GÝRÝÞ ve AMAÇ: Gebeliðin indüklediði hipertansiyon sorunu (preeklampsi, eklampsi, HELLP sendromu) maternal morbidite ve mortalitenin önemli nedenlerinden biridir. Görülme sýklýðý % 7-10 aralýðýndadýr. Bu çalýþma ile kliniðimizde yoðun bakým sürecine kadar giden olgularý inceledik.
YÖNTEM ve GEREÇLER: Baðcýlar EAH Kadýn hastalýklarý ve doðum kliniðine 1 Ocak 2011-31 Aralýk 2011 tarihleri arasýnda baþvuran doðum olgularý içinde preeklampsi, eklampsi ve/ veya HELLP sendromu tanýsýyla yoðun bakýma nakledilen olgular (7 olgu) retrospektif olarak incelendi. Olgularýn demografik özellikleri, gebelik haftalarý, doðum þekli, anestezi tipi, yoðun bakým kalýþ süreleri, komplikasyonlarý ve mortaliteleri deðerlendirildi.
BULGULAR: Bu periyotta kliniðimizde 3996 doðum gerçekleþtirilmiþ olup, bunlarýn 2497’si normal doðumdur (% 62,5), 1499 tanesi sezaryendir (% 37,5). Yoðun bakýma nakledilen 7 olgunun tamamý sezaryen ile doðurtulmuþtur. Bu olgularýn gebelik haftasý ortalamasý 35 hafta +/- 5 haftadýr. Yoðun bakýmda ortalama kalýþ süresi 10.7 gündür. Maternal morbidite olarak akut böbrek yetmezliði 2 olguda (% 28,5), dissemine intravasküler koagülasyon (DIC) 2 olguda (% 28,5), akciðer ödemi 3 olguda (% 42.8), asit 3 olguda (% 42.8), akut respiratuar distress (ARDS) 2 olguda (% 28,5), intraserebral hemoraji 1 olguda (% 14.3) görülmüþtür. Maternal mortalite 1 olguda (% 14.3) intraserebral hemoraji nedeniyle kafaiçi basýnç artýþý sonrasý görülmüþtür.
TARTIÞMA ve SONUÇ: Gebelikle indüklenen hipertansiyonda kesin tedavi doðumun gerçekleþtirilmesidir, amaç annede geliþebilecek intraserebral hemoraji, akut tübüler ve kortikal nekroz, retina dekolmaný, karaciðerde subkapsüler hematom ve rüptür, akciðer ödemi, kalp yetmezliði, dissemine intravasküler koagülopati gibi komplikasyonlarý önlemektir. Antenatal takipler sýrasýnda bu olgularýn erken dönemde tespit edilip tedavilerinin düzenlenmesiyle yoðun bakým gereksinimleri azaltýlabilir

INTRODUCTION: Pregnancy induced hypertension (preeclampsia, eclampsia, HELLP syndrome) is the most common reason of maternal morbidity and mortality. Its incidence is 7-10. percent. In this study, we analyzed the cases who were transferred to the intensive care unit.
METHODS: This was a retrospective study. Seven pregnant women with preeclampsia, eclampsia, HELLP syndrome who refered to Baðcýlar Training and Research Hospital obstetrics and gyecology clinic between January 1 and December 31 2011 were analyzed. Demographic features, gestational age, mode of deliveries, types of anesthesia, duration of stay in the intensive care unit complications, mortalities were analyzed.
RESULTS: During this period, in our clinic 3996 deliveries were performed. 2947 of them (% 62,5) were normal vaginal births and 1499 of them (% 37.5) were cesarean births. All of 7cases who transported to the intensive care unit were delivered by cesarean section. Mean gestational age was 35 weeks +/- 5 weeks. The mean duration at intensive care unit was 10,7 days. Maternal morbidities included acute renal failure (28.5 %, 2/7), disseminated intravascular coagulation DIC (n=3; 42.8 %) pulmonary edema (n=3; 28.6 %), ascites ((n=3; 42.8 %), acute respiratory distress (ARDS) (n=2; 28.5 %), and intracerebral hemorrhage (n=1; 14.3 %). In only 1 case (14.3 %) maternal mortality occured because of intracerebral hemorrhage.
DISCUSSION AND CONCLUSION: In pregnancy induced hypertension, definitive treatment is the realization of delivery The aim is to protect mother from potential intracerebral hemorrhage, acute tubular and cortical necrosis, retinal detachment, subcapsular hematoma of liver, pulmonary edema, heart failure, DIC. During antenatal care, if cases with gestational hypertension are recognized in the early stage, then, the need for intensive care reduce.

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GÝRÝÞ ve AMAÇ: SVST tanýsýnda BT incelemenin yerini tartýþmak ve BT bulgularýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Manyetik rezonans venografi (MRV) ile serebral venöz sinüs trombüs tanýsý konulan 27 hastanýn retrospektif (geriye dönük) olarak kontrastsýz kraniyal BT tetkikleri deðerlendirildi. Çalýþmaya alýnan 27 olgunun yaþlarý, cinsiyetleri, klinik bulgularý, etiyolojileri sorgulandý.
BULGULAR: Toplam 27 olgunun 16’sý (% 59.2) kadýn, 11’i (% 40.8) erkekti. Yirmi üç olguda (% 85) baþ aðrýsý mevcut olup, en sýk görülen semptom olarak deðerlendirildi. Olgularýn 12’sinde (% 44) hemiparezi veya hemianopsi, 9’unda (% 33) statüs epileptikus, 9’unda (% 33) papil ödem, 5’inde (% 18.5) bilinç etkilenmesi mevcuttu. Hastalarýn 18’inde (% 66.6) etyoloji mevcutken, 9’unda (% 33.3) bilinen bir etiyoloji mevcut deðildi. Yirmi yedi hastada 38 adet serebral sinüs trombozu tespit edildi. Bu 38 serebral sinüsün 13 tanesi (% 34) süperior sagital sinüste, 17 tanesi (% 45) transvers sinüste, 6 tanesi (% 16) sigmoid sinüste, 2 tanesi (% 5) kavernöz sinüste yerleþimlidir. Olgularýn 8’inde (% 29.6) birden fazla serebral sinüste trombüs izlendi. Yirmi yedi hastanýn 8 tanesinde (% 30) kontrastsýz kranial BT incelemesinde bulgu saptanmamýþ olup BT incelemeleri normal olarak deðerlendirildi. On dokuz olguda (% 70) parankimal deðiþiklikler (indirekt bulgu) ve tromboze sinüslerdeki dansite deðiþiklikleri (direkt bulgu) izlenmiþtir. Birden fazla sinüste oklüzyon olan olgularýn % 100’ünde BT incelemede bulgu saptanmýþtýr. Bulgularýn % 57.8’i indirekt bulgular olarak deðerlendirildi.
TARTIÞMA ve SONUÇ: BT inceleme, SVST tanýsýnda ilk tercih edilen yöntem olmakla birlikte, BT incelemenin SVST tanýsýnda duyarlýlýðý düþük bulunmuþ olup, ek görüntüleme yöntemlerine gereksinim duyulmaktadýr. BT incelemede en sýk bulgu parankime ait deðiþiklikler olup, olgularýn yalnýzca % 40.7’sinde saptanmýþtýr.

INTRODUCTION: The purpose of this study is to discuss the place of CT in the diagnosis of CVST, and evaluate relevant CT findings.
METHODS: Nonenhanced cranial CT scans of 27 patients with the diagnosis of cerebral venous sinus thrombosis established by MR venography (MRV) was evaluated, retrospectively. Age, gender, clinical findings, etiology of 27 patients were interrogated.
RESULTS: Total of 27 cases consisted of 16 females and 11 males. 23 of them had headache which was-evaluated as the most frequently seen symptom. 12 (44 %) cases had hemiparesia or hemianopsy, 9 (33 %) of them had status epilepticus, 9 (33 %) of them had papiloedema, 5 of them had mental disorder In 18 (66.6 %) of the patients had an etiologic factor, while on the other hand 9 (33.3 %) of them did not have any known etiology. 38 incidents of cerebral sinus thrombosis were found in 27 patients. The locations of 38 cerebral sinuses were as follows: superior sagittal sinus (-n=13); transverse sinus. (-n=17) sigmoid sinus (n=6); cavernous sinus (n=2). In 8 % of the patients thrombosis was observed in more than one cerebral sinuses. Nonenhanced cranial CT of 8 of 27 patient did not demonstrate any evidence of venous sinus thrombosis and CT investigations wwere evaluated as normal. Parenchymal changes -(indirect finding) and density changes (direct finding) in thrombotic sinuses were observed in 19 patients. During CT investigation evidences were found 100 % of the patients which had occlusions in more than one sinuses. 57,8 % of the evindences was evaluated as indirect evidences.
DISCUSSION AND CONCLUSION: CT investigations are the preferred first choice for the establishment of CVST diagnosis in addition to this it has been observed that CT investigations (methods) have lower diagnostic sensitivities for CVST and additional imaging methods are required. In CT investigation parenchymal changes are the most frequent findings in 40,7 % of cases.

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GÝRÝÞ ve AMAÇ: Oryantasyon eðitimleri kuruma yeni baþlayan personelin hem kendi performansýný hem de kurumun performans ve verimliliðini arttýrmasý açýsýndan oldukça önemlidir. Saðlýk kurumlarýnda kurumsallaþma yolunda personelin, oryantasyon eðitimine tabi tutulmasý þarttýr. Kurumun hedef ve politikalarýnýn belirlenmesinde ve kaliteli hizmet sunumunda personelin katýlýmýný saðlamak motivasyonunu arttýrmak, kurum ve bireyin beklentilerinin daha iyi anlaþýlmasýný saðlamak amaçlý bu eðitimler yapýlmaktadýr.
YÖNTEM ve GEREÇLER: Göztepe Eðitim ve Araþtýrma Hastanesi’nde oryantasyon eðitimleri 2008 yýlýna kadar bütün personele genel oryantasyon eðitimi adý altýnda paket eðitim olarak verilmekteydi. Bu tarihten sonra eðitimin etkinliðini arttýrmak için oryantasyon eðitimleri, hemþire ve diðer saðlýk personeline genel oryantasyon eðitimi, asistan hekimlere asistan oryantasyon eðitimi ve hasta danýþmanlarý için ise hasta danýþmaný oryantasyon eðitimi olarak üç gurupta düzenlenmeye baþlanmýþtýr. Bu çalýþmada 2010 yýlýnda gerçekleþtirilen asistan oryantasyon eðitimi kapsama alýnmýþtýr. Eðitimler hastanemiz tarafýndan oluþturulan asistan oryantasyon eðitici ekip tarafýndan gerçekleþtirilmiþtir. Eðitimlerde kurum tanýtýcý yayýnlar ve oryantasyon kitabý kullanýlmýþ, Eðitim planý çerçevesinde hazýrlan eðitimlerin etkinliði anketler ve sýnav ile ölçülmüþtür. Ayrýca sahadaki eðitimin etkinliði de klinik þeflerine yapýlan anketle deðerlendirilmiþtir.
BULGULAR: 2010 yýlýnda asistan oryantasyon programý 92 asistan oryantasyon eðitime alýndý. Eðitimler toplam 25 saat 5 tam gün olarak verildi. Her oryantasyon eðitimi sonrasýnda eðitim etkinliði sýnav ve anketlerle deðerlendirildi. Birinci grupta eðitim baþarýsý %86, ikinci grup baþarý oraný% 75.4 ve üçüncü grup baþarý oraný % 82 olarak bulundu. Eðitim sonrasý yapýlan anketler ile eðitim konu baþlýklarýnýn her biri ayrý olarak deðerlendirildi.
TARTIÞMA ve SONUÇ: Göztepe Eðitim ve Araþtýrma Hastanesi olarak 2010 yýlýnda asistan oryantasyon planýmýz baþarý ile gerçekleþtirildi. % 81 oranýnda katýlýmcýlar tarafýndan eðitim programý yararlý ve etkin bulundu. Asistan oryantasyon eðitimleri, eðitim etkinliði açýsýnda baþarýlý olmasýnýn yanýnda asistanlarýn kuruma ve iþe uyum saðlayýp saðlamadýðý, kurum için belirlenen sürede hedeflenen performans deðerlerine ulaþýp ulaþmadýðýnýn gözlemi klinik þeflerinin görüþleri ve geri bildirimleri doðrultusunda denetlenmektedir. Oryantasyon eðitimi planlanýrken yeni baþlayanlara gruplar halinde oryantasyon eðitimi verilmesi, grubun homojen olmasý, eðitim durumlarýnýn, iþ tecrübelerinin göz önünde bulundurulmasý eðitimlerin daha baþarýlý olduðunu göstermiþtir.

INTRODUCTION: Orientation training plays a vital role for new personnel with the aim to increase their own and the institution’s performance and efficiency. It is inevitable for the personnel working at institutionally developing medical institutions to get orientation training. These training activities are held to obtain the utmost participation of the staff, to increase their motivation and to improve understanding of institutional and individual expectations in determining institutional targets, policies and quality service presentation.
METHODS: In Istanbul Goztepe Education and Research Hospital, orientation trainings had been given to all staff as a package training programme under the heading of General Orientation Training Programme until 2008, Whereas after this date, to achieve a better degree of training, this education is being given in three groups which are General Orientation Training, Assistant (residents) Orientation Training and Orientation Training of Patient Consultants. This study covers Assistant Orientation Training Programme which was held in 2010. Training activities had been carried out by assistant orientation training team. Institutional presentation publications and orientation books were used. The effectiveness was measured by surveys and quizes. It was also assessed through a questionnaire survey held on the senior doctors in charge.
RESULTS: 92 residents were enrolled in the orientation programme in 2010. It was given for 5 hours a day for five days.. The effectiveness of the programme was evaluated by questionnaires and exams. Overall success rate was 86 % in the first group, 75.4 % in the second group and 82 % in the third one. Each topic was evaluated aspirately by posttraining questionnaire surveys.
DISCUSSION AND CONCLUSION: Our Assistant Orientation Programme we implemented in 2010 in Göztepe Training and Research Hospital was successfully achieved, and 81 % of the participants found it beneficial, and effective. Apart from the success of the assistant orientation ttaining as for its effectiveness, adaptation of the participants to the institutional work were analyzed through opinions and feedbacks from their clinic chiefs according to achievement of level of performance within the predetermined time. It is obvious that in the planning of the training for the new beginners, organizing the study groups homogenously according to the admittance time, educational level and professional experience leads to a better degree of orientation training.

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GÝRÝÞ ve AMAÇ: Safra kesesi taþý hastalýðý nedeniyle açýk veya laparoskopik kolesistektomi yapýlan hastalarda geliþen sistemik immün cevabý deðerlendirmek.
YÖNTEM ve GEREÇLER: Elektif operasyon uygulanan 20 açýk, 24 laparoskopik olmak üzere toplam 44 kolesistektomi hastasý çalýþmaya alýnmýþtýr. Travmaya sekonder ortaya çýkan inflamatuvar yanýtta primer rolü IL-1, IL-6, IL-8 ve TNF alfa kan düzeylerine bakýlmýþtýr.
BULGULAR: Laparoskopik teknik uygulanan olgularýn preop ve postop IL-1β ortalamalarý arasýnda anlamlý fark saptanmamýþtýr (p=0,317). IL-6 ortalamalarýnýn preop ve postop farký istatistiksel olarak anlamlýdýr (p=0,000). IL-8 ortalamalarýnýn ise preop ve postop farklarý istatistiksel olarak anlamlý bulunmamýþtýr (p=0,145). Konvansiyonel teknik uygulanan olgularýn preop ve postop IL 1β ortalamalarý arasýnda anlamlý fark saptanmamýþtýr (p=0,896). IL-6 ortalamalarýnýn preop ve postop farký istatistiksel olarak anlamlýdýr (p=0,000). Ortalamalar incelendiðinde konvansiyonel teknik uygulanan olgularýn postop IL-6 ortalamasý preop IL-6 ortalamasýna göre anlamlý olarak daha yüksek bulunmuþtur IL-8 ortalamalarýnýn ise preop ve postop farklarý istatistiksel olarak anlamlý bulunmamýþtýr (p=0,881).
TARTIÞMA ve SONUÇ: Cerrahi sonrasý akut faz yanýtý kýsmen travmaya olan inflamatuar reaksiyona baðlýdýr. Konvansiyel teknik uygulanan hastalarýn preop-postop IL-6 deðiþimleri, laparoskopik teknik uygulanan hastalara göre daha fazladýr. Bu bulgular ýþýðýnda immün sistem aktivasyonuna baðlý akut faz yanýtýnýn laparoskopik kolesistektomiden sonra açýk cerrahiye oranla daha düþük olduðu dolayýsýyla laparoskopik kolesistektominin daha az travmatik bir giriþim olduðu ve bunun açýk kolesistektomiye karþý önemli bir avantaj teþkil ettiði sonucuna varýlmaktadýr.

INTRODUCTION: To evaluate the systemic immune response developed in patients who underwent laparoscopic or conventional open cholecystectomy with the indication of cholelithiasis.
METHODS: A total of 44 cholecystectomized patients; (laparoscopic procedure, n=24; open surgery n=20) were included in this study. Blood levels of IL-1, IL-6, IL-8 and TNF alfa which have the major role in the inflammatory response due to trauma were examined in this study.
RESULTS: There were no significant differences between the preop and postop mean IL-1β levels of the patients operated by the laparoscopic technique (p=0.317). The differences between the preop and postop mean IL-6 levels were statistically significant (p=0,000). However the differences were not statistically significant between the preop and postop mean IL-8 levels (p=0.145). Also there were no significant differences between the preop and postop mean IL-1β levels in the cases who were operated by the conventional technique (p=0.896). The differences between the preop and postop mean IL-6 levels were statistically significant (p=0.000). When the mean IL-6 levels were evaluated, postop mean IL-6 levels were statistically significantly higher than those of the preop levels in the conventional cholecystectomy group. However the differences were not statistically significant between the preop and postop mean IL-8 levels (p=0.881).
DISCUSSION AND CONCLUSION: Acute phase response after the surgery partially depends on inflammatory reaction to trauma. The difference between the preop and postop IL-6 values was obviously -higher in cases who underwent conventional open cholecystectomies when compared with the laparoscopy group. This study showed that acute phase response which is induced by the immune system activation is lower in the laparoscopic procedure compared with the open surgery. Also it has been shown that the laparoscopic cholecystectomy is a less traumatic, and more advantageous procedure relative to the open cholecystectomy.

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GÝRÝÞ ve AMAÇ: Konka bülloza tipleri ile sinonazal patolojiler arasýndaki iliþkiyi saptamak.
YÖNTEM ve GEREÇLER: Retrospektif olarak konka bülloza saptanan 75 hastanýn koronal planda bilgisayarlý tomografileri (BT) incelendi. Orta konkanýn havalanmasýnýn lokalizasyonuna göre konka büllozalar (KB); lameller, bülböz ve ekstensif olarak sýnýflandýrýldý. Her bir konka bülloza tipi ile sinüs hastalýðý ve septum deviasyonu arasýnda iliþki olup olmadýðý araþtýrýldý.
BULGULAR: Her bir KB tipiyle beraber en sýk görülen sinonazal patoloji 68 hasta ile (% 90.6) SD idi. Sinüs tutulumu 51 hastada (% 68) görüldü. En sýk maksiller sinüs (% 62.6) ve etmoid sinüs (% 20) tutulumu saptandý. KB tipleri arasýnda SD ve sinüs patolojisi görülme sýklýðý benzer þekilde bulundu.
TARTIÞMA ve SONUÇ: KB tiplerine göre sýnýflandýrýlan hastalarda sinonazal patoloji görülme sýklýðý ve daðýlýmý açýsýndan belirgin bir farklýlýk görülmedi.

INTRODUCTION: To determine the possible relationship between sinonasal pathologies and types of concha bullosa.
METHODS: Computed CT scans of 75 patients with concha bullosa were analyzed retrospectively. The bullous middle turbinates were classified as lamellar, bulbous, and extensive according to the localization of aeration of middle conchas. The association (if any) between each type of concha bullosa, sinus pathology and nasal septum deviation were investigated in each group.
RESULTS: The most common sinonasal pathology associated with CB was SD (68 patients, 90.6 %). Sinus involvement was seen in 51 (68 %). patients Maxillary sinus was the most commonly involved sinus (62.6 %), followed by the ethmoid sinuses (20 %). Among the CB types, the incidence of SD and sinus pathologies was found to be similar.
DISCUSSION AND CONCLUSION: No significant differences between incidence and distribution of sinonasal pathologies were observed in patients who were classified according to the types of their CB.

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GÝRÝÞ ve AMAÇ: Akut pankreatit (AP), karýn aðrýsý ve serumda pankreas enzimlerinin artýþý ile karakterize ani baþlayan bir pankreas inflamasyonudur. AP’in en sýk nedeni safra kesesi taþlarý ve alkol kullanýmýdýr. Ýlaçlar AP’in yaygýn olmayan ve önemli nedenleri arasýndadýr. Bu çalýþmada AP tanýsý ile yatan hastalarýmýzda antihipertansif ilaç kullaným sýklýðýný tespit etmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya iç hastalýklarý kliniðinde AP teþhisi ile yatýrýlan 39 erkek, 28 kadýn, ortalama yaþ (52.88±19.06) 67 hasta alýndý. Hastalarýn demografik ve laboratuvar deðerleri kaydedildi. AP þiddeti klinik olarak Ranson kriterlerine ve radyolojik olarak Balthazar kriterlerine göre deðerlendirildi.
BULGULAR: AP’li olgularýn % 10.4’ü antihipertansif ilaç kullanýmýna sekonder olarak deðerlendirildi. Antihipertansif ilaç kullanýmýna baðlý AP geliþen hastalarýn Ranson kriterleri, yatýþ gün süreleri ve Balthazar skorlarý diðer nedenlere baðlý AP’ler arasýnda istatistiksel olarak anlamlý fark bulunamadý (p>0.05).
TARTIÞMA ve SONUÇ: Çalýþmamýzda AP’li hastalarda antihipertansif ilaç kullaným sýklýðýnýn literatürde belirtilen oranlardan daha fazla olduðu görüldü. Bunun nedeni safra kesesi taþýna baðlý AP olgularýnýn genel cerrahi servislerinde takip edilmeleri ve hastalarýmýzda kronik hastalýk sýklýðýnýn fazla olmasýna baðlý olabilir. Antihipertansif ilaç kullanan hastalar AP açýsýndan yakýndan izlenmelidir.

INTRODUCTION: Akut pancreatitis (AP) is a sudden-onset inflammation of pancreatic tissue characterized by abdominal pain and increased pancreatic enzymes in serum. Cholelithiasis and alcohol intake are the most common etiologic factors of AP. Drug use is a rare cause of AP. Our aim is to determine the frequency of antihypertensive medication induced AP.
METHODS: Sixty seven patients (39 males, and 28 females) were enrolled into the study. The mean age was 52.88±19.06 years. Demographic and laboratory data of the patients were recorded. Clinical and radiological staging were performed according to criteria proposed by Ranson and Balthazar.
RESULTS: The frequency of antihypertensive therapy-induced AP was 10.4 %. There was no significant difference between antihypertensive therapy-induced AP and AP due to other etiologic factors in terms of Ranson criteria, duration of hospitalization and Balthazar scores (p>0.05).
DISCUSSION AND CONCLUSION: We observed higher frequency of antihypertensive therapy-induced AP when compared to previous reports. This might be attributed to the fact that cholelithiasis-induced AP cases were followed up in the Department of General Surgery and higher frequency of comorbid chronic diseases in our patients. Patients receiving antihypertensives should closely followed up in terms of drug related AP.

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Tüberküloz radyolojik olarak bazý tümöral, inflamatuvar ve sistemik hastalýklara benzer bulgular vererek taný güçlüklerine yol açabilir. Kitle lezyonu nedeniyle araþtýrýlan iki akciðer tüberkülozlu sunuldu.
Olgu 1: 72 yaþýnda erkek hastanýn akciðer tomografisinde sol akciðer apikoposterior segmentte düzensiz konturlu 5 cm çapýnda solid kitle lezyonu saptandý. Bu arada balgamda ARB yaymalarý (++) gelmesi üzerine tüberküloz tanýsý konuldu.
Olgu 2: 53 yaþýnda erkek hastanýn akciðer tomografisinde saptanan solid lezyon için yapýlan bronkoskopide endobronþiyal lezyon saptanmadý. Hastanýn torax tomografisindeki mediastinal lenf nodu için mediastinoskopik biyopsi nekrotizan granülomatöz lezyon saptandý.
Diyabetlilerde ve yaþlýlarda akciðer tüberkülozu atipik radyolojik bulgularla seyredebilir. Bu tür hastalarda tüberküloza ön tanýlarýmýz arasýnda yer almasýnýn yararlý olabileceðini düþündük.

Tuberculosis, can lead to difficulties in diagnosis because of radiologic findings similar to some tumoral, inflammatory, and systemic diseases. Two cases with pulmonary tuberculosis that was investigated as a mass lesion, were presented.
Case 1: Pulmonary computed tomograms of a 72-year-old male patient showed irregular solid mass 5 cm in diameter in the apicoposterior segment of his left lung. The sputum smear was AFB (++) and the patient was diagnosed as tuberculosis.
Case 2: A solid lesion was revealed with chest computed tomography in a 53-year-old male patient. Endobronchial lesion was not found in bronchoscopy. The patient’s thorax computed tomography showed mediastinal lymph nodes. Mediastinoscopic biopsy revealed a necrotizing granulomatous lesion.
Pulmonary tuberculosis may progress with atypical radiologic findings in people with diabetes and the elderly. We have thought that inclusion of tuberculosis among our initial diagnoses may be useful in these patients.

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genellikle daha önce taný almýþ kist ya da tümörü oan overlerde meydana gelir. Normal bir overin ilerleyen gebelikte torsiyone olmasý nadirdir.
Olgu Sunumu: Burada, herhangi bir predispozan faktörü olmayan 9 haftalýk bir gebede adneksiyal torsiyon olgusunu sunduk. Hasta acil bölümümüze orta þiddetli pelvik aðrý ve bulantý þikayeti ile baþvurdu. Klinik ve ultrasonografik bulgularýn kötüleþmesi sebebiyle sað salpingo-ooferektomi yapýldý.
Sonuç: Her ne kadar nadir görülse de, adneksiyal torsiyon pelvik aðrý ile baþvuran gebelerde ayýrýcý taný olarak akýlda tutulmalýdýr.

Introduction: Adnexal torsion is rarely seen during pregnancy. Torsion usually occurs in ovaries with previously diagnosed cysts and tumors. It is rare for a previously normal ovary to undergo torsion in advanced gestation.
Case presentation: Here, we report a case of adnexal torsion during the 9th week of pregnancy without any predisposing factors. The patient was admitted to emergency department with moderate lower abdominal pain and nausea. With the worsening of clinical and ultrasonographic signs a right salpingo-ooforectomy was performed.
Conclusion: Adnexal torsion, though rare, should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation.

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Lipomlar kolonda çok nadir görülmekle birlikte, kolonun ikinci sýklýkta karþýlaþýlan benign tümörleridir. Neden olduklarý semptomlar, yerleþim yerleri ve yapýsal özelikleri nedeniyle çok sýk olarak kolon maligniteleri ile karýþýrlar. Bu benzerlik zaman zaman gereksiz ölçüde geniþ cerrahi tedavi uygulamalarýna zemin hazýrlar. Amacýmýz kliniðimizde taný koyduðumuz ve tedavi ettiðimiz olgumuz eþliðinde kolon lipomlarýnýn karakteristik özelliklerini ortaya koymak, taný ve tedavi seçeneklerini literatür eþliðinde irdelemektir.

Lipomas are very uncommon in the colon however the second most commonly encountered benign tumors of the colon. The symptoms they cause, because of of their locations and structural features, they are very often mixed with malignancies of the colon. This similarity sometimes predisposes to unnecessary applications, of invasive surgical treatments. Our aim is reveal characteristic features of colonic lipomas which we diagnosed, and treated in our clinic and analyze diagnostic tools, and treatment modalities in the light of the literature.

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Spontan heterotopik gebelik ender karþýlaþýlan bir durumdur. Olgu, 8 hafta 2 günlük intrauterin tek canlý gebeliði olan þiddetlli kasýk aðrýsý yakýnmasý ile acil servise baþvuran bir hastaydý. Yapýlan ultrasonografide sol rüptüre tubal gebeliðin de tespiti üzerine hastaya laparoskopik sol salpenjektomi yapýldý. Postoperatif kontrolünde 12 haftalýk canlý intrauterin gebeliðin sorunsuz devam ettiði izlendi. Karýn aðrýsý yakýnmasý ile gelen bir hastada intrauterin gebelik tespit edilse dahi, heterotopik gebelik akýlda tutulmasý gereken bir ayýrýcý taný olmalýdýr. Bu makalede spontan gebelik ile birlikte akut karýn bulgularýna yol açan heterotopik gebelik olgusunun güncel literatür bilgileri ýþýðýnda sunumu planlandý.

Spontaneous heterotopic pregnancy is seen very rarely. The patient who had a 8-week intrauterine alive singleton pregnancy applied to the emergency department with a severe inguinal pain. An ultrasound scan revealed left tubal ectopic ruptured pregnancy, and left total salpengectomy was performed. On her postoperative control a 12-week intrauterine fetus was seen at the last antenatal visit. It should be kept in mind that in a pregnant woman with pelvic pain, heterotopic pregnancy should be considered in the differential diagnosis Herein, a spontaneous heterotopic pregnancy complicated with acute abdomen is presented in the light of the literature findings.

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Gebelikte servikal prolapsus ve uterus anomalisi nadir görülen iki klinik durumdur. Servikal prolapsusu ve müllerien kanal anomalisi olan 39 yaþýndaki hasta erken membran rüptürü nedeniyle hastanemize 38. gebelik haftasýnda baþvurdu. Pelvik muayenede ödemli, parsiyel olarak ülsere olan ve redüksüyonu tam olmayan serviks saptandý. Ultrasonografik incelemede sol tarafýnda gebelik ürünlerini taþýyan sol tarafý ise heterojen kitle gibi görünen büyümüþ bir uterus izlendi. Servikal prolapsus varlýðý ve vajinal kanama saptanmasý nedeniyle sezeryan planlandý. Postop 4. gününde parsiyel servikal rezolüsyonu olan hasta komplikasyonsuz olarak taburcu edildi.

Uterine anomalies and cervical prolapse in pregnancy are two rare clinical conditions. A 39-year old pregnant woman admitted to the hospital with premature rupture of the membrans during labor at 38 weeks of gestation and a concomitant maternal mullerien duct anomaly and cervical prolapse. We determined an edematous, partially ulcerated and hardly reducing cervix on pelvic examination. Sonographic examination revealed an enlarged uterus carriying the fetoplasental units in the left compartment and the right compartment of the uterus seemed like an heterogenous mass. Because of cervical prolapse and onset of bleeding, cesarean section was performed. She was discharged on the postoperative 4. day without any complication, and partial resolution of the cervical prolapse.

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