Bu çalýþmada hipertansiyonlu hastalarda günlük tuz tüketim miktarýnýn bilinmesinin oluþturacaðý farkýndalýðýn tuz alýmý üzerine etkisi araþtýrýldý. Çalýþmaya hipertansiyon tanýsý konularak tedavi baþlanan ve tuz tüketimi ile ilgili bilgiler verildikten sonra takibi yapýlan 154 (80 E, 74K) hasta alýndý. Hastalara 24 saatlik idrarda Na ölçümü yapýlarak ne kadar tuz tükettikleri laboratuvar sonuçlarýyla birlikte anlatýldý. Üç ay sonra 24 saatlik idrarda tekrar Na kontrolü yapýldý. Kan basýncý deðiþiklikleri ve tuz tüketimi istatistiksel olarak karþýlaþtýrýldý. Çalýþmaya alýnan 154 hastanýn yaþ ortalamasý 48,4 ±14,9 yýl idi. Hastalarýn ne kadar tuz tüketiklerini bilmediklerinde ortalama 12,6±4.8g tuz tüketirken 24 saatlik idrarla birlikte kontrolünü gören hastalarda günlük tuz tüketimi 7,4±3,7g’a düþtüðü görüldü (p<0,001). Tuz tükemindeki azalmaya paralel olarak baþlangýç sistolik/diastolik kan basýncý deðerleri 145,46 ± 18,2/86,6 ± 8,6 mmHg’ dan 136,4 ± 11,6/81,8 ± 6,8 mmHg’ a geriledi (sýrasýyla; p=0,024 ve p=0,034). Hastalarýn günlük tuz tüketim miktarýný bilmesinin, kan basýncý kontrolu yapýlamayan olgularda rutin olarak uygulanmasýný farkýndalýðýn arttýrýlmasý için önermekteyiz.

In the present study, we investigated the impact of the awareness of the daily salt intake on dietary salt consumption in patients with primary hypertension. One hundred and fifty-four patients (male, 80, and female, 74) treated with the established diagnosis of hypertension, and also followed up after providing information about salt consumption were enrolled in the present study. Urinary sodium was measured in 24-hour urine samples, and the patients were informed about their salt consumption together with their laboratory results. Three months later urinary sodium levels were measured in 24-hour urine samples again. Changes in blood pressure, and salt consumption were compared statistically. Mean age of 154 patients enralled in the study was 48.4±14.9 years. It was observed that the patients had not known their daily salt consumption. Their daily salt intake had been 12.6±4.8 g, while their daily intake dropped to 7.4±3.7 g after control of salt intake with monitorization of urinary sodium. Baseline systolic/diastolic blood pressure (p=0.024 and =0.034, respectively) values decreased, in parallel with reduction in daily salt intake (12.6±4.8 g/day to 7.4±3.7 g/day) (p<0.001). We recommend providing information to the patients routinely about the amount of daily salt intake so as to raise, and increase awareness in patients with intractable blood pressure.

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Proteinüri, renal ve kardiyovasküler hastalýklarda önemli bir risk faktörüdür. Nefroloji pratiðinde, hastalarýn tedavileri proteinüri seviyelerine göre düzenlenmektedir. Bazý durumlarda tam idrar tahlili(TÝT), spot idrar protein/kreatinin oraný(PKO) ve 24-saatlik idrar proteinüri ölçümlerinde görülen tutarsýzlýklar, hastalarýn tedavilerinin düzenlenmesi sýrasýnda kafa karýþýklýðýna yol açmaktadýr. Bu çalýþmamýzda, bu üç proteinüri ölçüm yönteminin kendi arasýnda ve serum albümin seviyeleriyle karþýlaþtýrýlmasý ve korelasyonlarýnýn deðerlendirilmesi amaçlanmýþtýr. Toplam 1038 idrar örneði deðerlendirildi. TÝT, FUS-200/H-800 Tam Otomatik Ýdrar Analiz Sistemi(Dirui,Çin) kullanýlarak çalýþýldý. Spot ve 24-saatlik idrar örneklerinde proteinüri, turbidimetrik olarak Abbott Architect C8000 otoanalizöründe ölçüldü(Abbott Laboratuarlarý, ABD). Serum albümin konsantrasyonu fotometrik renk testi ile Olympus AU2700 (Hamburg, Almanya) otoanalizöründe ölçüldü. Ýdrar sedimentinde >10 lökosit veya eritrositi olan idrar örnekleri çalýþmaya dahil edilmedi. TÝT’deki proteinüri miktarý, spot idrar PKO (r=0.75, p<0.001), 24 saatlik proteinüri (r=0.76, p<0.001) ve serum albümin (r= -0.36, p<0.001) seviyeleri ile anlamlý olarak iliþkiliydi. TÝT’de 3+ proteinüri saptanan hastalarýn median spot idrar PKO’su 5.59 (2.76-9.11) g/gün, 24 saatlik proteinüri 4.54 (2.85-9.05) g/gün ve ortalama serum albümin seviyesi 3.08 ± 0.86 g/dL olarak belirlendi. Spot idrar PKO ile 24 saatlik proteinüri anlamlý olarak iliþkili bulundu (r=0.80, p<0.001). Hem spot idrar PKO hem de 24-saatlik proteinüri, serum albümin ile anlamlý olarak ters korele bulundu(sýrasýyla r= -0.54, p<0.001 ve r=-0.54, p<0.001). Hem sabah hem de öðleden sonra alýnan spot idrar PKO ile 24 saatlik proteinürinin anlamlý olarak iliþkili olduðu gözlendi(sýrasýyla r=0.83, p<0.001 ve r=0.82, p<0.001). Her üç proteinüri ölçüm yöntemi de birbirleriyle ve serum albümin seviyeleri ile anlamlý olarak iliþkilidir. Günün herhangi bir saatinde alýnan spot idrar PKO, proteinüri ölçümünde kolay ve güvenilir bir yöntem olarak kullanýlabilir.

Proteinuria is an important risk factor for renal and cardiovascular diseases. In nephrology practice, treatment decisions are made according to proteinuria levels. Inconstinencies in the measurements of proteinuria with different methods such as urinalysis, spot urine protein to creatinin ratio (PCR) and 24-hour-urine proteinuria lead to confusion in the management of the patients. Herein, we aimed to compare these three proteinuria measurement methods within themselves, and serum albumin levels,and evaluate existing correlations. A total of 1038 urine tests were evaluated. Urinalysis was performed using FUS-200/H-800 full-automatic urinalysis system. Spot urine PCR and 24-hour-urine proteinuria were measured turbidometrically. Serum albumin concentrations were measured photometrically. Urine samples with more than 10 leukocytes or erythrocytes in urine sediments were not included in the analysis.. Proteinuria detected with urinalysis was significantly associated with spot urine PCR (r=0.75, p<0.001), 24-hour proteinuria (r=0.76, p<0.001) and serum albumin levels (r= -0.36, p<0.001). In patients with 3+ proteinuria in urinalysis, urine PCR was measured as 5.59 (2.76-9.11) g/day; 24-hour proteinuria, 4.54 (2.85-9.05) g/day and serum albumin level, 3.08±0.86 g/dL. Spot urine PCR was significantly correlated with 24-hour proteinuria (r=0.80, p<0.001). Both spot urine PCR and 24-hour proteinuria were significantly and negatively correlated with serum albumin levels (r=-0.54, p<0.001 and r=-0.54, p<0.001, respectively). Spot urine PCR obtained from both morning and afternoon samples were significantly associated with 24-hour proteinuria (r=0.83, p<0.001 and r=0.82, p<0.001 respectively). All three methods of measurement for proteinuria were significantly associated with each other and serum albumin levels. Spot urine PCR is an easy and reliable method for measurement of proteinuria.

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Sezaryen ameliyatlarýnda kullanýlan anestezi uygulamasý seçimi; hastanýn kliniði, anestezistin tecrübesi, cerrahinin aciliyeti ve hastanýn isteðine göre belirlenir. Bu çalýþmada Kadýn Doðum hastanemizde son 10 yýlda yapýlan sezaryen operasyonlarýndaki anestezi uygulamalarý deðerlendirilmiþtir. 2006-2015 yýllarý arasýnda hastanemiz bilgisayar sistem kayýtlarý ve dosya arþivleri tarandý. Elektif ve acil olarak yapýlan sezaryen ameliyatlarýnda kullanýlan anestezi yöntemleri kaydedildi. Bu yöntemlerin yýllara göre daðýlýmý analiz edildi. Hastanemizde 2006-2015 yýllarý arasýnda toplam 28986 sezaryen ameliyatý gerçekleþtirilmiþtir. Sezaryenlerin %84 acil, %16’sý elektifti. 4848 (%17) hastada genel anestezi, 24138 (%83) hastada bölgesel anestezi tercih edilmiþ olup hastalarýn %2’sinde kombine spinal-epidural, %1’inde ise epidural anestezi tercih edilmiþtir. Kliniðimizde bölgesel anestezi yöntemlerinin kullanýmý Avrupa ülkelerine benzer þekilde yüksek bulunmuþtur. Kliniðimizde bölgesel anestezi yontemi olarak en cok spinal anestezi tercih edilirken; Özellikle acil vakalarda hiç kombine spinal-epidural ve epidural anestezi uygulanmadýðý görülmektedir. Elektif vakalarda ise kombine spinal-epidural uygulamasýnýn artýrýlmasý gerektiði düþüncesindeyiz.

The choice of anesthesia used in cesarean operations is determined by the patient’s clinical status, the experience of the anesthetist, the urgency of surgery and the patient’s wishes. This study evaluated anesthetic practices in cesarean surgery performed in the preceding 10 years in our Maternity Hospital, Turkey. Hospital computer system records and file archives between 2006 and 2015 were screened. Anesthesia techniques used in elective and emergency cesarean surgery were recorded. The distribution of these techniques by years was then analyzed. A total of 28.986 cesarean sections (cases) were performed in our hospital in 2006-2015. Eighty-four percent of them were emergency and 16% of them were elective CSs. General anesthesia was used in 4848 (17%) and regional anesthesia in 24.138 (83%) patients, while combined spinal-epidural anesthesia was used in 2% and epidural anesthesia in 1% of the patients. Regional anesthesia was used frequently in our clinic similar to European countries. Spinal anesthesia was the most commonly preferred method of regional anesthesia in our clinic. However, especially in emergency cases combined spinal-epidural or epidural anesthesia was not applied. We think that combined spinal-epidural anesthesia should be applied more frequently in elective cases.

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Nazolakrimal sistemde konjenital veya kazanýlmýþ olarak oluþan týkanýklýklar ve fonksiyonel bozukluklar sonucunda epifora ve dakriyosistit ataklarý oluþacaktýr. Kese ve nazolakrimal kanaldaki týkanýklýklarda medikal tedavilere yanýt alýnamadýðýnda dakriyosistorinostomi ameliyatý yapýlabilir. Cerrahi olarak eksternal ve endoskopik yaklaþýmlar ve bu yaklaþýmlarýn gözyaþý kanallarý entübasyonu ve lazerle kombinasyonlarý tarif edilmiþtir. Endoskopik dakriyosistorinostomi ameliyatlarýnda ise hangi cerrahi yöntemin kullanýlacaðý halen kesinlik kazanmamýþtýr. Çalýþmamýzda endoskopik dakriyosistorinostomi ve silikon tüp uygulamasý yaptýðýmýz hastalarda monopolar koter veya orak býçak, osteotom veya Kerrison punch kullanýmýnýn etkinliði karþýlaþtýrýldý. Retrospektif olarak 29 hasta ve 34 operasyon deðerlendirildi. Hastalar cerrahi sýrasýnda orak býçak, osteotom ve çekiç kullanýlanlar ile monopolar koter ve Kerrison punch kullanýlanlar olarak iki gruba ayrýldý. Hastalar postoperatif 1. hafta, 2. hafta, 1. ay, 2. ay, 3. ay ve sonrasýnda üçer ay aralýklarla kontrollere çaðrýldý. Hastalar 3 ay ile 18 ay arasýnda takip edildi. Hastalarda ortaya çýkan komplikasyonlar ve baþarýsýzlýk nedenleri deðerlendirildi. Ýstatistiksel deðerlendirmede Fisher exact testi kullanýldý. Postoperatif takiplerde birinci grupta bir hastada orta konka ile lateral nazal duvar arasýnda sineþi, iki hastada granülasyon dokusu geliþimi tespit edildi. Ýkinci grupta bir hastada orta konka ile lateral nazal duvar arasýnda sineþi ve beraberinde membranöz kapanma, bir hastada orta konka ile lateral nazal duvar arasýnda sineþi ve beraberinde granülasyon dokusu geliþimi, bir hastada sadece sineþi ve iki hastada da tüp gerginliðine baðlý punktum ve kanalikülde erozyon tespit edildi. Ýki grup arasýnda komplikasyonlar ve baþarý oranlarý deðerlendirildiðinde koter kullanýlan grupta komplikasyonlar anlamlý olarak fazla görüldü, baþarý oranlarý arasýnda ise anlamlý fark bulunmadý (p=0,0174), (p=0,281).

As a result of congenital or acquired obstructions and functional disorders of the nasolacrimal system, epiphorea and recurrent dacryocystitis will occur. Dacryocystorhinostomy can be performed for obstructions of the lacrimal sac, and nasolacrimal ductus refractory to medical treatments. Several approaches have been defined such as external, endoscopic approaches, and combinations of these approaches with laser and nasolacrimal stenting. It is still not clear which surgical methods will be used in endoscopic dacryocystorhinostomy. In our study, in cases which underwent endoscopic dacryocystorhinostomy and nasolacrimal stenting, the effectiveness of using monopolar cautery or sickle knife and osteotome or Kerrison punch was compared. We retrospectively evaluated 29 patients and 34 surgeries. Patients were divided into two groups as Group 1 which used sickle knife, osteotome and hammer, and Group 2 which used monopolar cautery and Kerrison punch. Patients were controlled postoperatively at 1st week, 2nd week, 1st month, 2nd month, 3rd month, and afterwards at 3 month intervals. They were followed up for 3 to 18 months. Reasons for complications and failure were evaluated. Fisher’s exact test was used in statistical analysis. In the postoperative follow up in one patient a synechiae, in two patients development of granulation tissue were detected in Groups 1. and 2, respectively. In addition, a synechiae accompanying membranous closure (n=1), or development of granulation tissue (n=1), isolated case of synechiae (n=1), and canalicular erosions (n=2) were detected. Complication rate was higher in Group 2 where cauterization was used, and however success rates were similar (p=0.0174), (p=0.281).

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Göðüs aðrýsý çocuk acile baþvurularýn en sýk nedenlerinden biridir. Bu çalýþmada polikliniðimize göðüs aðrýsý ile yönlendirilen hastalarýn etiyolojilerinin belirlenmesi, altta yatan kardiyak nedenlerin saptanmasý ve göðüs aðrýlý çocuklarda tanýya yaklaþýmda yapýlan ileri tetkiklerin gerekliliðinin sorgulanmasý amaçlanmýþtýr. Hastanemiz çocuk kardiyoloji polikliniðine þubat 2015 ile kasým 2015 tarihleri arasýnda göðüs aðrýsý ile baþvuran 248 hasta prospektif olarak deðerlendirildi. Her hasta için ayrýntýlý anemnez formlarý dolduruldu. Hastalar fizik muayene, elektrokardiogram, transtorasik ekokardiyografi ve gereken hastalarda kardiyak enzimler ve 24 saatlik ritm holter monitörizasyonu ile deðerlendirildi. Hastalarýn ortalama yaþlarý 12.7±3.9 idi. Etyolojide 235 olguda (%94.75) non kardiyak, 13 olguda (%5.24) kardiyak patoloji saptandý. Non kardiyak göðüs aðrýlarý içinde 158 olgu (%67.23) idiopatik, 49 olgu (%20.85) kostokondrit, 5 olgu (%2.12) kaslarýn aþýrý kullanýmý, 9 olgu (%3.82) gastroözefageal reflü hastalýðý, 10 olgu (%4.25) astým, 3 olgu (%1.27) konversiyon, 1 olgu (%0.42) jinekomasti olarak deðerlendirldi. Kardiyak patoloji saptanan gurupta, 4 hastada (%1.6) mitral kapak prolapsusu, 7 hastada (%2.8) myoperikardit, 1 hastada (%0.4) supraventriküler taþikardi, 1 hastada (%0.4) atriyal septal defek görüldü. Akut baþlangýçlý ve egzersizle iliþkili olmayan, senkop ya da baþ dönmesinin eþlik etmediði, aile öyküsü negatif bulunan, fizik muayene ve EKG’ sinde patolojik bulgu saptanmayan hastalarýn ekokardiyografi ve egzersiz testi gibi daha ileri tetkik amacýyla çocuk kardiyolojiye gönderilmesi hasta ve ailesinde gereksiz endiþeye ve aþýrý maliyete neden olmaktan öteye geçmeyecektir.

Chest pain is one of the most frequent causes of admissions into pediatric intensive care unit. In this study determination of the etiologies of the patients referred to our outpatient clinic with chest pain, detection of underlying cardiac causes, and questioning requirement for further diagnostic tests in children referred to our clinic with chest pain were aimed. We prospectively evaluated 248 children with chest pain who had had been referred to pediatric cardiology clinic of our hospital between November 2015, and February 2015. Detailed history forms were filled for each patient. All patients were evaluated with physical examination, electrocardiography, echocardiography, measurements of cardiac enzymes in case of need 24-hour Holter monitorization of cardiac rhythm The mean age of patients was 12.7±3.9 years. In 235 cases (94.75%), non-cardiac, and in 13 patients (5.24%) cardiac pathologies were existent vb. Non-cardiac chest pain was detected in patients was related to idiopathic etiologies (n=158; 67.23%), costochondritis (n=49; 20.85%), overuse of muscles (n=5; 2.12%), gastroesophageal reflux disease (n=9; 3.82%), asthma (n=10 patients; 4.25%), conversion (n=3; 1.27%), and gynecomastia (n=1; 0.42%). In the group with cardiac pathologies mitral valve prolapse (n=4; 1.6%), myopericarditis (n=7; 2.8%) in 1 patient (0.4%), supraventricular tachycardia (n=1; 0.4%), and atrial septal defect (n=1; 0.4%) were detected. Referral of the patients with acute onset pain unrelated to exercise and negative family history without associated dizziness or syncope and abnormal findings on physical examination and ECG to the clinics of paediatric cardiology for further testing will only cause anxiety, and high cost both for the patients and their families.

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Yaþlý hastalardaki kalça kýrýklarýnda mortalitenin tahmin edilebilmesi amacýyla, komorbid faktörleri esas alan çeþitli skorlama yöntemleri geliþtirilmiþtir. Ancak mükemmel risk modeli ve tahmin gücüne halen ulaþýlabilmiþ deðildir. ACE-27 skorlama yöntemi esas olarak onkoloji literatüründe kullanýlan baþarýlý bir mortalite risk tespit yöntemidir. Mevcut çalýþmanýn amacý ACE-27 skorlama yönteminin, kabul görmüþ ve yaygýn kullanýlan yöntemler olan CCI ve ASA ile karþýlaþtýrarak yaþlý hastalardaki kalça kýrýklarýnýn mortalitesindeki tahmin gücünü ve baþarýsýný ölçmektir. Çalýþmamýzda, kalça kýrýðý olan yaþlý hastalarýn bilgisi deðerlendirmeye alýndý. Hastalar 2 grup olarak düzenlendi: Grup 1’de ameliyat sonrasý 1 yýl içinde ölen 49 hasta varken; Grup 2’de ameliyat sonrasý 1 yýldan daha uzun yaþayan 65 hasta vardý. Her iki gruptaki hastalara retrospektif olarak dosya bilgileri üzerinden CCI ve ACE-27 skorlamalarý yapýldý. ASA skorunda ise anestezistin yaptýðý skor deðeri esas alýndý. Her üç skorlama sistemi mortaliteyi tahmin gücü açýsýndan karþýlaþtýrýldý. Her iki grup arasýnda yaþ (p=0.699), kadýn: erkek oraný (p=0.256), hastanede kalýþ süresi (p=0.314), travmadan ameliyata kadar geçen süre (p=0.375), ortalama ameliyat süresi (p=0.421) açýsýndan fark yoktu. Gruplar arasýnda ACE-27 (p<0.05), CCI ve ASA (p<0.05) deðerleri açýsýndan anlamlý fark mevcuttu. ROC analizinde eðri altýnda kalan alan en fazla ACE-27 ile elde edildi (AUC: 0.799). Yaþlý hastalardaki kalça kýrýklarýnýn 1 yýllýk mortalitesinin tahmininde ACE-27, CCI ve ASA’ya gore daha etkin, güvenilir bir skorlama yöntemidir ve ortopedi ve travmatoloji pratiði içinde güvenle kullanýlabilir.

Several methods have been developed taking comorbid factors into consideration for prediction of the mortality risk in hip fractures in the elderly patients; but the perfect risk model for predicting mortality following hip fracture surgery does not exist. ACE-27 scoring method is basically a successful method for the prediction of the risk of mortality used in the oncology literature.The aim of this study was to examine the success of the ACE-27 scoring in the prediction of mortality by comparison with the accepted methods of CCI and ASA. An evaluation was made of the data of patients with the diagnosis of hip fracture in the elderly. Patients were examined in 2 groups. Group 1: 49 patients who died within 1 year postoperatively and Group 2: 65 patients who survived longer than 1 year. The patients of both groups were retrospectively scored using CCI and ACE-27 scoring systems. The ASA scoring performed by an anesthetist was taken into consideration. The scoring systems were evaluated in terms of mortality and comparative effectiveness to each other. There were no significant differences between two groups with respect to age (p=0.699), female: male ratio (p=0.256), hospitalisation period (p=0.314), mean time from trauma to surgery (p=0.375), mean duration of surgery (p=0.421) A statistically significant relationship was found between the groups with respect to ACE-27 (p<0.05), CCI and ASA (p<0.05) scorings. In the ROC analysis, the greatest area under the curve was obtained with the ACE-27 (AUC: 0.799). ACE-27 has the highest predictive power and is a valid and reliable method which could be used in the prediction of 1-year mortality in elderly patients with a hip fracture.

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Bu çalýþmada sirotik karaciðerde hepatosellüler kanseri (HSK), displastik nodüllerden (DN) ayýrýmýnda diffüzyon aðýrlýklý görüntülerin (DAG) yararýný ortaya koymayý amaçladýk. Siroz ve hepatosellüler kanser veya siroz ve displastik nodülü olan hastalarýn DAG'larý geriye dönük olarak deðerlendirildi. DAG'da lezyonlarýn sinyal intensiteleri hiper, izo veya hipointens olarak sýnýflandýrýldý. Apparent diffusion coefficient (ADC) ve ADC oranlarý (lezyon ADC'sinin lezyonu çevreleyen karaciðer parankimi ADC'sine oraný) karþýlaþtýrýldý. Ýstatistiksel anlamlýlýk p < 0.05 olarak kabul edildi. 87 hastadan, 95 HSK tanýlý lezyon ve 44 DN tanýlý lezyon elde edildi. DAG’da hiperintensite, ortalama ADC ve ADC oraný istatistiksel olarak anlamlý bulundu (p < 0.001 tüm parametreler için). ROC analizi ile ADC deðeri olarak 1.316 x 10-3 mm²/s veya altý ve ADC oraný olarak 0.94 veya altý, en iyi kestirim deðeri olarak hesaplandý. DAG tek baþýna HSK tespit etmede kýsýtlý kabiliyete sahiptir. Ancak dinamik kontrastlý MRG’ye ek olarak, sirotik karaciðerde HSK tanýsýnda yardýmcý bulgular saðlayabilmek için kullanýlabilir.

We aimed to introduce the utility of diffusion-weighted images (DWI) in differentiating hepatocellular carcinoma (HCC) from dysplastic nodules (DN) in cirrhotic liver. DWI studies of the patients who had cirrhosis and HCC or cirrhosis and DN were evaluated retrospectively. Signal intensities of the lesions were classified as hyper-, iso- or hypointense on DWI. Apparent diffusion coefficient (ADC) and ADC ratios (the ratio between lesion ADC, and ADC of the surrounding liver parenchyma) was obtained, and mean values were compared. Statistical significance was set at p<0.05. Ninety-five lesions were diagnosed with HCC and forty-four lesions with DN from a total of 87 patients. The hyperintensity on DWI, mean ADC, and ADC ratio of HCCs were statistically significant (p<0.001 for all parameters). An ADC value of ≤ 1.316x10-3 mm²/s and an ADC ratio of ≤ 0.94 obtained by ROC curve analysis, were found to be the best cut-off values. DWI alone has a limited capability to detect HCC, but it can be used for imaging cirrhotic liver to supply ancillary findings in addition to dynamic contrast-enhanced MRI in diagnosing HCC.

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Amaç: Amacýmýz efor testi ile artan hsTnT’nin koroner arter hastalýðý tanýsýna katkýsýný araþtýrmaktý. Methods: Koroner anjiografi (KAG) yapýlan 45 hastayý(28 erkek, 17 kadýn ve ortalama yaþ 54.1±7.6 yýl) kapsamaktadýr. Tüm hastalardan EKG çekildi. Venöz yoldan tam kan sayýmý, serum lipidi, böbrek fonksiyonu ve hsTnT için kan alýndý. Egzersiz testinden 6 saat sonra hsTnT tekrar ölçüldü. Egzersiz sonrasý hsTnT deðeri ile öncesinde ölçülenin arasýndaki fark deðiþim hsTnT olarak hesaplandý.Sonuç: 30 hastada (%66.7) kritik olmayan darlýk,15 hastada (%33.3) kritik darlýk mevcuttu.Kritik darlýðý olan 15 hastanýn (%33.3) 11’inde(%24.4) hsTnT pozitifti.Kritik KAH grubunda kan üre nitrojeni (BUN) (p=0.005), kreatinin (Cr) (p=0.023), egzersiz öncesi hsTnT (p<0.001), egzersiz sonrasý hsTnT (p<0.001) ve delta hsTnT (p=0.001), kritik olmayan KAH grubuna göre daha yüksekti. Kritik KAH’ý belirlemede multiple lojistik regresyon analizi ile, egzersiz öncesi hsTnT (OR: 4.863, %95 CI: , 2.342 – 7.384, p<0.001), egzersiz sonrasý hsTnT (OR: 6.859, %95 CI: 1.554 – 12.165, p=0.012), delta hsTnT (OR: 6.768, %95 CI: 1.409 – 12.127, p=0.015) ve BUN (OR: 1.083, %95 CI: 0.109 – 2.059, p=0.03) baðýmsýz belirteç olarak tespit edildi. Egzersiz testi ile beraber hsTnT’nin özgüllüðü %93.3, duyarlýlýðý ise 73.3 % idi.Tartýþma: Egzersiz testinden sonra artmýþ hsTnT, kritik KAH için önemli bir belirleyici ve yüksek özgüllüðe ve duyarlýlýða sahiptir. Egzersiz testine ve miyokart perfüzyon sintigrafisine ek test olarak hsTnT’yi kullanabiliriz.

The aim of the study was to investigate the contribution of high- sensitivity troponin T (hsTnT)whose levels increase with exercise test on the diagnosis of coronary artery disease in patients undergoing exercise test. The study included 45 patients (28 male, mean age 54.1±7.6 years), in whom coronary angiography (CAG) was performed. HsTnT levels were measured before and after six hours of exercise test. The change in hsTnT was taken as the difference between hsTnT level before and after exercise. Noncritical coronary stenosis (n=30; 66.7%), and critical coronary stenosis (n=15; 33.3%) were detected in respective number of patients. Among 15 patients who had critical coronary stenosis, 11 (24.4%) had positive hsTnT after exercise. Blood urea nitrogen (BUN) (p=0.005), creatinine (Cr) (p=0.023), hsTnT values (p<0.001) before, and, after exercise tests (p=0.001) in critical CAD group were higher when compared with the non-critical CAD group. HsTnT levels before (OR: 4.863, 95%CI: 2.342-7.384, p<0.001), and after exercise (OR: 6.859, 95%CI: 1.554-12.165, p=0.012), Δ hsTnT (OR: 6.768, 95% CI: 1.409-12.127, p=0.015) and BUN (OR: 1.083, 95%CI: 0.109-2.059, p=0.03) were detected as independent predictors for critical CAD in multiple logistic regression analysis. The specificity of exercise test combined with hsTnT was 93.3%, while the sensitivity of exercise test combined with hsTnT was 73.3%. Elevated hsTnT after exercise test is a significant independent factor, and has higher sensitivity and specificity than exercise test. We may use hsTnT together with the exercise test and myocardial perfusion scintigraphy.

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Anormal uterin kanama jinekoloji polikliniklerine yapýlan baþvurularýn önemli bir nedenidir. Tedavi yöntemlerinden biri de levonorgestrel içeren rahim içi araçtýr (Mirena).
Bu çalýþmanýn amacý anormal uterin kanama endikasyonu ile Mirena uygulanan hastalarýn memnuniyetini deðerlendirmek ve Mirena tedavisi ile ilgili deneyimimizi paylaþmaktýr.
Bu retrospektif çalýþmaya disfonksiyonel uterin kanama tanýsý ile 1 Ocak 2015 - 31 Aralýk 2015 tarihleri arasýnda Mirena uygulanan hastalar alýnmýþtýr.
Hastalarýn yaþlarý, obstetrik ve jinekolojik anamnezleri, endometrial örnekleme sonuçlarý, pelvik ultrason raporlarý kayýtlardan elde edilmiþtir. Sonrasýnda hastalara telefon ile ulaþýldý. Hastalarýn memnuniyetleri, komplikasyonlar, amenore oraný, Mirena'nýn düþme veya kayma oraný, Mirena çýkartma gerekliliði ve eðer çýkartýldý ise sonra tercih edilen tedavi kaydedildi. Hasta memnuniyeti "hiç memnun deðil", "memnun", "çok memnun", "kesinlikle çok memnun" olarak dört tercihli soru ile deðerlendirildi.
Çalýþma sürecinde toplam 61 Mirena uygulandý. Çalýþmaya alýnma kriterlerini 50 hasta karþýladý; telefon ile 31 hastaya ulaþýldý. Mirena uygulamasý ile alakalý komplikasyon geliþmedi. 12 hasta amenoreik, 4 hasta oligomenoreik olmuþtu, 4 hasta lekelenmeden þikayetçi idi. Mirena kaymasý hiç olmadý fakat Mirena düþme oraný % 6,45 olarak saptandý. 4 hasta Mirena’nýn çýkartýlmasýný talep etti. 8 hasta hiç memnun olmadýðýný ifade etti, diðer hastalar Mirena tedavisinden memnundu.
Sonuç olarak Mirena iyi tolere edilen bir tedavi yöntemidir ve disfonksiyonel kanama nedeni ile Mirena uygulanan hastalarýn ¾’ü bu tedaviden memnun kalmaktadýr.

Abnormal uterine bleeding is a common cause for visits to gynecology polyclinics and one of the treatment options is levonorgestrel containing intrauterine device (LNG IUD; Mirena®). The aim of this study is to evaluate patient satisfaction following insertion of Mirena® in women with the indication of abnormal uterine bleeding and to share our data concerning the use of Mirena. The study population of this retrospective study consisted of women with the diagnosis of dysfuntional abnormal uterine bleeding with Mirena® inserted between 1 January 2015-31 December 2015. Information about age, obstetric and gynecologic history of the patients, histologic diagnosis of endometrial sampling, pelvic ultrasound reports were retrieved from medical records of the patients. Afterwards, interviews on phone were conducted. Patient satisfaction, complications, rate of amenorrhea, rate of expulsion or displacement, need for removal and if removed the treatment modality preferred were noted. Patient satisfaction was assessed by a scale of four as not satisfied, satisfied, very satisfied and extremely satisfied. A total of 61 Mirena® were inserted during study period and 50 patients were included in the study. We could interview with 31 patients on phone. No complication occurred related to vaginal insertion of Mirena® Twelve patients were amenorrheic, 4 patients oligomenorrheic, 4 patients were complaining of metrorrhagia (spotting). Displacement of Mirena® did not occur, however in 6.45%. of the patients Mirena® came out accidentally. Four patients wanted their Mirena® to be removed. Eight patients were “not satisfied” at all, the other patients were satisfied from the treatment. As a result, Mirena® was overall a well-tolerated treatment modality and around three-quarter of the patients with Mirena® inserted for the treatment of abnormal uterine bleeding are satisfied from the treatment.

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Düþük dansiteli lipoprotein (LDL) ve yüksek dansiteli lipoprotein (HDL) kolesterol alt gruplarýnýn oranlarýndaki anormal sapmalar, insanlarda koroner arter hastalýðý (KAH) geliþimi için temel bir etiyolojik faktör olan atreosklerotik plak oluþumuna zemin hazýrlar. Literatürde KAH oluþumunun engellenmesine yönelik çeþitli hipolipidemik etkili bitkilerin test edildiði saptanmýþtýr. Biz de bu çalýþmada, Trachyspermum Ammi (Ajvain, mýsýr anasonu) ve Linum Usitassimum (Alsi, keten tohumu) bitkilerinin ayrý ayrý ve beraber kullanýmlarýnýn anti-atherojenik ve hipolipidemik etkilerini araþtýrmayý planladýk. Çalýþma Pakistan Genel Hastanesi (General Hospital)’inde Þubat-Haziran 2016 tarihleri arasýnda yürütüldü. Çalýþmaya, Pakistan Lahor Jinnah Hastanesi Lipid Araþtýrma Kliniðinde takip edilen yüz (100) hiperlipidemi hastasý alýndý. Olgular yazýlý onamlarý alýndýktan sonra her biri 25 hastadan oluþan dört farklý gruba atandý. Grup 1 için tek baþýna Ajvain, Grup 2 için tek baþýna Alsi, Grup 3 için ise Ajvain ve Alsi kombinasyon tedavisi 3 ay süre ile uygulandý. Üç aylýk tedavi süresi sonrasýnda Ajvain grubunda LDL kolesterol seviyesinde 23.77 mg/dl düþüþ ve HDL seviyesinde 3.3 mg/dl artýþ, Alsi grubunda LDL kolesterol seviyesinde 7,5 mg/dl düþüþ ve HDL seviyesinde 5.3 mg/dl artýþ izlendi. Ýki ajanýn kombine kullanýldýðý grupta ise LDL kolesterol seviyesinde 16.1 mg/dl düþüþ ile birlikte, HDL kolesterol seviyesinde 6.6 mg/dl artýþ gözlendi. Özetle bu çalýþmada, hiperlipidemik hastalarda LDL kolesterolü düþürmede Ajvain ve Alsi’nin ayrý ayrý veya birlikte kullanýlmasý durumunda güçlü bir etki gösterilmiþken, HDL kolesterol seviyesini yükseltmede daha az etkili bulunmuþtur

Abnormal deviations ratio between subgroups of low- density lipoprotein (LDL) cholesterol and high-density lipoprotein cholesterol (HDL) in human body predisposes to the formation of atherogenic plaques which are main etiological factors for the development of Coronary Artery Disease (CAD). Many hypolipidemic herbs have been tested in the literature to prevent the occurrence of CAD. In this study we have used Trachyspermum Ammi (Ajwain; corn aniseed) and Linum Usitatissimum (Alsi, flaxseed) separately and in combination to investigate their anti-atherogenic and hypolipidemic features. Research was conducted at a Lahore General Hospital of Pakistan from February to June 2016. One hundred patients suffering from hyperlipidemia who were followed up in lipid research clinic of Jinnah Hospital, Lahore-Pakistan were enrolled in and approved written consent was taken from all patients. All patients were assigned to four different groups each, comprising of 25 patients. For three months, Group-I was treated with Ajwain, Group-II with Alsi, and Group-III with Ajwain plus Alsi. After three months therapy it was observed that Ajwain reduced LDL-cholesterol 23.77 mg/dl and increased HDL-cholesterol 3.3 mg/dl. Alsi reduced LDL-cholesterol 7.5 mg/dl and increased HDL-cholesterol 5.3 mg/dl. Whereas combination of both agents decreased LDL-cholesterol 16.1 mg/dl and increased HDL-cholesterol 6.6 mg/dl in three months therapy. It was concluded from this research work that Alsi and Ajwain given separately or in combination, have good enough potential to reduce LDL-cholesterol but are less potent effect on HDL-cholesterol in hyperlipidemic patients.

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Nörooftalmolojik aciller, gereken tedavi yeterince uygulanmadýðý takdirde görmeyi ve yaþamý tehdit edici durumlara neden olabilen bir grup hastalýktan oluþmaktadýr. Erken tedavi uygulanmýþ olsa dahi, çoðu zaman bu klinik durumlar yüksek morbidite oranlarý ile sonuçlanmaktadýr. Nöro-oftalmolojik aciller sýklýkla görme kaybý, çift görme ya da anizokori gibi belirtilerle ortaya çýkmaktadýr. Arteriyel anterior iskemik optik nöropati kalýcý ve ciddi görme kaybý, inme veya aort disseksionu ile birliktelik gösterebilen ve acil kortikosteroid tedavisi gereksinimi duyulan ciddi bir durumdur. Görme kaybý veya çift görme belirtileriyle ortaya çýkan, kavernöz sinüsü ve orbita apeksini etkileyen kavernöz sinüs trombozu veya mukormikozis gibi hastalýklar ise erken tedavi edilmediði takdirde beyin parankim dokusuna ulaþarak kalýcý nörolojik sekellere neden olabilmektedir. Yüksek morbidite riski taþýyan bir baþka durum ise serebral anevrizmalarýn neden olduðu izole üçüncü sinir felcidir. Horner Sendromu, genç eriþkinlerde inmenin önemli nedenlerinden biri olan karotis diseksiyonunun baþlangýç bulgusu olabilir. Erken müdahalenin çok önemli olduðu tüm bu hastalýklara yaklaþým, oftalmolog ve nörolog iþbirliði içinde ve mümkün olan en kýsa sürede olmalýdýr.

Neuro-ophthalmological emergencies are group of disease which may cause visual impairment or life-threatining conditions if treatment is not applied promptly. These clinical conditions can result in high rates of morbidity even with immediate therapy. Neuro-ophthalmological emergencies frequently appear with symptoms of vision loss, diplopia and anisocoria. Arterial anterior ischemic optic neuropathy is a severe condition which can be associated with permanent vision loss requiring immediate corticosteroid therapy. Cavernous sinus thrombosis and mucormycosis which can affect orbital apex and cavernous sinus are other conditions that can appear with vision loss and diplopia symptoms requiring emergency corticosteroid therapy. These diseases extend to the brain paranchymal tissue and cause permanent neurological sequelae if not treated urgently. Cerebral aneurysm causing isolated third-nerve palsy is another condition carrying risk of high morbidity. Horner Syndrome may be the initial sign of carotid dissection, which is an important cause of stroke in young adults. Immediate approach is very important in all these diseases, therefore the treatment approach should be initiated as soon as possible with the cooperation of the ophthalmologist and the neurologist.

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Hemþirenin bakým hizmeti verirken hastayý anlayabilmesi, onun duygularýný yönetebilmesi için etkili iletiþim kurmasý ve empati yapabilmesi çok önemlidir. Bunu yapabilmesi için hemþirelerin kendi duygularýný fark etmesi, ifade etmesi, yönetmesi ve empati becerilerini geliþtirmesi gerekmektedir. Bu becerilerin mesleki uygulamalarda kullanýmý bakýmýn kalitesini artýracaðýndan eðitim sürecinde kazandýrýlmasý önem kazanmaktadýr. Bu derlemede, hemþirelik öðrencilerinin lisans eðitimlerinde duyuþsal becerileri düzeyleri güncel literatür ýþýðýnda gözden geçirilmiþtir.

When providing care, it is very important for nurse to understand the patient, to manage his/her emotions, to empathize, and communicate effectively. In order to achieve this, nurses primarily need to aware of, express, and manage their own feelings and develop skills of empathy. Because the use of these developed skills in occupational practices would increase the quality of care, it is important to make these skills gained during education period. In this review, affective domain skills of nursing students in their undergraduate education was be examined in the light of current literature.

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Pilomatriksoma genellikle kafa ve boyun bölgesinde lokalize yavaþ büyüyen, tek subkutan veya intradermal nodül olarak bulunan benign cilt lezyonudur. Pilomatriksomanýn nadir görüldüðü bir lokalizasyon olan vulvada saptanan bir pilomatriksoma olgusunu sunuyoruz. 44 yaþýndaki kadýn hasta 5 vulvasýnda ele gelen sert kitle þikayetiyle baþvurdu. Muayenede sol labium majusun yaklaþýk 2.5 cm alt kýsmýnda ortalama 2.0×1.0 cm aðrýsýz, mobil, sert kitle saptandý. Üzerindeki cilt saðlamdý. Çýkarýldýktan sonra patolojii sonucu pilomatriksomayla uyumlu saptandý. Bir yýllýk takibinde tekrarlama olmadý. Kafa ve boyun bölgesi dýþýndaki dermal veya subkutanöz nodüllerde de pilomatriksoma ayýrýcý tanýda akýlda bulundurulmalýdýr.

Pilomatrixoma is a benign skin neoplasm generally presenting as a singular, slow-growing, subcutaneous or intradermal nodule generally found at the head and neck region. A 44-year-old female patient was admitted to our outpatient unit due to a hardness in the vulva. A palpable hard, mobile, painless mass approximately 2.0x1.0 cm in size was detected about 2.5 cm below the left labium major. The overlying skin appeared unremarkable. After surgical removal of the mass pathologic findings were found compatible with “pilomatrixoma.” No recurrence noted in the one year follow-up examination.
Pilomatrixoma should be kept in mind as a diagnosis for dermal or subcutaneous nodules localized outside the head and neck region.

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Transvenöz kalýcý kalp pili yerleþtirilmesi iþlemi sýrasýnda veya sonrasýnda oluþan komplikasyonlar tedavi þeklini dahi deðiþtirebilecek önemli sonuçlar oluþturabilir. Bu komplikasyonlardan bir tanesi transvenöz kalp pili takýlmasý sýrasýnda oluþan geçici subklavyen ven spazmýdýr. Diðer bir komplikasyon kalp pili bataryasýnda olan seðirmedir. Biz transvenöz kalp pili yerleþtirilmesi sýrasýnda geçici olarak oluþan subklavyen ven spazmý ve epikardiyal kalp pili bataryasýnda seðirme olan bir vaka ve ayrýca epikardiyal kalýcý kalp pili olan baþka bir hastada ayný þekilde kalp pili bataryasýnda seðirme olan diðer bir vakayý sunacaðýz.

Complications occurring during or after the implantation of permanent pacemaker through transvenous route may have important consequences that can even change the treatment modality. One of these complications is temporary subclavian vein spasm occurring during the transvenous permanent pacemaker implantation. Another one is twitching on the pacemaker pocket. We will present two cases; one of them who has temporary subclavian vein spasm occurred during the transvenous permanent pacemaker implantation and twitching on epicardial pacemaker battery, another one has twitching on epicardial pacemaker battery.

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Pott's puffy tümör frontal sinüzitlerden sonra görülebilen bir cerrahi acili olarak kabul edilebilecek bir komplikasyondur. Nadir olmasýna raðmen, ciddi morbiditesi olduðu için, skalpte fluktasyon eritematöz þiþlikle giden durumlarda Pott's puffy tümörden þiddetle þüphenilmelidir. Bu hastalýðýn tanýsýnda klinik olarak þüphelenmek ve görüntüleme yöntemleri ile tanýyý doðrulamak gerekir. Tedavide intrakraniyal komplikasyonlardan kaçýnmak için cerrahi ve medikal tedavi yöntemlerinin kombine edilmesi önemlidir.

Pott’s puffy tumor is a complication that can be seen after frontal sinusitis and considered as a surgical emergency. Although it is rare, given the potential for significant morbidity, a high index of suspicion for Pott’s puffy tumor is required in patients presenting with fluctuant, tender, erythematous swelling of the scalp. High clinical suspicion for the diagnosis of the disease and confirmation of the diagnosis with imaging studies are necessary. In treatment it is important to combine the medical and surgical treatment modalities to avoid intracranial complications. In this case report, a male patient with a Potts puffy tumour developed after frontal sinusitis was presented.

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