Kalça kýrýklarý yaþlý nüfusta sýk karþýmýza çýkan kýrýk tiplerindendir. Ülkemizde de her yýl on bine yakýn hastada kalça kýrýðý geliþmesi beklenmektedir. Osteoporotik kalça kýrýklarý çoðunlukla yaþlý bireylerde görüldüðünden kýrýða eþlik eden diðer sistemik hastalýklarýn varlýðý kýrýk sonrasý saðkalýmý olumsuz etkilemektedir. Ülkemizde ortalama yaþam süresinin artmasýyla acile baþvuran ileri yaþ grubundaki hasta sayýsý da artmaktadýr. Bu çalýþmanýn amacý intertrokanterik femur kýrýðý nedeniyle proksimal femoral çivileme ameliyatý uygulanan yaþlý hasta grubunda saðkalým iliþkisinin incelenmesidir.
2011-2013 yýllarý arasýnda hastanemiz Ortopedi ve Travmatoloji Kliniðine baþvuran intertrokanterik femur kýrýðý olan 65 yaþ ve üstü hastalar deðerlendirildi. Patolojik kýrýðý ve implant çevresi kýrýðý olan hastalar ile daha evvel kalça ameliyatý geçirmiþ hastalar çalýþmaya dâhil edilmedi. Takip süresi en az bir yýl olan 312 hastanýn 159’una ulaþýldý. Arþiv dosyalarýndan elde edilen bilgilerden hastalarýn hastanede kalýþ süresi, yatýþtan ameliyata kadar geçen zaman, yaþ gibi etmenlerin saðkalým ile iliþkisi incelendi.
Üç yüz on iki hasta telefonla aranarak yeterli bilgi edinilen 159’u çalýþmaya dâhil edildi. Hastalarýn % 63’ünü kadýn, % 36’sý ise erkekti. Altmýþ beþ yaþ üzerinde gerçekleþtirdiðimiz bu çalýþmada, ortalama yaþ 79.1 (65-102) olarak hesaplandý. Yaþayan hastalarýn ortalama takip süreleri 28.6 ay (12-37 ay) idi. Ölenlerin yaþayan hastalara oranýnýn 54/105 (% 33/% 66) olduðu tespit edildi. Ölen 54 hastanýn % 61.1’inin ilk bir yýlda öldüðü ve tüm hasta grubunda ortalama yaþam süresinin 18.75 ay olduðu saptandý.
Yapýlan sayýmlamada ameliyata dek geçen süre ile hastanýn yaþý arasýnda anlamlý iliþki olmadýðý saptandý (p=0,100, r=0,03). Ölüm oranýnýn ise yaþ ile yakýn iliþkili olduðu tespit edildi (p=0,01, r=0,87). Ameliyat sonrasý iþlevler dikkate alýndýðýnda yaþ ile iliþkisinin orta düzeyde olduðu saptandý (p=0,06, r=0,37).

Hip fractures are commonly encountered types of fractures es-pecially in advanced age population. In our country, every year nearly ten thousand patients is expected to suffer from hip fractures. Since osteoporotic fractures are mostly seen in elder individuals, comorbidities also adversly effect survival of the patients. Advanced aged patients admitting to emergency de-partments increase gradually due to increase in life expectancy. This study aims to investigate survival rates in elder patients who had undergone proximal femoral nailing surgery with the indica-tion of hip fracture.
Patients aged over 65 years with intertrochanteric femoral frac-tures who were admitted to the clinics of Orthopaedics and Trau-matology between 2011 and 2013 were included in our study. Pathological fractures, periprostethic fractures and the patients who previously had hip surgery were excluded from the study. Among a total of 312 patients whose minimal follow-up period was one year, only 119 cases were reached on phone. Data of their age and hospitalization duration were obtained from their hospital records. Relationship between these data and survival rates was statistically analyzed.
A total of 312 patients (female, 63 %, and male, 36 %) were called and 159 of them who gave sufficient data were included in the study. The average age of the study was noted as 79.1 (65-102). The average follow-up period of surviving patients was 28.6 months (12-37 months). The ratio between deceased, and surviv-ing patients was reported as 54/105 (33%/66 %). Most (61.1 %) of the 54 patients exited in first year and the average life expec-tancy after hip fracture surgery was detected as 18.75 months.
According to statistical analyzes, we found out that there was no significant relationship between duration of hospitalization be-fore surgery and death rate (p=0,100; r=0,03). Death rate was closely related with age (p=0,01; r=0,87). While daily activity skills were moderately correlated with age (p=0,06; r=0,37).

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Objective: To compare vaginoscopy with traditional technique of hysteroscopy combined with local anesthesia for surgical procedures in terms of patient compliance and ease of procedure.
Material and Method: A total of 98 women who were scheduled for operative hysteroscopy were divided into two groups: Group 1 (vaginoscopy), Group 2 (traditional technique with local anesthesia). Patient compliance was assessed by using a Visual Analog Scale (VAS) at five different time points as follows: before placement of speculum, phase 1 (baseline pain perception); after placement of the speculum, phase 2; after grasping with tenaculum, phase 3; during hysteroscopy, phase 4; and 5 min after the procedure, phase 5.VAS-4 reflected the compliance of patients. We determined the ease of the procedure by employing Likert-type scale to clinicians.
Results: VAS-2 scores were statistically higher in Group 2 than Group 1 (P=0.001). There were no significant differences between VAS-1, VAS-3 and VAS-5 scores. VAS-4 scores were statistically higher in Group 1 than Group 2 (P=0.001) Likert-type scale scores were statistically higher in Group 2 (P<0.001), but the procedure time was longer in Group 1 than Group 2 (P=0.001).
Conclusion: Usage of tenaculum and speculum decreases the compliance of the patient although they help to facilitate the procedure. However based on our study, we suggest that traditional technique combined with local anesthesia may be better than vaginoscopy for operative procedures in terms of

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Ýstanbul Anadolu Kuzey Kamu Hastaneler Birliðinde (ÝAKKHB) bulunan radyoloji asistanlarýna yönelik yapýlan eðitim kursundan sonra güncel radyoloji ihtisas eðitiminin durumunu ortaya koymak ve daha iyi bir radyoloji uzmanlýk eðitimi için onlarýn önerilerini sunmayý amaçladýk. Çalýþma kesitseldir. ÝAKKHB’de bulunan 5 eðitim ve araþtýrma hastanesinde çalýþan 34 radyoloji uzmanlýk öðrencisine 31 hafta süre ile eðitim kursu düzenlendi. Kurs sonunda tüm uzmanlýk öðrencilerine anket ve deðerlendirme sýnavý yapýldý. Eðitim ve araþtýrma hastanelerindeki altyapý ve eðitim kursunun radyolojik bilgi ve becerilerine katkýlarý Likert tipi skala ile deðerlendirildi. ÝAKKHB’deki radyoloji eðitimi altyapýsý ortalamanýn altýndadýr. Hastanelerin yetersiz altyapýsý deðerlendirme sýnavýný orta ve positif yönde etkilemektedir (r=0.52 and p=0.008). Radyoloji uzmanlýk öðrencilerine göre ÝAKKHB’deki hastanelerin, radyoloji eðitimi açýsýndan altyapýsý ortalamanýn altýndadýr. Öðrencilerin radyoloji alt bölümlerinden eðitimin daha iyi olduðu hastanelerde eðitimini, pratik eðitiminde olduðu eðitim kurslarýnýn devamýný da içeren yeni bir eðitim

We aimed to present the current status in radiology resident education in Association of Public Hospitals of Northern Anatolian Region of Istanbul (IANR-PHA) as expressed through the views of radiology residents using the outcome of a training course and the suggestions made by residents for achieving a better radiology resident education. The study designed a sa cross-sectional study. A training course was given to 34 radiology residents from five different training and research hospitals (institutions) in IANR-PHA for 31 weeks. At the end of the training course, a questionnaire and an assessment exam were applied to all radiology residents for collecting data. The infrastructure of institutions and the contribution of the training course to residents’ radiological knowledge and skills were evaluated using a Likert-type scale. The infrastructure of institutions were below average in IANR-PHA. The infrastructure of the institutes had a moderate and positive effect on the assessment exam (r=0.52 and p=0.008). According to radiology residents, the infrastructure of institutions in IANR-PHA was below the average for the radiology resident education. A new education model including training in subbranches of radiology in qualified institutions and continuous training courses with workshops, could improve the inadequate infrastructure of the institutions.

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Giriþ: Enteral nütrisyonun (EN); yoðun bakým hastalarýnda malnütrisyonu azaltarak, klinik gidiþi olumlu yönde etkilediði, hastanede kalýþ süresini ve infeksiyon sýklýðýný azalttýðý bilinmektedir. EN uygulamasýnda ilk tercih edilen oral yoldur. Genellikle oral yolun olasý olmadýðý ve tüple beslenmenin kullanýldýðý yoðun bakým hastalarýnda, tüple beslenme 4-6 haftadan daha uzun süre gerekli ise ostomi planlanmaktadýr. Sýklýkla tercih edilen minimal invaziv bir giriþim olan perkutan endoskopik gastrostomidir (PEG). Bu çalýþmada Yoðun Bakým Ünitesinde izlediðimiz ve PEG uygulanan 20 olguyu ve sonuçlarýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Ocak 2011-Eylül 2014 tarihleri arasýnda baþarýlý þekilde PEG uygulanan 20 hastanýn týbbi kayýtlarý retrospektif olarak deðerlendirildi.
Bulgular: Çalýþmadaki 20 hastanýn 5’i (% 25) kadýn, 15’i (% 75) erkek, yaþ ortalamasý 43,4±20,8, ortalama yatýþ süreleri 77,6±39,8 idi. Yatýþlarýnýn ortalama 37,8±21,9. gününde PEG iþlemi uygulandý. Ýþlem sýrasýnda hiçbir komplikasyon yaþanmadý. Üç (% 15) hastada iþlem sonrasý yara yeri infeksiyonu görüldü. PEG iþlemi öncesi 18 (% 90) hastada antibiyotik kullanýmýný gerektiren akciðer infeksiyonu saptanýrken, alýnan endotrakeal aspirasyon örneðindeki üreme sýklýðýnýn ortalama 2,6±1,2 olduðu görüldü. PEG iþlemi sonrasýnda ise 11 (% 55) hastada antibiyotik kullanýmýný gerektiren akciðer infeksiyonu görülürken endotrakeal aspirasyon örneðinde üreme sýklýðý 2,3±1,3 olarak saptandý (p: 0,18).
Sonuç: Oral alýmý olmayan, uzun süreli beslenme desteði gereken hastalarda PEG düþük komplikasyon oranlarýna sahip, akciðer infeksiyon insidansýný azaltan, uygulanmasý kolay ve güvenli bir yöntemdir.

Introduction: It is known that enteral nutrition (EN) affects clinical course favourably, and decreases length of stay in hospital and incidence of infection by decreasing malnutrition of the patients in the intensive care unit. Oral route is firstly preferred for EN. When long-term EN (>4-6 weeks) is anticipated, ostomy is planned for patients in whom oral intake is not possible and tube feding is used in intensive care unit. In this article we aim to assess 20 patients, and their outcomes who underwent PEG in intensive care unit.
Material and Method: We retrospectively reviewed medical records of 20 patients in whom PEG was succesfully employed between January 2011, and September 2014.
Results: Five of 20 patients were women (20 %), and fifteen were men (75 %). The mean age of the patients was 43.4±2.8 years, mean length of hospital stay was 77.6±39.8 days. The mean time from admission until application of PEG was 37.8±21.9 days. There were no complications during the PEG procedure. The wound infection was occured on 3 (15 %) patients. Before PEG placement, pulmonary infection that need to be treated with antibiotics was detected in 18 (90 %) patients and it was determined that mean positive results of sample of endotracheal aspirate culture was 2.6±1.2. After PEG placement, pulmonary infection requiring antibiotherapy was seen in 11 (55 %) patients, Within an average of 2.3±.1.3 days bacterial growth was detected was detected in endotharcheal aspirates (p: 0,18).
Conclusion: PEG insertion in patients who cannot receive adequate oral intake is an established route for providing long-term enteral nutrition. Our experience suggests that the PEG is a safe and a simple method which decreases incidence of pulmonary infection with a low complication rate.

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Ezetimib etken maddeli farmasötik preparatýn tek baþýna uygulanarak, lipit moleküllerini düþürücü etkisi üzerine birçok araþtýrmada yer verilmiþtir. Ancak, bu farmakolojik ajanýn tek baþýna lipoprotein-(a) üzerine etkisinin araþtýrýldýðý kinik çalýþmalara literatürde az rastlanmaktadýr. Bu yüzden bu çalýþmada, ezetimibin, Lipoprotein-(a) ve diðer lipit parametrelerinin üzerine etkisinin deðerlendirilmesi amaçlandý. Dahiliye polikliniðine baþvuran ve hiperlipidemi tanýsý alan olgulara, 3 aylýk ezetimib tedavisi verildi. Tedavi öncesi ve sonrasý; total kolesterol, düþük dansiteli lipoprotein, çok düþük dansiteli lipoprotein, yüksek dansiteli lipoprotein ve trisgliserid ile lipoprotein-(a) düzeyleri biyokimyasal olarak test edildi. Elde edilen verilerin tanýmlayýcý istatistiklerine ilave olarak, niceliksel verilerin karþýlaþtýrýlmasýnda, eþleþtirilmiþ serilerde t testi, parametreler arasýndaki iliþkilerin incelenmesinde Pearson korelasyon testi kullanýldý. Sonuçlar % 95’lik güven aralýðýnda, anlamlýlýk p<0.05 düzeyinde deðerlendirildi. Tedavi sonrasýnda, total kolesterol, LDL ve lipoprotein-(a) düzeylerinde düþüþ saptanmýþ olup, anýlan diðer lipoproteinlerde ve trigliserit düzeylerinde görülen deðiþim istatistiksel olarak anlamlý bulunmamýþtýr (p>0,05). Hiperlipidemi tedavisinde ezetimib, diðer antihiperlipidemik ilaçlara bir ek tedavi ya da tek baþýna alternatif bir tedavi olabilir.

The effect of ezetimibe monothrepy on decreasing lipid molecules has been widely studied in the literature so far, but scarce number of clinical studies have evaluated the effect of this pharmacological agent on lipoprotein-(a). In our study, we aimed to evaluate the effect of ezetimibe monotherapy on lipoprotein-(a) and other lipid parameters with clinical aspects. Ezetimibe monotherapy for three months was used for the hyperlipidemic patients admitted to our internal medicine outpatient clinic. Lipoprotein-(a) total cholesterol, low-density lipoprotein, very-low-density lipoprotein, high-density lipoprotein, and triglyceride levels before and after ezetimibe therapy were subjected to biochemical analysis. In addition to descriptive statistics of data, paired-t-test and Pearson Correlation analysis were used. All results were evaluated within 95% confidence interval and considered as statistically siginificant if p values were lower than 0.05. After treatment lipoprotein-(a), total cholesterol, and LDL-cholesterol levels decreased but the changes in very low-density lipoprotein, high-density lipoprotein, and triglyceride levels were not statistically siginificant (p>0.05). In the treatment of hyperlipidemia, ezetimibe can be an adjunct to other antihyperlipidemic drugs or an alternative monotherapy.

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Venöz tromboemboli pek çok ülkede gebelik ve doðum sonrasý dönemin en önemli mortalite ve morbidite nedenlerinden biridir. Gebelikte koagülasyon faktörlerinin artmasýyla birlikte doðal antikoagülanlar ve fibrinolitik aktivite de azalma olmaktadýr. Ayrýca büyüyen uterus nedeniyle venöz dönüþün artmasý, artmýþ östrojen ve progesterone nedeniyle oluþan venöz atoni ve mobilizasyonun azalmasý tromboz eðilimi arttýran yeni bir hemostatik denge oluþturmaktadýr. Gebe bir kadýnda derin ven trombozu tanýsý için doppler ultrasonografi, kompresyon ultrasonografi veya kontrast venografi; tedavide ise yaygýn olarak fraksiyone olmayan heparin ve düþük molekül aðýrlýklý heparin kullanýlmaktadýr. Hemþirelik bakýmýnda Tromboz Risk Faktörü Tanýlama Aracý kullanýlarak risk altýnda olan gebelerin erken tanýlanmasý, fetal ve maternal saðlýðýn korunmasýnda, aktivite-egzersiz programýnýn oluþturulmasý, solunum egzersizleri, antiembolik çorap kullanýmý, antikoagülan tedavinin etkileri ve olasý komplikasyonlarý, yaþam biçimi deðiþiklikleri yer almalýdýr

Venous thromboembolism is one of the most important causes of mortality and morbidity during pregnancy and the postpar-tum period in many countries. Natural anticoagulants and fibri-nolytic activity are decreased with the increase of coagulation factors in pregnancy. Moreover, increasing venous return caused by the growing uterus, venous atony caused by increasing estro-gen and progesterone levels and tendency to thrombosis caused by the decreased mobilization create a new hemeostatic balan-ce. Doppler ultrasonography, compression ultrasonography or contrast venography are used to diagnose deep vein thrombosis (DVT), Unfractionated heparin (UH, and low-molecular weight heparin (LMWH) have been widely used in the treatment of a pregnant woman. The nursing approaches should include early detection of pregnant women who are under risk by using the Thrombosis Risk Factors Diagnostic Tool, formulation of activity-exercise program, breathing exercises, anti-embolism stocking, determineation of the effects and possible complications of anticoagulant therapy and lifestyle changes for the protection of the feto maternal health.

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Hemanjiomlar, normal ya da anormal vasküler yapýlarýn proliferasyonu ile geliþen benign neoplazmlardýr. Sýklýkla bebeklik çaðýnda kutanöz ve mukozal yüzeylerde rastlanýrlar. Ancak ender olarak iskelet kaslarýndan da kaynaklanabilirler. Muskuler hemanjiomlar adý verilen bu gurup, “kapiller” ve “kavernöz” hemanjiomlar olarak iki alt guruba ayrýlýr. Daha çok ekstremitelerin ve gövdenin büyük kaslarý arasýna yerleþen bu neoplazmlar, göðüs duvarýnda çok ender görülürler. Kýrk üç yaþýnda bir erkek olan olgumuzu, doðumundan beri taþýdýðý bu dev kitle nedeni ile sunulmaya deðer bulduk.

Hemangiomas are benign neoplasms which develop as a result of normal or abnormal proliferation of vascular structures. Fre-quently, they are encountered in cutaneous and mucosal surfaces in infancy. However hemangiomas may rarely arise from skeletal muscles. This condition termed as muscular hemangioma and divided into two subgroups called “capillary” and “cavernous” hemangiomas. Muscular hemangiomas which are mostly settled in major muscles of the body and extremities, are rarely seen on the chest wall. In this case report, a 43 year-old male patient, who has been carrying a giant mass since birth has been presented.

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Supervarfarin günümüzde tarýmsal ilaçlamalarda sýklýkla kullanýlmaktadýr. Özellikle fare zehirlerinde yüksek miktarlarda bulunmakta olup, koruyucu önlemler alýnmazsa zehirlenmelerle karþýlaþýlabilmektedir. Literatürde superwarfarinin özkýyým amaçlý oral alýmýyla ilgili birçok zehirlenme ve kanama olgusu bildirilmiþtir. Supervarfarinin, olgumuzda olduðu gibi cilt emilimiyle entoksikasyonuna dair olgularsa enderdir. Ayrýca, yetiþkinlerde K vitamini eksikliðine de pratikte pek sýk rastlanmamaktadýr. Bu olguda ender bir zehirlenme yolu olan cilt emilimi ile superwarfarin entoksikasyonu sonrasý saptanan INR yüksekliði ve K vitamini eksikliðinden söz edilecektir.

Superwarfarin is commonly used for agricultural pesticidal purposes. It is found in higher concentrations especially in rodenticides and may cause intoxications. The literature reveals several cases of superwarfarin intoxication after oral intake for suicidal purposes, however lesser number of cases with superwarfarin intoxication have been reported after skin exposure. Besides, vitamin K deficiency is rare in adults. This case report presents a case with superwarfarin intoxication causing high INR levels and vitamin K deficiency after skin exposure.

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Akut travmatik aort yaralanmalarý ender durumlardýr ve genellikle hýzlý deselerasyona baðlý olarak yüksek enerjili travma sonrasý abdomen bölgesine gelen direkt ya da endirekt güçler sonucunda meydana gelir. Bu raporda sizlere erkek hastada meydana gelen izole travmatik aort yaralanmasýný sunduk.
Otuz dört yaþýnda erkek hasta acil servisimize araba kazasý nedeniyle getirildi. Tek yakýnmasý orta derecede göðüs aðrýsýydý. Ýleri inceleme sonrasýnda hastada baþka bir yaralanma olmaksýzýn aortik yýrtýlma saptandý.
Aort yaralanmasý þüphesi varlýðýnda, eþlik eden yaralanma olmasa bile hastalar kontrastlý bilgisayarlý tomografi ile incelenmelidir

Acute traumatic aortic injuries are rare conditions usually caused by direct or indirect forces to the abdomen induced by high-energy trauma often associated with rapid deceleration. In this report, we present an isolated traumatic aortic injury in a male patient.
A 34-year-old male patient was brought to our Emergency department because of a car accident. His only complaint was moderate chest pain. After further investigation, it was determined that the patient had aortic transection due to trauma without any concomitant injuries.
In case of suspicion from aortic injuries, patients must be investigated with contrasted Computerized Tomography, even though they do not have any concomitant injuries.

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