Amaç: Keratokonuslu gözlerde limbal gevþetici insizyon ile birlikte yapýlan lens çýkarýlmasý ve ya katarakt cerrahisinin görsel ve refraktif sonuçlarýný deðerlendirmek
Metod: Bu çalýþmaya limbal gevþetici insizyon ile kombine lens çýkarýlmasý ve ya katarakt cerrahisi uygulanan 12 keratokonus hastsýnýn 18 keratokonuslu gözü dahil edildi. Düzeltilmemiþ uzak görme keskinliði (UDVA), düzeltilmiþ uzak görme keskinliði (CDVA), sferik eþdeðer (SE), ve silindirik deðer deðiþiklikleri deðerlendirildi.
Sonuçlar: Preoperatif SE -8,87 ±6,97 dioptri (D) iken ve son muayene SE deðeri -2,27 ±1.48 D idi. Refraktif astigmatizma deðeri -4,65 ±1,68D iken -2,40 ±1,8D’ye anlamlý derecede azaldý.(p<0.001) Vektör analizi ile hesaplanan cerrahiye baðlý astigmatizma deðeri ortalamasý 1.93 ±1.57D idi. Ortalama logMAR CDVA deðeri 0.71 ±0.39 den 0.24 ±0.18’ye yükselmiþ idi.(p<0.001) CDVA deðerleri gözlük ile elde edilmiþ olup hiçbir hastada sert kontakt lenslere ihtiyaç duyulmadý.
Conclusion: Lens çýkarýlmasý ve ya katarakt cerrahisi ile kombine yapýlabilen limbal gevþetici insizyon düzensiz astigmatizmayý azaltmak için etkili bir þekilde kullanýlabilir. Bu teknik düzeltilmiþ ve düzeltilmemiþ görme keskinliðini keratokonuslu gözlerde sferik ve silindirik hatalarý azaltarak kontakt lens baðýmlýlýðýný azaltmaktadýr.

Purpose: To evaluate the refractive and visual outcome of lens extraction or cataract surgery combined with limbal relaxing insicion in keratoconic eyes
Method: This study included 18 keratoconic eyes of 12 patients who underwent lens extraction or cataract surgery combined with limbal relaxing insicion. Changes in the uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), and cylindrical error were assessed.
Results: The preoperative mean SE was -8.87 ± 6.97 diopters (D) and this number improved to -2.27 ± 1.48 D at the last visit. The refractive astigmatisms were significantly reduced from -4.65 ± 1.68 D to -2.40 ± 1.8 D (p < 0.001). The mean surgically induced astigmatism, calculated by a vector analysis, was 1.93 ± 1.57 D. The mean preoperative steepest meridian keratometry reading (K1) value was 52.97 ± 5.1 D, which decreased to 50.96 ± 4.5 D at the last visit (p < 0.001). The mean logMAR CDVA improved from 0.71 ± 0.39 to 0.24 ± 0.18 (p < 0.001). The CDVA was achieved with spectacles, and no patients needed to return to rigid contact lenses.
Conclusion: Limbal relaxing insicion combined with lens extraction or cataract surgery can be used effectively to decrease irregular astigmatism. This technique improves corrected and uncorrected visual acuity by decreasing both spherical and cylindrical error in keratoconic eyes, and thus reduces dependency on contact lenses.

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Bu çalýþmadaki amacýmýz hem anneyi hem de bebeði etkileyen ve ciddi sorunlara yol açabilen depresyon ve anksiyetenin birinci trimestrda görülme oranlarýný ve obstetrik öykü ile olan iliþkisini incelemektir. Klinik Araþtýrmalar Etik Kurul onayý alýndýktan sonra, Kadýn Hastalýklarý ve Doðum AD polikliniðimize Nisan 2014 ile Temmuz 2014 tarihleri arasýnda baþvuran, gebelik haftasý 11-14 hafta arasýnda olan 197 gebe dahil edildi. Geçmiþinde anksiyete ve affektif bozukluðu olan ya da þu anda aktif anksiyete ve affektif bozukluðu olan gebeler, kronik sistemik hastalýðý olanlar, yardýmcý üreme yöntemleri ile gebe kalanlar, ultrasonografide malformasyon tespit edilenler, hiperemezis gravidarum ve çoðul gebeliði olanlar çalýþma dýþý býrakýldý. Gebelik haftalarý ultrasonografik olarak belirlendi. Olgularýn depresyon ve anksiyete düzeylerinin deðerlendirilmesi için Beck Depresyon Envanteri (BDE) ve Beck Anksiyete Envanteri (BAE) kullanýldý. Hastalarýn yaþ, parite, gebelik sayýsý, abortus sayýsý ve yaþayan çocuk sayýsýný içeren demografik verileri kayýt edildi. Hastalar abortus yapýp yapmadýklarýna, gebelik sayýsýna, canlý çocuk sayýsýna göre sýnýflandýrýlarak BDE ve BAE deðerlendirilmelerinden elde edilen puanlar karþýlaþtýrýldý. Beck Depresyon Envanteri için sýnýr deðer 17 olarak kabul edildiðinde tedaviye ihtiyaç duyacak depresyonun 49 hastada (%25,1) var olduðu izlendi. Çalýþmaya alýnan tüm hastalarýn ortalama BAE skoru 11,91±9,47 idi. Gebelerin %49,2’sinde anksiyete bozukluðu tespit edildi. Sonuç olarak; gebelikte izlenen depresyon ve anksiyetenin fetal ve maternal saðlýðý negatif yönde etkileyebileceði literatürde belirtilmiþtir. Gebeliðin birinci trimestrýnda yapýlacak olan uygun deðerlendirmeler ile, affektif bozukluklarýn tanýsýnýn erken dönemde yapýlabileceði ve böylece uygun tedavisi ile fetal ve maternal saðlýk üzerine olan olumsuz etkilerinin önlenebileceðini düþünmekteyiz.

The aim of this study is to evaluate the occurance rate of depression and anxiety in the first trimester those affecting both mother and baby and leading to serious problems, and to assess the association with obstetric history. After obtaining Clinical Research Ethics Committee approval, a total of 197 pregnants whose admitted to the outpatient unit of Obstetrics and Gynecology Department in the gestational weeks of 11-14 between April 2014 and July 2014 were included. A history or the presence of affective or anxiety disorder, presence of chronic systemic disease, pregnancy after assisted reproductive techniques, presence of malfomations diagnosed by ultrasonography, presence of hyperemesis gravidarum and presence of multiple pregnancy were excluded. Gestational weeks were detected by ultrasonography. Beck Depression Inventory (BDE) and Beck Anxiety Inventory (BAE) were used for evaluating the level of depression and anxiety of the subjects. The demographic values including age, parity, gravida, number of abortus and live births of the patients were recorded. The BAE and BDE values were compared after the patients were grouped according to the presence of abortus, gravida, and the number of live births. A total of 49 (%25,1) patients required medical treatment for depression according to a cut-off value of 17 for Beck Depression Inventory. The mean BAE score of all enrolled patients was 11,91±9,47. Anxiety disorder was found in 49.2% of pregnants. In conclusion; the negative effect of depression and anixety during pregnancy on fetal and maternal health have been indicated in the literature. It is suggested that an efficient examination in the first trimester of pregnancy may provide to diagnose of affective disorders in early stages, thus leads to an appropriate treatment preventing negative effects on fetal and maternal health.

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Kosta kýrýklarý hastanýn hastanede kalýþ süresini uzatan, yoðun bakým ve göðüs tüpü ihtiyacý olan ve aðrýlý bir travmadýr. Tedavisinde konservatif yaklaþýlabileceði gibi cerrahi de uygulanmaktadýr. Cerrahi teknikler içerisinde hangi metodun ve materyalin kullanýlacaðýna dair bir fikir birliði mevcut deðildir. Nisan ve Aralýk 2007 tarihleri arasýnda 14 çoklu kosta kýrýðý olan hastaya multidisipliner olarak açýk cerrahi redüksiyon ve plak-vida ile fiksasyon uygulandý. Ortalama 1.5gün yoðun bakýmda ve 5 gün de hastanede kalýþ süreleri elde edildi. Bu oranlar genel pratiðimize kýyasla oldukça düþük olarak tespit edildi. Hastalarda yara yeri sorunlarý izlenmedi. Aðrý kontrolü tek bir ilaçla tam yanýt olarak saðlanabildi. Multidisipliner yaklaþýmýn, açýk redüksiyon ve internal fiksasyon yapýlan çoklu kosta kýrýklarýnda cerrahi baþarýyý artýrdýðýný, hastanede kalýþ süresini ve dolayýsý ile maliyetleri azalttýðýný, pulmoner komplikasyonlarýn önüne geçtiðini ve hasta memnuniyetini artýrdýðýný düþünüyoruz.

Rib fractures are painful injuries that need intensive care which may prolong the patient's stay in hospital. The management consists of either a conservative approach or surgery. It is controversial that which methods and materials will be chosen in surgical techniques. Between April and December 2007, 14 multiple rib fractures were treated multidisciplinary with open surgical reduction and plate-screw fixation. Average 1.5 days intensive care stay and 5 days hospitalization time were obtained. These ratios were found to be quite low compared with our general practice. No wound problems were observed. Pain control could be established with a single painkiller. We think that the entire process dealed with multidisciplinary approach, improvement in surgical success, lower pulmonary complications and hospital stay with diminished cost and an increase in patient satisfaction
can be achieved.

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Çalýþmanýn amacý preeklampsili kadýnlarýn prevelansýný saptamak ve erken, ciddi preeklampsi alt gruplarýnda olumsuz sonuçlarý deðerlendirmektir. Bu çalýþma retrospektif tanýmlayýcý kesitsel bir çalýþma olarak gerçekleþtirildi. akademik 3. basamak bir merkezde doðum yapan 116 preeklampsili gebe kadýn bu çalýþmaya alýndý. Çalýþma sonuçlarý preeklampsi oranlarýný üç yýl için 100 tekil doðumda 1.4, 2012 için 1.5, hem 2013 hemde 2014 için 1.3 olarak göstermektedir. Bu üç yýllýk süreçte þiddetli ve erken baþlangýçlý preeklampsi oranlarý 100 canlý tekil doðum baþýna 0,5 ve 0,4 olarak bulundu. Bir olguda ölüm ve 18 olguda anneye ait olumsuz sonuç geliþti. Ciddi preeklampside, ortalama gebelik yaþý, doðum kilosu ve doðumda 5. Dakika apgar skoru sýrasýyla 33 hafta, 1935 gr ve 6,8 puan bulundu. Ciddi preeklampside, yeni doðan yoðun bakýma kabul oraný %67 ve yenidoðan ölüm oranlarý %24’dür. Ortalama doðum aðýrlýðý ve doðumda 5. Dakika apgar skoru, erken baþlangýçlý preeklampside 1454 gr ve 5,4 puan olarak bulundu. Yeni doðan yoðun bakýma kabul ve yenidoðan ölüm oranlarý erken baþlangýçlý preeklampside %91 ve % 30’dur. Erken baþlangýçlý preeklampsideki ciddi preeklampsi oraný %59’dur. Ciddi preeklampsili kadýnlar %41 ile taburculukta en yüksek anti hipertansif ilaç önerilme oranýna sahiptir. Preelampsili kadýnlar, özellikle erken baþlangýçlý ve ciddi preeklampsi saðlýk sunucularýnýn ayrýcaklý dikkatine ihtayaç duyarlar.

The purpose of the study is to determine the prevalence of women with preeclampsia and to evaluate the maternal and the fetal adverse outcomes in the severe and the early onset preeclampsia subgroups.116 pregnant women with preclampsia that gave birth in an academic tertiary centre were included in this study.The preeclampsia rate was 1.4 per 100 singleton births in three years;1.5 in 2012 and 1.3 in both 2013 and 2014 in this study. The rates of severe and early onset preeclampsia were found as 0.5 and 0.4 per 100 singleton births in this three years period. Maternal adverse outcomes occurred in 18 cases. Maternal mortality occurred in 1 case. In severe preeclampsia (PE), the mean gestational age, birth weight and apgar score at 5th minute at delivery were found as 33 w, 1935 g and 6.8 scores respectively. The admission to Neonatal Intensive Care Unit (NICU) and neonatal death were 67 % and 24% respectively in severe PE. In early onset preeclampsia, the mean birth weight and apgar score 5th minute at delivery were found as 1454 g and 5.4 scores. The admission to NICU and neonatal death were 91% and %30 in early onset PE. The rate of severe PE in early onset PE was 59%. The women with severe preeclampsia had the highest anti hypertensive drug prescribing rate (41%) at discharge. The women with preeclampsia, particularly early onset and severe preeclampsia require special attention of the healthcare providers.

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Amaç: Son yýllarda spontanpnömotoraksýn cerrahi tedavisinde tek port VATS (video yardýmlý torakoskopik cerrahi)prosedürlerinin kullanýmý yaygýnlaþmaya baþlamýþtýr. Bu çalýþmada kliniðimizde tek port VATS ile tedavi edilen 16 spontanpnömotoraks olgusunun sonuçlarý bildirilmiþtir.
Materyal ve Metod: Tek port VATS uygulanarak tedavi edilen 16 spontanpnömotorakslý hastanýn kayýtlarý retrospektif olarak incelendi. Olgularýn 14 (%87,5)’ü erkek, 2(%12,5)’si kadýn, yaþ ortalamasý 28.50 (minimum: 18 maksimum 63) idi. Tüm hastalar pnömotoraksýn tarafýna, preoperatif klinik özelliklerine, cerrahi prosedürlerine, postoperatif klinik özelliklerine ve takipteki nüks oranlarýna göre deðerlendirildi.
Bulgular: Olgularýn %56,3’ünde sað, %43,8’inde (n: 7) sol pnömotoraks vardý. Operasyon süresi ortalama 38,75 dakika, cerrahi insizyon boyutu ortalama 2,5 cm, drenaj miktarý ortalama 185,25 ml, postoperatif dren kalýþ süresi ortalama 4,13 gün, postoperatif hastanede kalýþ süresi ortalama 5,13 gün olarak hesaplanmýþtýr. Ýlk 24 saatte Görsel analog skala (VAS) aðrý skoruna göre hastalarýn %62,5’inde düþük aðrý, %12,5’inde orta düzeyde aðrý, %25’inde þiddetli aðrý mevcuttu. Hastalarýn ortalama 12,50 aylýk postoperatif takip süreleri boyunca hiçbir hastada nüks ile karþýlaþýlmadý.
Tartýþma: Pnömotoraks tedavisinde tek port VATS uygulamalarý, ileride geliþtirilecek yeni cerrahi ekipmanlar ve artacak tecrübeler ile daha kýsa port kesi uzunluðu, ameliyat süresi, drenaj miktarý, dren süresi ve hastanede kalýþ süreleri ile daha yaygýn kullanýlýr hale gelecektir.

In recent years,single-port VATS (video-assisted thoracoscopic surgery) applications have become widespread in the surgical treatment of spontaneous pneumothorax. In this study, the results of 16 patients with spontaneous pneumothorax who were treated by single-port VATS in our clinic have been reported.
Materials and Methods: The records of 16 patients with spontaneous pneumothorax who were treated by single-port VATS were analyzed retrospectively. 14 (87.5%) of the patients were male, 2 (12.5%) of the patients were female, the average age of the patients was 28.50(minimum: 18, maximum 63). All patients were evaluated according to the affected side of the chest,preoperative clinical characteristics, surgical procedures, postoperative clinical characteristics and recurrence rates in the follow-up.
Findings: 56.3% (n=9) of the patients had a right pneumothorax and 43.82% (n = 7) of the patients had a left pneumothorax.The mean operation time was 38.75 minutes, the mean size of the surgical incision was 2.5 cm, the average amount of drainage was 185.25 ml, the mean duration of stay of postoperative drain was 4.13 days,the mean postoperative hospital stay was 5.13 days. The mild pain was present in 62.5% of the patients, moderate pain was present in 12.5% of the patients, severe pain was present in 25% of the patients according to visual analogue scale (VAS) pain score in the first 24-hour. There was no recurrencein any patients duringmean 12.50 month postoperative follow-up period.
Discussion: Single-port VATS applications in the treatment of pneumothorax will become commonly used with shorter port incision length, shorter operation time, smaller amount of drainage, shorter drainage time and shorter hospital length of stay by development of new surgical equipment and increased experience in the future.

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Þok dalga tedavisinin üroloji alanýnda kullanýmý 1970-1980 dönemlerine rastlamaktadýr. 1970’lerde üreter taþlarý için yapýlan deneysel çalýþmalar sýrasýnda iliumda meydana gelen osteoblastik aktivite deðiþiklikleri þok dalgalarýnýn kas-iskelet sistemi tedavilerinde kullanýlabilirliðini gündeme getirmiþtir. Þok dalgalarý ile tedaviler son dekadlarda gittikçe daha fazla yer bulmaya baþlamýþtýr. Plantar fasiit, kalkaneal spur, lateral epikondilit, omuzun kalsifik tendiniti hastalýklarýnda bazen ilk seçenek bazen de destek tedavisi olarak sýklýkla kullanýlmaktadýr. Ancak son dönemlerde þok dalga uygulamalarý deðiþik hastalýklarýn tedavisinde de denenmeye baþlanmýþ, olumlu sonuçlar bildirilmeye baþlanmýþtýr. Bu derlemenin amacý dental tedavilerden, miyokardial iskemiye, spastiteden, tendinitlere kadar þok dalga tedavisinin kullanýmýný etki mekanizmalarý, uygulama dozlarý ve süreleri baðlamýnda özetlemektir.

Use of shock wave therapy in urological field coincides during 1970-1980. Experimental studies for ureteral stones in the 1970s showed osteoblastic activity changes in ilium, and revived ability of shock waves in the treatment of musculoskeletal system. Treatment with shock waves got popular in recent decades. Sometimes as first choice or as supportive treatment is also commonly used for plantar fasciitis, calcaneal spur, lateral epicondylitis and in calcific tendonitis of the shoulder. Shock wave applications recently begun to be tested in the treatment of various diseases have been reporting positive results. The purpose of this review is to summarize the use of shock wave therapy in terms of dose and duration of application regarding dental treatment, myocardial ischemia, spasticity, and tendonitis.

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Bu makalede klinik, nöroradyolojik ve histopatolojik kriterlere göre tanýsý konulan spinal kordun çok ender izlenen primer malign melanomu vakasý sunulmuþtur. Bu tümörler için cerrahi rezeksiyon tercih edilen tedavi þeklidir ve nörolojik semptomlarda gerileme ve yaþam kalitesinde iyileþme saðlanýr. Prognoz hastanýn yaþýna, iyi tanýmlanmýþ tümör sýnýrlarýna ve tanýsý konulduðu zaman lokal uzanýmý ve yayýlýmýnýn olmamasýna baðlýdýr. Olgumuzda tümör tamamen çýkartýldý. Takip döneminde pnömoni geliþen hasta cerrahiden 1 ay sonra kaybedildi.

In this paper, an interesting and a very rare case of primary spinal cord malignant melanoma which was diagnosed according to clinical, neuroradiological and histopathological criteria was presented. Surgical resection is the preferred treatment for these tumors and leads to the regression of neurological symptoms and improvement of the quality of life. The prognosis is related to the patient’s age, well-defined borders of the tumor and the absence of dissemination or local extension at the time of diagnosis. In our case, the tumor was resected totally. During follow- up period, he developed pneumonia and died one month after the surgery.

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Herpes Zoster (HZ) tüm dünyada yaygýn bir klinik problem olup özellikle immunsupresiflerde ciddi morbidite ve mortaliteye yol açmaktadýr. HZ enfeksiyonlarý sýklýkla eriþkinlerde görülmekle beraber 0-14 yaþ arasý çocuklarda insidansý 0.45/1.000’dir. Yazýmýzda erken yaþta görülen farklý dermatom tutulumlarý olan 2 çocuk olgu ele alýnmýþtýr. Bu olgular sayesinde özellikle birinci basamakta erken teþhis ve doðru tedavi ile komplikasyonlarýn önlenmesi amaçlanmýþtýr.

Herpes Zoster is a subgroup of herpesviredea consisting of a double-stranted DNA virus. It is a worldwide common clinical problem and has an important mortality and morbidity rate among immunsuppresed patients. HZ infections are oftenly seen in adults, however its incidence is 0.45/1.000 in 0-14 years-old children. Here, we present two children with different clinical presentations. Our aim is to emphasize important complications of HZ infections and prevent them with early diagnosis and appropriate treatment.

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Tüm böbrek malignitelerinin yaklaþýk %10’unu oluþturan mezenkimal neoplaziler içerisinde malign mezenkimoma oldukça nadirdir. Prognozu kötü seyreden bu antitede ikiden fazla sarkom türünün bir arada olmasý ve zemininde iðsi hücreli sarkomun eþlik etmesi ile karakterizedir. Oldukça nadir görülen bu tümör literatür verileri eþliðinde tartýþýlmýþtýr.

Malign mesenchymoma is infrequent among the mesenchymal neoplasies of the kidney in which the latter was also about 10 % within the renal malignancies. Malign mesenchymoma is characterized by the two accompanied sarcomas and with underlying spindle cells. We report a novel case of this rare tumor with literature review.

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Makrotia nadir görülen konjenital dýþ kulak deformitelerinden biridir. Bu deformite dýþ kulaðýn standart boyutlarýnýn artmasý ile oluþur. Ancak dýþ kulakta baþka nedenlerle de büyüme olabilir ve gerçek makrotia gibi klinik olabilir. Bu raporda, daha önce sol kulaðýnda tek taraflý, hafif dýþ kulak asimetrisi olan, son dört yýl içinde spontane olarak sol kulaðý büyüyen, genetik dermatolojik ve romatolojik patolojisi bulunmayan yetiþkin hasta sunulmaktadýr. Deformiteye cerrahi müdahale öncesi ayýrýcý tanýdaki diðer olasýlýklarýn düþünülmesi ve kapsamlý bir araþtýrma yapýlmasýný önermekteyiz.

Macrotia is one of the rare congenital external ear deformities. This deformity occurs when the measurements of the ear exceeds the standard values. However, expansion of ear may occur by other causes and have clinical implications like true macrotia. In this report, we present an adult who had previously unilateral, slight auricular asymmetry on his left ear and then growing left ear spontaneously for last four years without genetic, dermatological and rheumatological pathologies. We recommend considering other possibilities in the differential diagnosis and making comprehensive research before surgical intervention to the deformity.

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