve hastalýk þiddeti arasýnda herhangi bir korelasyon izlenmedi (p>0.05).
TARTIÞMA ve SONUÇ: Elde ettiðimiz sonuçlar leptinin psoriasisde görülen kronik inflamasyonda rol oynayabileceðini ve BMI ile sýký bir korelasyon içinde olduðunu ancak hastalýk þiddetinin göstergesi olmadýðýný düþündürdü.

INTRODUCTION: Psoriasis is considered to be a T-cell-mediated inmunological skin disease, with a preponderance of type I cytokines. Leptin, promotes type I cytokine synthesis and supresses type 2 cytokine production. In this study we aimed to investigate serum leptin levels in psoriasis patients, association between body mass index (BMI) and disease severity.
METHODS: Eighty patients with psoriasis (31 male, 49 female) and 80 age and sex matched healthy control subjects (32 male, 48 female) were recruited in this study. The body mass index (BMI) was calculated for subjects. Serum leptin levels was determined with ELISA method.
RESULTS: The mean serum leptin concentration was statistically different in patients with psoriasis (9.48 ng/ml) when compared with that in healthy control subjects (5.94 ng/ml) (p<0.05). When we compare the leptin levels of psoriatic patients with control group; female patients have high concentration of leptin (p<0.01) but male patients do not (p>0.05). Also it is observed in female patients that there is a positive relation between the serum levels of leptin and the disease beginning age (p<0.05) but not in male patients (p>0.05). There is an important relation between the serum leptin levels and BMI in both male and female patient population (p<0.01). But there is not any correlation between family history and disease severity (p>0.05).
DISCUSSION AND CONCLUSION: We conclude that leptin has a correlation with BMI and may have a role in the chronic inflamation of psoriasis but it can not be used as a marker in evaluation of disease severity

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GÝRÝÞ ve AMAÇ: N-hekzan içeren yapýþtýrýcýlarýn kronik inhalasyonu, duysal-motor aksonal polinöropatiye neden olmaktadýr. N-hekzan nöropatisi yine, ayakkabý üretiminde sýklýkla kullanýlmasýndan dolayý, ayakkabý iþçilerinde de vaka sunumlarý þeklinde bildirilmiþtir.
Bu çalýþmada, polikliniðimizden 2000-2005 yýllarý arasýnda takibi yapýlan ayakkabý iþçilerinin klinik ve elektrofizyolojik özelliklerinin tanýmlanmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Polikliniðimize nöropati semptomlarý ile baþvuran 26 ayakkabý iþçisi çalýþmaya alýndý. Bütün hastalara nörolojik muayene ve sinir ileti çalýþmalarýný içeren elektrofizyolojik çalýþma yapýldý.
BULGULAR: 26 hastanýn 2’si erkekti (% 80). Hastalarýn ortalama yaþý 34.5 idi. En sýk nörolojik semptomlar, distal lokalizasyonlu uyuþukluk (% 91.2) ve distal lokalizasyonlu kas güçsüzlüðü (% 65.3) idi. 10 hastada (% 39) normal elektrofizyolojik bulgular saptanýrken, 16 (% 61) hastada elektrofizyolojik olarak nöropati bulgularý saptandý. Sinir ileti çalýþmalarýnda en belirgin deðiþiklikler, duysal aksiyon potansiyel amplitüdlerinde küçülme, motor aksiyon potansiyel amplitüdlerinde küçülme, motor ileti hýzlarýnda yavaþlama ve distal latanslarda uzama idi. 7 hastada (+43) mikst duysal-motor aksonal polinöropati, 3 hastada (% 18) motor ve 6 hastada (% 37) duysal aksonal nöropati varlýðý mevcuttu.
TARTIÞMA ve SONUÇ: Ayakkabý endüstrisinde N-hekzan maruziyeti, semptomatik aksonal nöropatiye neden olmakta ve en sýk rastlanana nöropati tipi ise mikst duysal-motor tip olarak karþýmýza çýkmaktadýr.

INTRODUCTION: Chronic inhalation of glues containing n-hexanes induces sensory-motor polyneuropathy. N-hexane neuropathy has also been described as case reports at the shoe industry workers be cause of its common use in the production of footwear.
In this study we aimed to describe the clinical and electrophysiological characteristics of the patients who had been followed up from our polyclinic between 2000-2005, as shoe makers working in the shoe industry.
METHODS: 26 shoe makers who have been admitted to our clinic with neuropathy symptoms have been included in the study. Neurological examination and electrophysiological studies as nerve conduction study were applied to all of the patients.
RESULTS: 21 of the 26 patients were male (80 %). The mean age of the patients was 34.5. The most common neurological symptoms were distally localized numbness (91.2 %) and distally localized muscle weakness (65.3 %).
10 patients (39 %) showed normal electrophysiological findings while 16 (61 %) had electrophysiologically neuropathic findings.
The main changes in the nerve conduction study were reduced amplitude of the sensory action potentials, followed by reduced amplitude of motor action potentials, reduction in motor conduction velocities and increase in distal latencies.
7 patients (43 %) had mixed sensory-motor axonal polyneuropathy while 3 (18 %) of them had motor and 6 (37 %) of them had sensory axonal neuropathy.
DISCUSSION AND CONCLUSION: The results indicate that exposure to N-hexanes in shoe industry can cause symtomatic axonal neuropathy and the most common type of the neuropathy is mixed sensory-motor type.

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GÝRÝÞ ve AMAÇ: Down sendromlu(DS) hastalarda bulbar yüzey epitel deðiþikliklerini konjunktival impresyon sitolojisi tekniði ile saptamak ve serum vitamin A düzeyi ile korelasyonunu araþtýrmak.
YÖNTEM ve GEREÇLER: Hasta grubunu, hastanemiz pediatri kliniðinde takip edilen 18 DS’lu hasta (36 göz), kontrol grubunu ise ayný yaþ grubundaki 20 saðlýklý çocuk (40 göz) oluþturdu. Üst bulbar konjuktivaya uygulanan impresyon sitolojisi yöntemi ile sellüloz asetat kaðýdý yüzeyine alýnan örnekler (% 70’lik etil alkol, % 37’lik formaldehit ve glisial asetik asitin 20: 1: 1 oranýndaki) solüsyonunda fikse edildi. Örnekler Periodik Asid Schiff ve Hematoksilen-eosin ile boyandý. Iþýk mikroskobisi ile oluþan okuler yüzey deðiþiklikleri deðerlendirildi. DS hastalarda serum vitamin A düzeyi HPLC ile ölçüldü.
BULGULAR: DS'lu grupta goblet hücre yoðunluðu (73.2±21.2 mm2) kontrol grubuna göre (113.5±30.1 mm2) azalmýþ olarak saptandý (p<0.01). DS’lu grupta serum vitamin A düzeyi 1.32±0.6 mumol/l olarak saptandý. DS’lu grupta goblet hücre yoðunluðu ve vitamin A düzeyi arasýnda pozitif korelasyaon saptandý (p<0.05).
TARTIÞMA ve SONUÇ: DS’lu hastalarda ortalama goblet hücre yoðunluðunun azaldýðýný gösterdik. Bu sonuç, konjunktival impresyon sitolojisinin DS’lu hastalarda erken göz problemlerinin tanýsýnda basit, objektif, tanýsal tarayýcý olarak kullanýlabileceðini göstermektedir. Yine DS’lu hastalarda okuler yüzey anormallikleri erken vitamin A desteði ile önlenebilir.

INTRODUCTION: The purpose of this study was to evaluate bulbar surface epithelium changes with conjunctival impression cytology (CIC), and to determine if we could detect ocular surface abnormalities in the eyes and to correlate with serum vitamin A levels in Down syndrome (DS) patients.
METHODS: The study groups included 36 eyes of 18 DS patients who were followed up at pediatrics clinics of our hospital and 40 eyes of 20 healthy control subjects from the same age group. Specimens for CIC were obtained with a cellulose acetate filter paper from the upper bulbar conjunctiva and fixed with 70 % ethyl alcohol, 37 % formaldehyde and 20: 1: 1 glicial asetic acid solution. Specimens were stained with periodic acid schiff’s and hematoxylin-eosin. Ocular-surface changes were evaluated on the cell content of the surface conjunctival epithelium by CIC with light microscopy. Serum vitamin A level was measured with HPLC in DS patients.
RESULTS: A marked reduction of goblet cell dencity was found in the DS group (73.2±21.2 mm2) in comparison with the control group (113.5±30.1 mm2) (p<0.01). Serum vitamin A levels were found 1.32±0.6 mumol/l in DS patients. The number of goblet cell dencity and vitamin A levels were evaluated and positive correlation was found in DS patients (p<0.05).
DISCUSSION AND CONCLUSION: We have shown decreased mean density of goblet cells in patients with DS. The results indicate that CIC may be a first step simple, objective, and diagnostic test as a screening tool for early eye problems in DS. In patients with DS, ocular surface abnormalities may be prevented by early vitamin A treatment.

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GÝRÝÞ ve AMAÇ: Son dönemlerde anne sütüyle beslenen yenidoðanlarda, morbidite ve mortalitesi yüksek olan hipernatremik dehidratasyon sýk bildirilmektedir. Bu çalýþmanýn amacý hipernatremik term yenidoðan hastalarýn demografik özelliklerini, klinik, laboratuar bulgularý ve takip sonuçlarýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Yenidoðan Yoðun Bakým Ünitesi’ne Ocak–2006 ile Haziran-2008 tarihleri arasýnda hipernatremik dehidratasyon (Na: >150 mmol/L) tanýsýyla yatýrýlan toplam 31 term yenidoðan hasta çalýþmaya alýndý.
BULGULAR: Olgularýn doðum aðýrlýðý ortalama 3362±711,3 gr, ortalama baþvuru yaþý 6,3±3,4 gün olarak tespit edildi. Olgularýn tümü anne sütü ile beslenmiþti. Hastalarýn % 19,4’ü evde, % 64,5’i baþka hastanelerde, % 12,9’u hastanemizde, % 3,2’si saðlýk ocaðýnda doðmuþtu. En sýk baþvuru þikayeti % 61,3 sarýlýk ve % 19,4 emmeme ve emmede zayýflýk idi.
Hastalarýn baþvuruda yapýlan laboratuar incelemelerinde ortalama serum sodyum deðerleri 161,7±12,8 mmol/L olarak bulundu. Anne sütü sodyum ölçümü yapýlan dört annenin ikisinde 100 mmol/L üzerinde, ikisinde ise 78 mmol/L ve 43 mmol/L olarak tespit edildi. Kranial MR görüntülemede bir olguda (% 3,2) subdural kanama, üç olguda ise (% 9,7) her iki hemisferde oksipital ve bazal ganglionlarda yaygýn peteþial kanama tesbit edildi. Takipte iki olguda (% 6,5) motor retardasyon, iki olguda (% 6,5) motor-mental retardasyon tespit edildi. Ýki olgu (% 6,5) ise kaybedildi.
TARTIÞMA ve SONUÇ: Morbidite ve mortalitesi yüksek bir saðlýk sorunu olan yenidoðan dönemindeki hipernatremik dehidratasyon, bazý tedbirlerle önlenebilir. Özellikle yenidoðan bebeklerin ilk günlerde rutin muayene edilmesi erken taný ve tedavi için önemlidir. Erken taburculuk, evde doðum, ilk gebelik, sezaryen doðum ve sýcak mevsimlerde doðum hipernatremi için önemli riskler olduðunu düþünmekteyiz.

INTRODUCTION: Hypernatremic dehydration of the newborn with breastfeeding, which has a high morbidity and mortality rates, has been reported to be increased in the recent years. In this study, it was aimed to evaluate the demographic, clinical features and the results of management in newborns with hypernatremic dehydration.
METHODS: A total of 31 term newborns with hypernatremic dehydration (Na > 150 mmol/L) who admitted to the Newborn Intensive Care Unit between January 2006 and June 2008 were included in this study.
RESULTS: Mean±SD weight and age of the newborns were 3362±711.3 g and 6.3±3.4 days respectively and all were breastfeeding. 19.4 % of the patients were born at home, 64.5 % and 3.2 % of the patients were born in city and cottage hospitals respectively. Only 12.9 % of the patients were born in our hospital.
Jaundice (61.3 %) and poor sucking (19.4%) respectively were the most common presenting signs. Mean±SD serum and mean breast milk sodium concentrations were 161.7±12.8 mmol/L and >100 mmol/L in two, 78 mmol/L in one and 43 mmol/L in one mother, respectively. Subdural hemorrhage (in one newborn) and diffuse petechial bleeding in both two hemispheres and basal ganglions (in three newborns) were observed, with Cranial MRI. Motor retardation and mental-motor retardation were observed in 2/17 and 2/ 17 of the newborns, respectively. Two newborns died.
DISCUSSION AND CONCLUSION: Morbidity and mortality rates due to hypernatremic dehydration of the newborn may be lowered with simple preventive measures. Routine newborn examination in the first few days of life is important in the early diagnosis and prevention. These results have suggested that delivery at home, first pregnancy, cesarean delivery, delivery in hot season and early discharge after delivery are important risk factors in development of hypernatremic dehydration.

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Granulomatous rosacea is a variant of rosacea characterized by hard erythematous and asymptomatic cutaneous papules and nodules in relatively normal-appearing skin. Granuloma-tous rosacea which is categorized under the title of idiopathic facial granulomatous eruptions is common in middle age female population.
Herewe present the case of a 52-year-old woman with a 1-year history of facial erythema with multiple papules on the cheeks, and nose. We defined the case as granulomatous rosacea due to histopathological appareance of perifollicular noncaseating tuberculoid granulomas. On the other hand, patient‘s clinical appareance which is differentially diagnosed from the other idiopathic facial granulamotous eruptions was supporting the diagnosis.

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Gianotti-Crosti syndrome (GCS) is a distinctive viral exanthem of childhood that is characterized by papular or papulovesicular lesions that are most prominent on the face, buttocks and extremities. It was first reported by Gianotti in 1966. They do not affect the mucous membranes. Although children are predominantly affected, GCS has been observed in adults also. GCS was originally reported to be associated with infection by hepatitis B virus. Many different viral infections including EBV, hepatitis B virus, Coxsackie A virus, parvovirus B19, and parainfluenza virus have been reported associated with this syndrome.
Here we report a case of an 15-month-old girl with Gianotti-Crosti syndrome associated with primary Epstein-Barr virus infection.

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Children with chronic disease, in terms of behavioral and emotional problems have more at risk. Netherton syndrome (NS) is rarely type of ichthyosis, autosomal recessive, and chronic disease. In this presentation, the psychiatric results of two brothers with diagnosis of the NS who are borned intermarriage is aimed to discus.

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Tuberculosis (TB) is still remained serious public health problem. Anti-TB treatment is given twice weekly caused by immun thrombocytopenia. This complication is rare when the medication is given in small daily doses (10 mg/kg). 16 years old man case with anti- TB is given daily doses (10 mg/kg) but to develop this complication is reported. This patient had applied to emergency service with epistaksis and is administered symptomatic therapy. Patients who had taken anti-TB treatment this complication to retain and should be follow.

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Hydatid cyst is a parasitic disease that may involve many organs. Hydatid cyst with pulmonary artery involvement is a very rarely encountered form. It was aimed to present a rare bilateral pulmonary artery involvement determined in a 61-year-old male case with hydatid cyst. In our case, the lesions were determined in many segments of bilateral lungs, right atrium lateral wall of the heart and in many branches of bilateral pulmonary artery. Pathological evaluation of the patient underwent surgery for the cardiac mass revealed hydatid cyst. The patient, who refused the proposal of surgery for the lesions in lungs and pulmonary artery, was given medical drug therapy. We think that it may be helpful to include hydatid cyst in prediagnosis list for the patient applied to a doctor with multiple cystic or nodular images.

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