Menapoz, kadýnlarýn üreme çaðýndan, over fonksiyonlarýndaki gerilemeye baðlý üreme yeteneðinin kaybolduðu çaða geçtiði bir yaþam dönemidir. Dünya çapýnda ortalama menopoz yaþý 51 iken, bu oran 45-55 arasýnda deðiþmektedir. Geliþmekte olan ülkelerde menopoz yaþý geliþmiþ ülkelere göre daha erkendir. Menopoz dönemde, östrojen hormonunun azalmasýna baðlý olarak kadýnlarda hormonal, fiziksel ve duygusal deðiþimler meydana gelmektedir. Menopoz dönemde alternatif tedavi arayýþýnda olan kadýnlar genellikle kültürel yapýlarýyla baðdaþan tedavi yöntemlerini tercih ederler. Bu yöntemler arasýnda akupunktur, yoga, rahatlama hareketleri, manipülasyon teknikleri, meditasyon, egzersiz, homeopati, geleneksel Çin ilaçlarý, doðal östrojen kaynaklarý, diyet, vitaminler ve minareller yer almaktadýr.

Menopause, is woman’s transition from women’s reproductive age to the lost of her reproductive ability due to the regression of ovarian functions. Average age of menopause is 51 years worldwide, and its rate ranged from 45 to 55 years. Early Menopausal age in developing countries comes earlier than in developed countries. During menopause, hormonal, physical and emotional changes occur due to decrease in estrogenic hormone. During menopause, women seeking alternative treatment methods usually prefer treatment modalities compatible with their cultural backgrounds. These methods include acupuncture, yoga, relaxation movements, manipulation techniques, meditation, exercise, homeopathy, traditional Chinese medicine, natural sources of estrogen, diet, vitamins and minerals.

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Bitkiler ve bitkisel týp, sýk rastlanan birçok hastalýðýn tedavisinde özellikle Doðu ülkelerinde çok eski dönemlerden beri kullanýlmaktadýr. Genellikle insanlar, terapatik ve koruyucu amaçlar ile bitkileri “doðal kaynaklý” olmasý nedeni ile güvenilir görmekte ve bitkisel ürünleri bu nedenle kullanmaktadýr, ancak bitkisel ürünlerin toksikolojik ve farmakolojik etkileri ile ilgili bilimsel kanýtlar yetersizdir. Bazý çalýþmalarda, Ginkgo Biloba, Ginseng, Kava, Sarýmsak, Ekinezya, Valerian, St. John’s worth gibi bitkilerin terapatik ilaçlar ile etkileþtiðine dair kanýtlar bulunmaktadýr. Genel olarak bitkisel ürünler faz 1 ve faz 2 yollarý ile metabolize olur ve çeþitli taþýyýcýlar için substrat görevi yaparlar. P-glikoprotein ve sitokrom P450 3A4 enzimleri oral olarak emilen ilaçlar üzerinde bariyer etki yaparlar. Yapýlan in vitro çalýþmalar, bitkisel bileþiklerin, ilaçlarý metabolize eden enzim ve taþýyýcýlarý indükleyebildiðini ve inhibe edebildiðini göstermektedir. Taþýyýcý ve enzimlerle etkileþim nedeniyle bitkisel besinlerin varlýðýnda ilaçlarý metabolize eden enzim ve taþýyýcýlarýn aktivitesi deðiþmektedir. Yapýlan literatür çalýþmalarý, klinik raporlar ve in vitro çalýþmalar, birçok ilacýn ve bitkisel aktif bileþenlerin hem P-glikoproteinin hem de sitokrom P450 3A4 enziminin substratý olduðunu göstermektedir.

Herbal medicines have been frequently used for thousands of years in the East in the hope of treatment of some diseases. Patients who self-medicate with herbs for preventive and therapeutic purposes may assume that these products are safe because they are “natural” but some products cause adverse effects or have the potential to interact with prescription medications despite their mechanisms of action being generally unknown, the lack of evidence of efficacy, and inadequate toxicological data.There are some evidence that herbs such as ginkgo biloba, ginseng, kava, garlic, echinacea,valerian, st. john’s worth have been reported to interact with drugs leading to clinically relevant adverse drug reactions. Herbal products contain several chemicals that are metabolized by phase 1 and phase 2 pathways and also serve as substrates for certain transporters. P-glycoprotein and cytochrome P450 3A4 together constitute a highly efficient barrier for many orally absorbed drugs. Induction and inhibition of drug metabolizing enzymes and transporters by herbal component has been documented in several in vitro studies. Due to their interaction with these enzymes and transporters there is a potential for alteration in the activity of drug metabolizing enzymes and transporters the presence of herbal components Available literature studies, clinical reports and in vitro studies indicate that many drugs and active herbal constituents are substrates for both P-glycoprotein and cytochrome P450 3A4.

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Aþýlar halk saðlýðý alanýnda yaþanan en büyük ilerleme araçlarýdýr. Her çocuðun ulusal bir programa göre aþýlanmasý gerekmektedir. Bu çalýþmada da amaç Göztepe Eðitim ve Araþtýrma Hastanesi (GEAH) Saðlam Çocuk Polikliniðine baþvuran çocuklardaki Saðlýk Bakanlýðý ulusal aþý takvimine göre yapýlan rutin aþýlar ile ulusal aþý takvimi uygulamalarý dýþýnda yapýlan özel aþý uygulamalarýný deðerlendirmek, aþý düzen ve uyumunu araþtýrmak, özel aþý uygulamalarýndaki genel eðilimi belirlemektir. Saðlam Çocuk Polikliniðine baþvuran 1.115 olgunun yaþ daðýlýmlarý, cinsiyet daðýlýmlarý, aþýlarýn çeþidi, doz sayýlarý ve düzen durumlarý tek tek retrospektif olarak incelenmiþtir. Veriler GEAH Çocuk Hastalýklarý Saðlam Çocuk Polikliniði’nde Eylül 2008-Eylül 2010 tarihleri arasýnda aþý yaptýran çocuklarýn kayýt formlarýndan elde edilmiþtir. Bu çalýþmada Saðlýk Bakanlýðý rutin aþýlarý (hepatit B, karma, pnömokok, OPV, KKK) ve özel aþýlarýn (hepatit A, suçiçeði, rotavirus, grip) oran ve düzenli uygulama durumlarý ve aralarýndaki iliþkiler deðerlendirilmiþtir. Özel aþýlarýn durumlarý incelediðinde; hepatit A aþýsý % 34.1, suçiçeði aþýsý % 23, rotavirus aþýsý % 0.007 ve grip aþýsý % 0,016 oranlarýnda uygulanmýþ olarak saptanmýþtýr. Aþý oranlarý ve düzenli uygulamanýn araþtýrýldýðý bu çalýþmanýn sonucuna göre; devlet tarafýndan saðlanan aþýlar ücretli aþýlara göre daha yüksek oranda ve daha düzenli olarak yaptýrýlmaktadýr. Bu durum baðýþýklama hizmetlerinde hizmetin ücretsiz saðlanmasýnýn önemini göstermektedir.

The great progress in the field of public health is the use of vaccines. Every child should be vaccinated in compliance with a national vaccination protocol. In this study, our aim is to evaluate vaccinations performed in compliance with Ministry of Health`s national vaccination calendar, and vaccinations applied outside this protocol, to investigate regularity, and patient compliance to vaccinations, and top determine general tendency in the application of vaccines. children (n=1115) who were were admitted to Healthy Child Outpatient Clinics of Göztepe Education and Research Hospital` were examined retrospectively one by one with respect to their age and sex, type of the vaccine applied, number of doses and chronological order of their applications. Data were obtained from vaccinated children`s registration forms who were admitted to Göztepe Educational and Research Hospital`s Healthy Child Outpatient Clinic between September 2008, and September 2010. Regular application status of both routine and paid vaccines were assessed. (This study is consisted of 47% girls and 53% boys. Age distribution was seen as 10.2% 0-6 months, 8.4% 6-12 months, 21.4% 12-18 months, 22.9% 18-24 months, 29.7% 24-72 months, 7,4% >72 months. According to Ministry of Health Immunisation of children calendar 2010, 57,3% (n = 640) of children had immunization in the full number of doses and accurate timing of vaccines on a regular basis Bu bilgiler Türkçe özette yok). When we examined the status of paid vaccines, it was determined that rates of vaccination varied for hepatitis A ( 34.1%), chicken pox ( 23%), rotavirus ( 0.007%) and influenza (0.016%). According to the result of this study which investigated rates, and regularity of vaccinations vaccines provided by the Ministry of Health are applied at a higher rate and at a more regular basis compared to the paid vaccines. This situation shows the importance of providing free immunization services by Ministry of Health.

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GÝRÝÞ ve AMAÇ: QT disperisyonunun (QTd), iskemik kalp hastalýðý olan hastalarda ventriküler aritmiyi ve ani ölümü predikte ettiði, ayrýca, sigara, diyabet, hipertansiyon gibi major koroner risk faktörlerinin QTd’nu uzattýðý bilinmektedir. Bu çalýþmada, izole hiperlipidemi ve QT dispersiyonu arasýndaki olasý iliþki araþtýrýldý.
YÖNTEM ve GEREÇLER: Çalýþmaya, izole hiperlipidemili 76 hasta (39 kadýn, 37 erkek, yaþ ortalamasý 46.22±9.89) ve 62 saðlýklý birey (30 kadýn, 32 erkek, yaþ ortalamasý 43.56±9.96) dâhil edildi. Tüm hasta ve bireylerin istirahat halinde 25 mm/sn hýzýnda çekilen 12 derivasyonlu EKG kayýtlarý alýndý. Düzeltilmiþ QT deðeri (QTc) Bazett formülüne göre hesaplandýktan sonra, en uzun ve en kýsa QT deðerleri arasý fark düzeltilmiþ QT dispersiyonu (QTcd) olarak kabul edildi.
BULGULAR: Çalýþma grubunun QTcmax ve QTcd deðerleri, kontrol grubuna göre anlamlý derecede yüksekti (p<0.001). Buna ek olarak, izole yüksek LDL kolesterol ve trigliserid alt gruplarýnýn QTcd deðerleri, kontrol grubuna göre anlamlý derecede yüksekti (p<0.001).
TARTIÞMA ve SONUÇ: Ýzole hiperlipideminin, QT intervalleri ve ventriküler miyokardýn repolarizasyon fazýna, doðrudan etkisi olabilir.

INTRODUCTION: It is known that in patients with ischemic heart disease, QT dispersion (QTd), predicts ventricular arrhytmia and sudden cardiac death. It is also acknowledged that major coronary risk factors such as smoking, diabetes mellitus, hypertension prolong QTd. In this study, possible relationship between isolated hyperlipidemia and QT dispersion was investigated.
METHODS: 76 patients (39 females, 37 males; mean age 46±9.89) with isolated hyperlipidemia and 62 healthy subjects (30 females, 32 males, mean age 43.56±9.96) were included in the study. Resting 12 derivation ECGs recorded at 25 mm/sec. of all patients and subjects were recorded. Corrected QTd (QTcd) values were obtained according to Bazett’s Formula and then corrected QT dispersion (QTcd) was accepted as the difference between the longest and shortest QT values.
RESULTS: QTcmax and QTcd values of the study group were significantly higher than those of the control group (p<0.001). In addition, QTcd values of isolated high LDL cholesterol and triglyceride subgroups were significantly higher than those of the control group (p<0.001).
DISCUSSION AND CONCLUSION: Isolated hyperlipidemia may have a direct effect on the QT intervals and repolarization phase of the ventricular myocardium.

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GÝRÝÞ ve AMAÇ: Solunum yetmezliði ile takip edilen hastalara uzun süreli oksijen tedavisi (USOT) gerekmektedir. USOT almasý gereken hastalarýn kýsa kanüller nedeniyle hareketleri kýsýtlanmaktadýr. Uzun kanüller ile hasta hem odasý içinde daha rahat hareket edebilmekte hem de gerekli ihtiyaçlarýný yine oksijen alýrken giderebilmektedir. Çalýþmamýzda, evde oksijen konsantratörü ile USOT alan hastalarda uzun kanülün etkinliði araþtýrýldý.
YÖNTEM ve GEREÇLER: Kliniðimizde solunum yetmezliðiyle takip edilen ve evde oksijen konsantratörü ile USOT alan 30 hasta çalýþmaya alýndý. Hastalarýn 1. gün oksijensiz pulse oksimetre ve Arter Kan Gazlarý (AKG) analizi ile oksijen saturasyonlarý deðerlendirildi. Daha sonra 1 saat 2 m kanülle 2 lt/dk oksijen alan hastanýn yine pulse oksimetre ve AKG ile O2 saturasyonlarýna bakýldý. Ayný uygulama 2. gün 7.6 m oksijen kanülü ile yinelendi.
BULGULAR: AKG ile 2m kanülle O2 verilmeden önceki O2 saturasyonlarý ortalama %76.33±11.22 iken, 7.6 m kanülle ortalama 76.94±10.7 idi. Aralarýnda anlamlý fark yoktu. Bir saat 2 m kanülle 2 lt/dk O2 aldýktan sonra AKG’ye göre O2 saturasyonlarý ortalama % 88.12±5.12 ve 7.6m kanülle % 88±5.25 olup, aralarýndaki fark anlamsýzdý. Benzer çalýþma pulse oksimetre ile de eþzamanlý olarak yapýldý. Oksijen tedavisi alýrken O2 saturasyonu ortalamasý 2 m kanülle % 88.7±4.33 iken, 7.6 m kanülle % 88.83±4.51 olarak bulundu.
TARTIÞMA ve SONUÇ: Oksijen konsantratörü ile oksijen verilen hastalarda 2 m kanül ile 7.6 m kanül arasýnda AKG ve pulse oksimetre takipleri ile belirlenen O2 saturasyon deðerleri arasýnda anlamlý fark olmadýðý gösterildi. Uzun kanül kullanýmýnýn hastalara getirdiði hareket serbestliði ve hastalarýn cihaz gürültüsü ile ilgili yakýnmalarýnýn çözümlenmesi de göz önüne alýndýðýnda gerekli hastalarda kullanýmýnýn uygun ve emniyetli olduðu düþünüldü.

INTRODUCTION: Patients with chronic respiratory failure (CRF) need long-term oxygen therapy (LTOT). Due to short cannulas, they have limited mobility during sessions. With long cannulas, they can move more freely within the room and meet their own needs while LTOT. The effectiveness of long cannula among patients receiving LTOT using an oxygen condensator.
METHODS: Thirty patients who were receiving LTOT with oxygen concentrator, and followed up with the indication of respiratory failure in our clinic were enrolled in the study. First day, O2 saturations (SO2) of the patients were evaluated using pulse oxymetre, and analysis of arterial blood gasses (ABG). Then, ACG, and O2 concentrations of the patients who were receiving O2 therapy (2 L/min) with 2 m cannula for one hour were assessed. Same procedures were repeated with 7.6 m oxygen cannula on the 2nd day.
RESULTS: By ABG analysis, the mean SO2 prior to the therapy with 2 m cannula was found to be 76.33±11.22 %, whereas it was 76.94±10.7 % with 7.6 m cannula (p>0.05). The mean SO2 after therapy with 2 m cannula for one hour (2 L/min) was 88.12±5.12 %, and it was 88±5.25 % with 7.6 m cannula (p>0.05). By pulse oxymeter, the mean SO2 were found to be 88.7±4.33 % with 2 m cannula and 88.83±4.51 % with 7.6 m cannula.
DISCUSSION AND CONCLUSION: This study demonstrated that there was no significant difference between 2 m and 7.6 m cannulas in terms of SO2 measured by ABG and pulse oximeter. When considering the ease of patient movement provided and patients’ complaints about concentrator resolved by the long cannula, we thought that it could be appropriate and reliable when necessary.

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GÝRÝÞ ve AMAÇ: Sistemik hipertansiyonun saf ses odyometri ve distorsiyon product otoakustik emisyon (D.P.O.A.E.) üzerine etkisinin araþtýrýlmasý.
YÖNTEM ve GEREÇLER: Bu prospektif, kontrollü klinik çalýþma Ocak 2011 ve Aralýk 2012 yýllarý arasýnda Ümraniye Eðitim ve Araþtýrma Hastanesi-K.B.B. Kliniðinde deðerlendirilen, 60 hasta ile yapýlmýþtýr. Çalýþmaya katýlan 60 hastanýn 30’unda sistemik hipertansiyon mevcutken, sistemik hipertansiyonu olmayan 30 hasta da kontrol grubu olarak belirlendi. Tüm hastalarýn hipertansiyon öyküsü alýndý ve sistemik hipertansiyonun objektif olarak deðerlendirilebilmesi için göz dibi muayenesi yapýldý. Tüm katýlýmcýlarýn iþitme anamnezleri sorgulandý, saf ses odyometri ve otoakustik emisyon ölçümleri yapýldý.
BULGULAR: Hipertansiyonu olan grupta tinnitus görülme oraný % 90 olarak tespit edilirken, kontrol grubunda % 40 olarak tespit edildi (p=0.001). Yapýlan saf ses odyometri sonuçlarýna göre; hipertansiyonu olan hastalarda, kontrol grubuna göre 500 Hz ve üstü tüm frekanslardaki iþitme kayýplarýnda anlamlý bir artýþ mevcuttu (p<0.05). Sað kulak, 4000 Hz D.P.O.A.E. deðerlendirmelerinde, hipertansiyonu olan hasta grubunun % 80’inde yanýt alýnýrken, kontrol grubunun % 96.7’sinde yanýt alýnmýþtýr (p=0.103). Bununla beraber, 6000 Hz incelemelerde, hipertansiyonu olan hasta grubunun % 20’sinde yanýt alýnýrken, kontrol grubunun % 96.7’sinde yanýt alýnmýþtýr (p=0.001). Sol kulak, 4000 Hz D.P.O.A.E. deðerlendirmelerinde ise; hipertansiyonlu hasta grubunun % 73.3’ünde yanýt alýnýrken, kontrol grubunun % 96.7’sinde yanýt alýnmýþtýr (p=0.026). 6000 Hz incelemelerinde ise sýrasýyla hipertansiyon grubunun % 26.7’sinde yanýt alýnýrken, kontrol grubunun % 93.3’ünde yanýt alýnmýþtýr (p=0.001).
TARTIÞMA ve SONUÇ: Sistemik hipertansiyon, saf ses odyometride 500 Hz’den itibaren iþitme kaybýna neden olmaktadýr. Bu kayýp 4000 Hz’den itibarende anlamlýlýk göstermektedir. Ayný zamanda 4000 ve 6000 Hz’deki otoakustik emisyon yanýtlarýný da anlamlý bir oranda azaltmaktadýr.

INTRODUCTION: To find out the effect of systemic hypertension on 1) pure tone audiometry (PTA) 2) distortion product emissions (DPOAE) in adults.
METHODS: This clinical controlled prospective study was conducted -with 60 patients evaluated between January 2011-December 2011 at Umraniye Education and Research Hospital Otolaryngology Clinic. Thirty subjects with systemic hypertension and 30 controls were included in the study. The patients were interrogated as for past history of hypertension, and all subjects underwent a physical exam including fundus examination, PTA and DPOAE for objective evaluation of systemic hypertension.
RESULTS: Percentage of tinnitus in subjects with hypertension and in controls was 90 % and 40 %, respectively (p=0.001). Pure tone audiometry results revealed a significantly higher sensorineural hearing loss in all frequencies above 500 Hz in the hypertensive patients (p<0.05). In the right ear DPOAE assessments responses were elicited at 4000 in 80 % of hypertensive patients and 96.7 % of controls (p=0.103) and at 6000 Hz in 20 % of hypertensive patients and 96,7 % of controls (p=0.001), respectively. In the left ear, DPOAE assessments revealed responses at 4000 in 73.3 % of the hypertensive patients and 96,7 % of controls (p=0.026) and at 6000 Hz in 26.7 % of hypertensive patients and 93.3 % of controls (p=0.001), respectively.
DISCUSSION AND CONCLUSION: Systemic hypertension induces hearing loss from 500 Hz on. This hearing loss wgtains significance from 4000 Hz. It also significantly decreases otoacoustic emissions at 4000 to 6000 Hz.

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GÝRÝÞ ve AMAÇ: Hastanemizde iki göðüs hastalýklarý kliniðinde tetkik edilen 36 meme kanserli hastanýn klinik ve radyolojik özellikleri retrospektif olarak deðerlendirildi.
YÖNTEM ve GEREÇLER: Onkoloji takipleri sýrasýnda solunumsal yakýnmalarý olan ve radyolojik bulgular saptanan, hastaneye yatýrýlarak tetkik edilmiþ olan meme kanserli hastalar deðerlendirildi. Hastalarýn pulmoner lezyonlarý 2 grupta deðerlendirildi; Grup I: meme kanseri metastazýna baðlý malign lezyonlar, Grup II: malignite dýþý lezyonlar.
BULGULAR: Hastalarýn yaþ ortalamasý 52,4±14,8 (28-93) yýl olarak saptandý. Otuz dört hastada tek taraflý, 2 olguda çift taraflý duktal meme kanseri öyküsü mevcuttu. Hastalarýn % 27’si (n=10) sigara kullanmaktaydý, (ortalama 10,7±6,81 paketyýl). Meme kanseri saptanmasý ve solunumsal yakýnmalarýn baþlamasý arasýnda geçen ortalama süre 57,02±53,83 (3-180) ay, en sýk rastlanan radyolojik bulgu plevral efüzyon olarak saptandý (n=23). Pulmoner lezyonlar hastalarýn 27’inde (% 75) malign (Grup I), 9 (% 25) hastada ise malignite dýþý (Grup II) nedenlere baðlý saptandý. Malign histopatoloji saptanan hastalarda (n=27) taný yöntemleri sýrasýyla; plevral sývý sitolojisi 13 (% 48.1), plevra biyopsisi 4 (% 14.8), Fiberoptik bronkoskopi 8 (% 29.6), transtorakal biyopsi 1 (% 3.7), torakotomi 1 (% 3.7). Malign plevral efüzyon saptanan hastalarda meme kanseri tanýsý ile malign efüzyon saptanmasý arasýnda geçen süre 69,91±64,21 (3-180) ay olarak saptandý. Dokuz (% 25) hastada pulmoner lezyonlar malignite dýþý nedenlere baðlý olarak deðerlendirildi: pnömoni 3 (% 33.3), pulmoner emboli ve derin ven trombozu 3 (% 33.3), tüberküloz 2 (% 2.22), pulmoner fibrozis 1 (% 11.1).
TARTIÞMA ve SONUÇ: Meme kanserli hastalarda pulmoner bulgular sýklýkla metastazlar nedeniyle ortaya çýkmaktadýr ve meme kanseri tanýsýndan uzun süre sonra ortaya çýkabilirler diðer taraftan malignite dýþý pulmoner nedenler de unutulmamalý, histopatolojik doðrulama yapýlmalýdýr.

INTRODUCTION: Clinical and radiological features of 36 patients with breast cancer were investigated retrospectively.
METHODS: Patients with breast cancer who had pulmonary complaints and radiologic abnormalities observed during oncology follow-ups were hospitalized, and investigated in clinics of chest disease. Pulmonary lesions were classified into 2 groups; Group I: malignant lesions due to metastasis of breast cancer, and Group II: nonmalignant lesions.
RESULTS: The mean age of the patients was 52.4±14.8 (28-93) years. Thirty-four patients were previously diagnosed with unilateral and 2 patients with bilateral ductal breast carcinoma. Twenty seven percent (n=10) of the patients were smokers (mean 10.7±6.81 pack-years). The mean time between the detection of breast cancer and the manifestations of pulmonary symptoms was 57.02±53.83 (3-180) months). The most common radiological abnormality was pleural effusion (n=23;63.9 %). Twenty-seven (75 %) patients had malignant (Group I), and 9 (25 %) patients had nonmalignant (Group II) pulmonary lesions. Malignant histopathology (n=27) was established by pleural fluid cytology in 13 (48.1 %), fiber optic bronchoscopy in 8 (29.6 %), pleural biopsy in 4 (14.8 %), CT guided transthoracic needle aspiration biopsy in 1 (3.7 %) and thoracotomy in 1 (3.7 %) patient, respectively. Mean time interval between the diagnosis of breast cancer and the detection of malignant pleural effusion was 69.91±64.21 (3-180) months. Nine (25 %) patients had nonmalignant pulmonary lesions including pneumonia in 3 (33.3 %), pulmonary thromboembolism and DVT in 3 (33,3 %), tuberculosis in 2 (22.2 %) and pulmonary fibrosis in 1 (11,1 %) patient.
DISCUSSION AND CONCLUSION: Pulmonary manifestations of breast cancer are most commonly related to metastases and can be observed in long time after the diagnosis of breast cancer. Besides, these nonmalignant reasons should be kept in mind and histopathologic confirmation should me made.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzýn amacý ayak bileði yaralanmasýyla acil servise baþvuran hastalarda gereksiz radyografi istemini azaltma açýsýndan Ottawa ayak bileði kurallarýnýn (OAK) yararlýlýðýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Kasým 2012-Þubat 2013 tarihleri arasýnda acil servisimize ayak bileði travmasý öyküsü ile baþvuran 150 hasta çalýþmaya alýndý. Hastalarýn radyografi istemine OAK uygulanarak karar verildi. Kýrýk saptanan hastalarýn travma mekanizmasýný deðerlendirmek amacý ile Lauge-Hansen sýnýflamasý yapýldý. Ottawa ayak bileði kurallarýnýn duyarlýlýðý, özgüllüðü, pozitif ve negatif prediktif deðerleri saptandý ve kullanýlabilirliði deðerlendirildi.
BULGULAR: Ortalama yaþ 32 (daðýlým 16-68 yýl) yýldý. Seksen iki (% 55) hasta erkek ve 68 (% 45) hasta kadýndý. Otuz Sekiz (% 25.3) hastada kýrýk vardý ve bu hastalarýn 33’ü (% 22) malleolar bölge ve distal tibia kýrýðý iken, beþ (% 3.3) hastanýn kýrýðý ayak bölgesindeydi. Lauge-Hansen sýnýflamasýna göre altý hastanýn supinasyon-addüksiyon, 21 hastanýn supinasyon-dýþ rotasyon, sekiz hastanýn pronasyon-abdüksiyon ve üç hastanýn pronasyon-dýþ rotasyon yaralanmasý vardý. OAK’nýn duyarlýlýðý % 94.7 ve özgüllüðü % 69.6 bulundu. Pozitif prediktif deðer % 51.4 ve negatif prediktif deðer % 97,5 bulundu.
TARTIÞMA ve SONUÇ: Ottawa ayak bileði kurallarý uygulanabilirliði kolay ve etkin sonuçlara ulaþýlabilen bir karar verme aracýdýr. Bunun yanýnda kurallar uygulanýrken, geliþebilecek yasal sorunlarýn elemine edilmesinin kurallarýn uygulanabilirliðini ve getireceði ayaklarý artýracaðýna inanýyoruz.

INTRODUCTION: The aim of this study is to evaluate the effectiveness of Ottawa ankle rules (OAR) by means of reducing the unnecessary radiographic examinations demanded in the emergency service patients.
METHODS: One hundred and fifty patients who were admitted to the emergency service, between November 2012 and February 2013, due to ankle injury, were included in the study. The demanded radiographical evaluations were decided according to OAR. Lauge-Hansen classification was made to evaluate the trauma mechanism in the patients.The sensitivity, the specificity, positive and negative predictive values of OAR were defined and the feasibility was evaluated.
RESULTS: The mean age was 32 (range 16-68) years. Eighty two (55 %) of the patients were male and 68 (45 %) of the patients were female. There were fractures in 38 (25,3) patients. Of these fractures 33 of them were in the malleolar and distal tibial region, whereas 5 of them were in the foot. Six of the fractures were classified as supination-adduction type, 21 of the fractures were supination- external rotation type, 8 of the fractures were pronation-abduction type and 3 of the fractures were pronation-external rotation type.the sensitivity of OAK was found as 94,7 % and specificity was found as 69,6%. The positive predictive value was 51,4 % and the negative predictive value was 97,5 %.
DISCUSSION AND CONCLUSION: Ottawa ankle rules are easy to apply and effective in decision making. Also we suggest that the elimination of the legal issues while the rules are applied may increase the feasibility and usefulness.

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Pancoast tümörü brakiyal pleksus alt trunkusunun ve vertebra corpusunun invazyonu sonucu üst ekstremitede, boyunda aðrýya, el ve parmak kaslarýnda motor ve duyusal kayýplara neden olabilen bronkojenik karsinomadýr. Tümörün periferik yerleþiminden dolayý akciðer semptomlarý hastalýðýn geç dönemlerinde görülmektedir. Bu nedenle hastalar yanlýþ tanýlarla takip edilmektedir. Biz ulnar tuzak nöropatisi nedeniyle opere edilip yakýnmalarý geçmeyen ve akciðere yönelik radyolojik incelemelerde sað akciðer apeksinde tümör saptanan 53 yaþýnda bir erkek hasta sunduk. Bu olgu ile tuzak nöropatinin ayýrýcý tanýsýnda iðne EMG ile brakiyal pleksopati ve radikülopatinin dýþlanmasý gerektiðini, boyun-kol aðrýsý olan, sigara kullaným öyküsü olan erkek hastalarda ayýrýcý tanýda akciðer patolojilerinin de düþünülmesi gerektiðini vurgulamayý amaçladýk.

Pancoast tumor is a bronchial carcinoma which can cause neck and upper extremity pain, motor and sensory defisits in the hand due to infiltration of the lower trunk of the brachial plexus, and corpus of vertebra. The pulmonary symptoms occur later because of tumor’s peripheral localisation. Therefore patients can be followed up with inaccurate diagnosis. Here, we describe a case of A 53- year- old man with a Pancoast tumor, presenting with ulnar nerve entrapment and operated with this indication. However, his complaints were not relieved, and his pulmonary radiograms revealed the presence of a tumor at the apex of his right lung. This case is reported to emphasize the importance of needle EMG for the exclusion of radiculopathy and brachial plexopathy in the differential diagnosis of nerve entrapments and necessity of considering pulmonary diseases in smokers with cervicobrachialgia.

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Yabancý cisim yutulmasý nedeniyle endiþeli bir þekilde acil merkezlere baþvuran eriþkin hastalarýn birçoðunda yutulan cisim toplu iðne gibi küçük cisimler olduðu bilinmektedir. Bu tür yabancý cisimlerin yutulmasý durumunda gastrointestinal traktusun dýþýna çýkmamýþ, peritonitin eþlik etmediði hastalarda genel kabul görmüþ yaklaþým non-cerrahi yaklaþým ve takiptir. Yuttuðu yabancý cismin farkýnda olmayan, kendiliðinden gastrointestinal traktusu terk etmesinin olasý olmadýðý cismin midesine yerleþtiði olgu üzerinden mide yabancý cisimleri irdelenmeye çalýþýldý.

In many anxious adult patients admitted to the emergency centers because of intake of foreign bodies, small items, such as a needle is known to be ingested. In patients who swallowed foreign bodies, which are not penetrated outside of the gastrointestinal tract, and thus not accompanied by peritonitis, generally accepted approach is non-surgical approach and follow-up of the patient. We tried to analyze gastric foreign bodies in consideration of the patient who was not aware of a swallowed foreign body which could not possibly pass out of the gastrointestinal tract spontaneously.

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Bronkojenik kistler, trakeobronþiyal aðacýn ender görülen konjenital lezyonlarýdýr. Genellikle mediastinum ve akciðerde lokalize olurlar. Bu makalede intratorasik bronkojenik kist tanýlý iki eriþkin olgu sunulmuþtur. Bronkojenik kist bir olguda mediastende, diðer olguda akciðerde lokalize idi. Bir hasta eþzamanlý karaciðer hidatik kistine sahipti. Her iki olgu da semptomatik idi. Hastalara cerrahi tedavi uygulandý.

Bronchogenic cysts are rarely seen congenital malformations of tracheobronchial tree. They are usually located in the mediastinum and intrapulmonary regions. In this paper two adult cases of intrathoracic bronchogenic cyst were presented. Bronchogenic cyst was located in the mediastinum (n=1) or in a intrapulmonary region. One patient had a synchronous hydatid cyst disease of the liver. The patients were symptomatic. The patients were treated by surgery.

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Aplazia kutis kongenita ender görülen deri tabakalarýnýn, subkutan dokunun daha ender olarak da kemiðin olmadýðý bir hastalýktýr. Olgularýn önemli bir kýsmý infeksiyonlar, elektrolit kaybý ve masif hemoraji nedeniyle kaybedilir. Biz bu çalýþmada sað bacaðýnda geniþ deri aplazisi alanýna sahip 2 günlük bir yenidoðaný sunduk.

Aplasia cutis congenita is a rarely seen disease in which dermis, subdermal tissue and extremely rarely bone are absent. Significant number of cases are lost due to infections, electrolyte imbalance, and massive hemorrhage. In this report, we present a 2-day-old infant who had a wide aplasia cutis area on the right lower limb.

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Akut dissemine ensefalomiyelit, merkezi sinir sisteminin enflamatuvar, demiyelinizan bir hastalýðýdýr. Tipik olarak yaygýn nörolojik bulgularla birlikte, beyin ve spinal kordda multifokal lezyonlarla karakterizedir. Etiyolojide viral, bakteriyel etkenlerin yaný sýra bazý aþýlar sorumlu tutulmaktadýr. Erkeklerde daha çok bildirilen bu hastalýk genellikle çocukluk çaðýnda görülmektedir. Taný klinik ve radyolojik bulgulara dayanýlarak konulmaktadýr. Bu makalede, genel durum bozukluðu ve bilinç deðiþikliði ile baþvuran, klinik ve radyolojik deðerlendirme sonrasý akut dissemine ensefalomiyelit tanýsý alan 40 yaþýnda bir kadýn olgu sunulmuþ; erken taný ve uygun tedavi ile % 80’i nörolojik sekel kalmadan iyileþebilen bu hastalýðýn daha çok çocuklarda görülse de eriþkin yaþ grubunda da hatýrlanmasý gerektiði vurgulanmak istenmiþtir.

Acute disseminated encephalomyelitis (ADEM), is an inflammatory and demyelinization disorder of central neurvous system (CNS). This disease is characterized by common neurologic findings with multifocal lesion at spinal cord. As etiological factors of ADEM, viral and bacterial infections and also some vaccines have been held responsible. Men are affected more than women, and the disease is generally seen in childhood. Diagnoses have been made based on clinic and radiologic findings. In this article a 40 year- old woman who presented with worsened general condition, and alteration of consciousness who was diagnosed as ADEM after clinical and radiological evaluations. In this article we wanted to emphasize that ADEM which can be cured without any sequelae in % 80 of the patients with early diagnosis and appropriate treatment is mostly seen in childhood, but it must be remembered as a diagnostic entity in adults.

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Endometriozis; overin hormonal uyarýsýna yanýt veren fonksiyonel endometrial gland ve stromal dokunun uterus dýþýnda bulunmasý olarak tanýmlanmaktadýr. Üreme çaðýndaki kadýnlarda sýklýkla pelvik organ ve peritoneumda bulunmakla birlikte abdominal duvar endometrozisi baþta olmak üzere pelvis dýþý endometriozis olgularý da görülmektedir. Abdominal duvarda geliþen endometriozis genellikle sezaryen veya diðer jinekolojik ameliyatlar sonrasý oluþmaktadýr. Bu olgu sunumunda; sezaryen insizyonunda ve sezaryen insizyonundan iliþkisiz rektus abdominalis kasýnda bulunan iki ayrý abdominal duvar endometriozis olgusu sunulmuþtur.

Endometriosis is defined as the presence of a functional endometrial gland and stromal tissue outside the uterus as a response to ovarian stimuli. Although, it is frequently found in the pelvic organs, and peritoneum in women of the productive age, cases of endometriosis are also seen outside of pelvis predominantly abdominal wall endometriosis. Endometriosis develops in the layers of the abdominal wall after cesarean section or other gynecological operations. We presented cases with two abdominal wall endometriosis which both occured after cesarean sections. One of them was located on the cesarean incision and the other was situated in the rectus abdominis muscle which is unrelated to cesarean incision.

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Uterus perforasyonu rahim içi araçlarýn ender görülen komplikasyonlarýndan biridir. Bu olgu sunumunda rahim içi araç takýlmasý sýrasýnda oluþan uterus perforasyonu sonucunda broad ligamentin iki yapraðý arasýnda bulunan rahim içi aracýn laparoskopik olarak çýkarýlmasý sunulmuþtur. Yirmi yedi yaþýndaki bir hastaya rahim içi araç takýlmasý sýrasýnda uterin perforasyon oluþmuþ ve ultrasonografik olarak rahim içi araç uterus dýþýnda saptanmýþ ve bu nedenle laparoskopi planlanmýþtýr. Laparoskopi sýrasýnda rahim içi araç broad ligamentin her iki yapraðý arasýnda, sol round ligament posteriorunda saptanmýþ ve laparoskopik olarak çýkarýlmýþtýr. Operasyon sonrasýnda herhangi bir komplikasyon saptanmamýþtýr. Uterus dýþýndaki rahim içi araçlarýn laparoskopik olarak çýkarýlmasý ilk tedavi seçeneði olarak düþünülmelidir.

Uterine perforation is one of the rare complications of intrauterine device (IUD). This case report is about laparoscopic removal of a dislocated IUD found between the two layers of the broad ligament due to perforation during insertion. During insertion of an IUD to a 27 year old patient, uterine perforation occurred. Ultrasonographic examination revealed an IUD outside the uterus. Laparoscopy was planned for the removal of the IUD. During laparoscopic examination, a copper IUD was detected between the two layers of the broad ligament on the posterior of the left round ligament and the tip of one of the arms of the IUD was seen. The IUD was removed, and any complications were not observed after the operation. Laparoscopic management of the extrauterine IUDs should be the first choice of treatment in these cases.

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