Gaziantep Týp Fakültesi Çocuk Saðlýðý ve Hastalýklarý Kliniði Yenidoðan Servisinde yapýlan bu çalýþmada, sepsis öntanýlý 17 hasta ve 17 saðlýklý toplam 34 yenidoðanýn serum örneklerinde TNF-α konsantrasyonlarý araþtýrýldý. Sepsis tanýsýnda Silveira ve ark.’nýn (22) kriterleri kullanýldý. Sepsis tanýsý bu kriterlerden en az 3 klinik bulgu ve inflamatuvar fenomenlerden ise en az 2 laboratuvar bulgusunun pozitif olmasý ya da kan kültürünün pozitif olmasý ile konuldu. Çalýþma ve kontrol grubundan bir kez analiz için kan alýndý. Sepsisli yenidoðanlarýn serum TNF-α düzeylerinin (9.25±14.13 pg/mL), kontrol grubunu oluþturan saðlýklý infantlara göre (7.14±4.31 pg/ml) anlamlý derecede yüksek olmadýðý belirlendi (p>0.05). Ölen hastalarýn serum TNF-α konsantrasyonlarýnýn sað kalanlara göre anlamlý derecede yüksek olmadýðý belirlendi (p>0.05). Elde ettiðimiz sonuçlar, makrofajlar tarafýndan sentezlenen ve sitokin ailesinin önemli bir üyesi olan TNF-α’nýn, yenidoðan sepsisi erken tanýsýnda önemli bir role sahip olmadýðýný ve prognozla iliþkisinin bulunduðunu göstermektedir

This study has been carried out on 17 newborns who were initially diagnosed as neonatal sepsis in the NICU (Newborn Intensive Care Unit) as well as 17 healthy newborns at the Medical Faculty Hospital of Gaziantep University to investigate the role of serum TNF-α concentration in the early diagnosis of neonatal sepsis and its relation with the prognosis. The clinical and hematological criteria of Silveira et al. (22) are used in the diagnosis of sepsis. Sepsis was diagnosed with at least 3 positive clinical signs and two positive inflammatory laboratory findings meeting these criteria or positive hemoculture. In the study and control groups plasma samples were taken only for once. Serum TNF-α concentrations of the newborns with sepsis (9.25±14.13 pg/ml) were not significantly higher than the control group (7.14±4.31 pg/mL) (p>0.05). Serum TNF-α concentrations of the patients who died were not significantly higher than the survivors (p>0.05). These data suggest that TNF-α, an important macrophage derived member of the cytokine family, hasn’t an important role in the early diagnosis of neonatal sepsis; and that there is a close relationship between its plasma levels and mortality rates.

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Amaç: Gebelikte hematolojik sistemde fizyolojik olarak belirgin deðiþiklikler meydana gelir. Gebeler artan demir gereksiniminin karþýlanamamasý nedeniyle demir eksikliði anemisi açýsýndan yüksek riskli popülasyon arasýnda yer almaktadýr. Trombositopeni tüm gebelerin % 6-10’unu etkiler. Gebelerde beslenme alýþkanlýklarýndaki farklýlýklar nedeniyle hematolojik parametrelerde bölgesel farklýlýklar olabilmektedir. Bu çalýþmada Doðu Karadeniz bölgesindeki gebelerde anemi, trombositopeni ve diðer bazý hematolojik parametrelerdeki deðiþikliklerin sýklýðýný belirlemeyi amaçladýk.
Gereç ve Yöntem: Çalýþmaya 1 Ocak 2011 ve 31Aralýk 2012 tarihleri arasýnda 38 hafta ve üstünde doðum yapmak üzere gebe polikliniðine baþvuran 2584 gebe dâhil edildi. Gebelerin son trimesterindeki hemoglobin ve hematokrit düzeyleri, lökosit ve trombosit sayýlarý, ortalama eritrosit ve trombosit hacimleri retrospektif olarak incelendi.
Bulgular: Gebelerin yaþ ortalamasý 29.09±5.81(16-48) olarak tespit edildi. Gebelerin %50.3’ünde anemi ve %9.3’ünde trombositopeni bulundu. Gebelerin %10.9’unda lökositoz ve %1.1’inde lökopeni tespit edildi. Trombositopeni tespit edilen hastalarýn yaþ ortalamasý diðer gebelerden yüksek bulundu.
Sonuç: Gebelik döneminde demir preparatlarýnýn rutin olarak kullanýlmasýna raðmen, Doðu Karadeniz bölgesinde yaþayan term gebelerde anemi hâlen yaygýn bir halk saðlýðý sorunu olarak önemini korumaktadýr. Obstetrisyenlerin ileri yaþtaki gebelerde trombositopeni açýsýndan daha dikkatli olmalarý gerekir.

Objective: Pregnancy induces a variety of physiological changes in the hematological system. Pregnant women are in the high-risk population for iron deficiency anemia because of increased iron requirement. Thrombocytopenia affects 6-10 % of all pregnancies. In pregnant women, the hematological regional disparities may be related to the differences in feeding habits. In our study, we aimed to determine the frequency of anemia, thrombocytopenia and changes of some other hematological parameters in pregnant women in the East Black Sea Region.
Materials and Methods: A total of 2584 pregnant women over 38 gestational weeks, who were admitted to our obstetric clinic between 01.01.2011 and 31.12.2012 were included in this study. Hemoglobin, hematocrit, red blood cell, leucocyte and platelet levels, mean corpuscular volume, mean platelet volume measured in the third semester of pregnancy were all retrospectively investigated.
Results: The mean age of the pregnant women was 29.09±5.81 (16-48 years). The prevalence rates of anemia and thrombocytopenia were 50.3 % and 9.3 % respectively. The prevalence rates of leucocytosis and leucopenia were 10.9 % and 1.1 % respectively. The mean ages of the patients with thrombocytopenia were found to be statistically significantly higher than those without thrombocytopenia.
Conclusion: During pregnancies, anemia is still a common and important public health problem for women living in the East Black Sea Region, despite routine use of iron medication. Also obstetricians should pay more attention to thrombocytopenia in pregnant women of advanced age.

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Amaç: Oftalmoloji alanýnda günümüze kadar yayýnlanmýþ Türkiye kaynaklý en çok sayýda atýf alan 100 makalenin incelenmesi ve bu makalelerin yazarlara, göz dergilerine ve kurumlara daðýlýmýnýn araþtýrýlmasý.
Gereç ve Yöntem: Institute for Scientific Information’ýn (ISI) Web of Science (WOS) arama motorunda “ophthalmology” ve “Turkey” kelimeleri kullanýlarak, oftalmoloji alanýnda yayýnlanmýþ Türkiye kaynaklý makalelerden en çok atýf alan ilk 103 makale tarandý. Listeye ilk isim olarak girenlerden birden fazla makalede adý geçen yazarlar ile birden fazla defa giren kurumlar ve en çok atfýn bulunduðu dergilerin listesi çýkarýldý.
Bulgular: Tarih sýnýrlamasý yapýlmadýðýnda WOS’da oftalmoloji alanýnda yayýnlanmýþ olan Türkiye kaynaklý makale sayýsýnýn toplam 3872 olduðu görüldü. En çok atýf alan ilk 3 makale Ýlknur Tuðal-Tutkun (n=148), Cem Evereklioðlu (n=129) ve Rengin Yýldýrým ve ark.’na aitti (n=94). Ýlk 100’de en çok kez yer alan ilk 3 dergi sýrasýyla Journal of Cataract and Refractive Surgery (n=17), American Journal of Ophthalmology (n=11) ve Ophthalmology (n=9) idi. Bu 103 makalenin üzerinde en çok çalýþtýðý konular, kornea ve ön yüzey (n=27), retina (n=25), katarakt (n=13), uvea ve Behçet hastalýðý (n=11) ve refraktif cerrahi (n=10) idi. Ýlk 100’de en çok kez yer alan kurumlar Ýnönü Üniversitesi (n=10), Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi (n=8), Gazi ve Ankara (n=7, her biri) üniversiteleri ile idi.
Sonuç: Bilgimize göre bu çalýþma oftalmoloji alanýnda Türkiye kaynaklý en çok sayýda atýf alan makaleyi inceleyen ilk çalýþmadýr. Çalýþmamýzda Türkiye kaynaklý en çok sayýda atýf alan makalenin 148 defa, 100. sýradakinin de 31 kez atýf aldýðý, Türkiye kaynaklý göz makalelerinin ortalama 6.31 kez atýf aldýðý kaydedildi.

Objective: To search the most frequently cited 100 ophthalmic articles with Turkish origin and to investigate the authors, institutions and journals found in this list.
Material and Method: In the search engine of Web of Science (WOS) of Institute for Scientific Information (ISI), we conducted an online retrospective search using the words of “ophthalmology” and “Turkey” and screened 103 most cited articles. The most cited journals, authors and their institutions were listed.
Results: A total of 3872 articles were found in the area of ophthalmology origined from Turkey. The most cited 3 articles were those of Ýlknur Tuðal-Tutkun (n=148), Cem Evereklioðlu (n=129) and Rengin Yýldýrým et al (n=94). The most cited 3 journals were, Journal of Cataract and Refractive Surgery (n=17), American Journal of Ophthalmology (n=11), and Ophthalmology (n=9). The majority of topics covered by these articles were cornea and anterior surface (n=27), retina (n=25), cataract (n=13), uvea and Behçet’s disease (n=11) and refractive surgery (n=9). The first 4 institutions having most articles in that list were Ýnönü University (n=10), Ýstanbul University Cerrahpaþa Medical School (n=8), Gazi and Ankara Universities (n=7, each).
Conclusion: According to us, this is the first study investigating the most cited top 100 ophthalmic Turkish articles. Citation numbers of the most cited ophthalmic articles were ranged from 148 to 31. We observed that the ophthalmic articles from Turkish origin has a mean citation number of 6.31.

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Amaç: Ýnhale nitrik oksid (iNO) term bebeklerde persistan pulmoner hipertansiyon tedavisinde kullanýlmakta olup, prematüre bebeklerde de özellikle konvansiyonel tedavilere yanýt vermeyen solunum yetmezliði durumlarýnda kullanýlmaktadýr.
Gereç ve Yöntem: Bu çalýþmada yenidoðan yoðun bakým ünitemizde iki yýllýk süreçte iNO tedavisi uygulanan 7 hastayý ve elde edilen sonuçlarý sunduk.
Bulgular: Hastalarýn ikisinde herhangi bir morbidite geliþmemiþtir. Bir hasta ex olmuþtur. Kalan 4 hastada da minör morbidite saptanmýþtýr.
Sonuç: iNO tedavisi preterm bebeklerde güvenilir ve etkili olabilecek bir tedavi yöntemidir, ancak daha geniþ klinik çalýþmalara gereksinim duyulmaktadýr.

Objective: Nitric oxide is used for persistent pumonary hypertension in term infants and respiratory failure which was not responded to conventional therapies in pretem infants.
Material and Methods: Here we present clinical results of 7 infants in whom nitric oxide therapy was used in our intensive care unit during 2 years.
Results: Morbidities of two patients did not improve. One patient died. Rest of them improved with only minor morbidities.
Conclusion: Nitric oxide therapy is one of very effective and reliable selection in preterm infants but more comprehensive investigations are necessary.

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Amaç: Bu çalýþmada sinonasal varyasyona rastlanma sýklýðý ve
cinsiyetler arasýndaki fark deðerlendirildi.
Materyal ve Metod: Ocak 2009-Haziran 2013 tarihleri arasýnda
S. B. Göztepe Eðitim ve Araþtýrma Hastanesi Radyoloji Kliniðinde
herhangi bir nedenle çekilmiþ 100 kadýn ve 100 erkek hastanýn
paranazal sinüs bigisayarlý tomografileri Lloyd % 2 (BT)
incelendi. Sinonazal polipozis gibi nazal kitlesi olan hastalar ve
daha önce bu bölgeden herhangi bir operasyon geçirmiþ hastalar
çalýþmaya dâhil edilmedi.
Bulgular: Çalýþma sonucunda en sýk rastladýðýmýz varyasyonlar
sýrasý ile agger nazi hücresi, nazal septal deviasyon, konka bülloza,
hiperpnömatize etmoid bulla, paradoks orta konka, haller
hücresi, onodi hücresi, medialize unsinat proses ve pnömatize
unsinat proses olarak bulundu.
Sonuç: Cinsiyetler arasýnda istatiksel olarak anlamlý bir fark
saptanamamakla beraber, bütün varyasyonlar sayýsal olarak
kadýnlarda daha fazla görüldü. Ayrýca, medialize unsinat proses
çalýþma grubumuzda topluma göre anlamlý derecede az bulundu.

Purpose/Introduction: In thýs study we evaluated the incidence of
variations in nasal and sinusal structures and difference of variations
between genders.
Material and Method: This study was made in the Department of
Radiology Goztepe Training and Research Hospital, between January
2009 and June 2013. Paranasal sinus computed tomography
images of 100 male and 100 female patients’ were evaluated. Patients
with sinonasal polyposis and who had previous nasal surgery
were excluded from the study.
Results: We determined that the most common variations in descending
order were agger nasi cells, nasal septal deviation, concha
bullosa, hyperpneumotized ethmoid bulla, paradoxial middle turbinate,
haller cell, onodi cell, medialized uncinate process, pneumoticated
uncinate process.
Conclusion: We did not find any statistical differences between the
genders. But the incidence of the medialized uncinate process in
our study was significantly lower than the incidence indicated in
other literature studies.

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Amaç: Periton diyalizi son dönem böbrek yetmezliði olan hastalarda sýk kullanýlan bir tedavi yöntemidir. Bu çalýþmada lokal anestezi altýnda mini-laparatomi ile yerleþtirilen periton diyaliz kateter uygulamalarýnýn sunulmasý amaçlanmýþtýr.
Gereç ve Yöntemler: Þubat 2013-Mayýs 2014 dönemi arasýnda Bezmialem Vakýf Üniversitesi Týp Fakültesi Hastanesinde son dönem böbrek hastalýðý olan 16 hastaya mini-laparatomi ile Tenckhoff periton diyaliz kateteri takýldý. Hastalarýn seçimi, kateter takýlmasý, hasta eðitimi ve takipleri periton diyaliz ve genel cerrahi ekipleri tarafýndan yapýldý.
Bulgular: Ameliyatlara tüm hastalara lokal anestezi ve sedasyon uygulanarak baþlandý ve güvenli bir þekilde tamamlandý. Hastalarýn tümü ameliyatý tolere etti. Ortalama ameliyat süresi 25.8 dk. (deðer aralýðý 15-30 dk.) idi. Hastalar iþlem sonrasý sekizinci saatte taburcu edildi. Ýki hastada iþlem sonrasý 1. günde malrotasyona baðlý kateter disfonksiyonu geliþti (% 12,5). Ayný teknik ile kateter revizyonu yapýldý ve devam eden takiplerde kateter disfonksiyonu geliþmeden periton diyalizi uygulandý. Bir hastada (% 6.25) kateterin omentumla sarýlarak týkanmasýna baðlý kateter revizyonu yapýldý. Takip süresi içinde hiçbir hastada kanama, perforasyon, ileus, eksternal cuff erozyonu ve insizyonel herni izlenmedi. Birer hastada kateter kenarýnda geçici sýzýntý (% 6.25), yara yeri enfeksiyonu (% 6.25) ve iþlem sonrasý 3. ayda peritonit (% 6.25) geliþti. Ortalama 13,9±3,79 aylýk takip süresinde bir hastada kateter fonksiyon bozukluðu geliþti (% 6.25).
Sonuç: Lokal anestezi altýnda mini-laparatomi ile periton diyaliz kateteri yerleþtirilmesi hastanede uzun süreli yatýþ gerektirmemesi, ameliyat süresinin kýsa olmasý ve önemli bir morbiditeye yol açmamasý nedeniyle tercih edilebilecek güvenli bir tekniktir.

Objective: Peritoneal dialysis is a commonly used treatment modality in patients with end-stage renal failure. In this study, it was aimed to present the placement of peritoneal dialysis catheter under local anesthesia.
Material and Methods: Between February 2013 and May 2014, Tenckhoff peritoneal dialysis catheter was placed in 16 end-stage renal failure patients via mini-laparotomy approach under local anesthesia in Bezmialem Vakif University Medical Faculty Hospital. Selection of the patients, placement of the catheters, patient education and the follow up were all perforrmed by the general surgeons and peritoneal dialysis team.
Results: All operations have started with local anesthesia and sedation, and ended without any problem. All patients tolerated the operation, and were discharged at postoperative 8th hour. Mean operation time was 25.8 minutes (range 15-30 minutes). In 2 patients, catheter dysfunction occurred due to malrotation in the postoperative first day (12.5 %). The same procedure performed in these patients with success. After the operations any catheter dysfunction was not observed and peritoneal dialysis performed properly. Catheter revision was required in another patient because of omental wrapping (6.25 %). During the follow-up period, any case of perforation, ileus, erosion of external cuff or incisional hernia was not observed. In each patient, temporary leakage from catheter entry site (6.25 %), wound infection (6.25 %) and peritonitis at the postoperative 3rd month (6.25 %) occurred. One catheter dysfunction (6.25 %) occurred during the mean follow-up period of 13.9±3.79 months.
Conclusion: Placement of peritoneal dialysis catheter with mini-laparotomy under local anesthesia is a safe approach with advantages of short hospitalization and operation time without significant morbidity.

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Kalsiyum ve fosfor birikiminin çoðu gebeliðin son trimesterinde
gerçekleþtiðinden prematüre bebekler kemik mineral hastalýðý
(osteopeni) açýsýndan risk altýndadýr. Prematüre doðumu takiben
kemik mineralizasyonunda azalma riskine katkýda bulunan ek etkenler
bulunmaktadýr. Bunlardan en önemlileri bebeðin gereksinimi
olan kalsiyum ve fosforun saðlamasýnda yetersizlik, uzamýþ
parenteral beslenme, bazý ilaç uygulamalarý ve uzun hareketsizlik
dönemleridir. Bugün için prematüre osteopenisinin tanýsý hâlen
serum alkalen fosfataz düzeyini biyokimyasal deðerlendirilmesi
ve radyolojik olarak osteopeni ve/veya kýrýk varlýðýna dayanmaktadýr.
Hastalýðýn tedavisinden çok prematüre osteopenisinin
önlenmesi amaçlanmalýdýr ve erken dönemde yeterli kalsiyum ve
fosfor desteðini içermelidir.

Preterm infants are at an increased risk of bone metabolic disease
(osteopenia) as most calcium and phosphorus deposition occurs
during the last trimester of pregnancy. There are added factors
that compound the risk of reduced bone mineralization following
premature delivery. The most important ones include inadequate
supply of calcium and phosphorus for the needs of the infant,
prolonged parenteral nutrition, some medications and prolonged
periods of immobility. Nowadays, the diagnosis of osteopenia of
prematurity is based mainly on biochemical evaluation of serum
alkaline phosphatase and radiological evidence of osteopenia
and/or fractures. Prevention of osteopenia of prematurity should
be aimed at prevention rather than the treatment of the disease
and adequate supply of calcium and phosphate at an early stage
is necessary.

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Ýntrakardiyak defibrilatör (ÝKD) ani kardiyak ölümleri azaltmada etkili bir uygulamadýr. Önemli bir giriþim olmakla birlikte, ÝKD uygulamasýna baðlý þok geliþme korkusu ve yaþam stilindeki deðiþiklikler hasta ve ailesinin yaþamýný olumsuz etkileyebilmektedir. Bu nedenle saðlýk çalýþanlarýnýn, hasta ve ailesinin ÝKD þoklamasý hakkýnda korku ve anksiyetelerini azaltmaya yönelik giriþimler planlamalarý gerekmektedir. Bu derlemede örnek bir olgu üzerinden konu tartýþýlmýþtýr.

Intracardiac defibrillator (ICD) is an effective procedure in reducing the sudden cardiac death. Although the ICD is an important initiative, it can negatively affect quality of patients’ and their families’ life due to fear of shock and life-style changes of ICD shock. Therefore, health proffessionals need to plan interventions to reduce the fear and anxiety of patients’ and their families’. The topic has been discussed with a case study in this review.

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Squamöz papillom larinksin Human Papilloma Virüs (HPV) kaynaklý benign bir tümörüdür. Genellikle multiple, rekürren karakterdedir ve pediatrik hasta grubunda saptanýr. Sýklýkla vokal kordlar üzerinde yerleþir, ancak oral kavite ve aerodigestif yollarla diðer bölgelere kolaylýkla yayýlabilir. Pediatrik hastalarda patoloji daha agresif ve progresif seyreder. Hava yolunda ciddi daralmalara neden olabilir hatta acil trakeotomi gerekebilir. Eriþkin yaþta daha sakin seyreden bu hastalýðýn en fazla neden olduðu yakýnmalar yutma güçlüðü ve ses kýsýklýðýdýr. Larenks muayenesinde pedinküllü, eksofitik yapýda, geniþ tabanlý lezyonlar halinde görülür. Squamöz papillomlu hastalarda klinik ilerleme genellikle deðiþkenlik gösterir. Sýklýkla benign olmakla birlikte, altta yatan displazi varlýðý olduðunda sýký takip edilmeli, gerekirse HPV tip tayini yapýlmalý ve patolojinin malign transformasyon gösterebileceði akýlda tutulmalýdýr. Bu olgu sunumunda 44 yaþýnda ses kýsýklýðý yakýnmasý ile kliniðimize baþvuran, larenks muayenesinde vokal kordlarda karþýlýklý kitlesel lezyonu tespit edilen, alýnan biyopsinin patolojik sonucu “displazi varlýðý gösteren squamöz papillom” olarak rapor edilen bir erkek hasta literatür eþliðinde tartýþýlmýþtýr.

Squamous papilloma is a benign tumor of the larynx caused by Human Papilloma Virus (HPV). Usually it tends to be multiple and recurrent and it is frequently detected in pediatric patients. It often settles on the vocal cords but through oral cavity and aerodigestive pathways it can easily spread into other regions. Pathology in pediatric patients is slightly more aggressive and progressive. This lesion can cause severe narrowing of the airway and even emergency tracheotomy may be necessary. The disease progresses slowly in adulthood and most frequently leads to complaints of dysphagia and dysphonia. In larynx examination, the pathology is seen as a pedunculated, exophytic structured broad-based lesion. Clinical progression in patients with squamous papillomas usually varies. Although it is usually benign, however if there is underlying presence of dysplasia, patients should be followed closely. Besides identification of HPV types needed to be done and it should be kept in mind that this lesion can show malignant transformation. In this case report, a 44-year-old male patient admitted to our clinic with the complaint of hoarseness, and in the vocal cord examination, the reciprocal mass lesion was detected and pathological result of the biopsy which was “squamous papilloma showing the presence of dysplasia” was presented and discussed in the light of the literature.

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Hulusi Behçet tarafýndan, 1937’de tanýmlanan Behçet hastalýðý (BH), yineleyen oral, genital ülserler ve göz bulgularýnýn yaný sýra kas-iskelet, nörolojik ve gastrointestinal tutulumlar ile seyreden geniþ daðýlýmlý bir vaskülittir. Anestezi seçimi açýsýndan organ tuttulumu ve kullanýlan ilaçlarýn yan etkileri nedeniyle özelliklidir. Bu olgu sunumunda total diz protezi planlanan Behçet hastasýnda anestezi yönetimini tartýþtýk.

Behçet’s Disease, defined by Hulusi Behçet in 1937 is a systemic vasculitis characterized by repetitive oral and genital ulcers and eye symptoms in addition to musculoskeletal, neurological and gastrointestinal involvements. It is a special disease in terms of anesthesia choice due to organ involvement and the adverse effects of the related medications. In this case report we discussed the method of anesthesia application in a Behçet’s disease patient who was scheduled for a total knee prothesis.

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