Amaç: Adenoidektomi ve/veya tonsillektomi yapýlan hastalarda ameliyat sýrasýnda kullanýlan aðýz ekartörüne baðlý olarak aðýz açýklýðý derecesinde ve temporomandibular eklemde (TME) etkilenme olup olmadýðýnýn dijital kumpas aleti kullanýlarak deðerlendirilmesi amaçlanmýþtýr.
Yöntem: Kasým 2015 - Kasým 2016 yýllarý arasýnda üçüncü basamak bir KBB kliniði tarafýndan aðýz ekartörü kullanýlarak adenoidektomi ve/veya tonsillektomi ameliyatý yapýlan 30 hasta ( 6 - 43 yaþlarý arasý, 17’si erkek ve 13’ü kadýn ) ile, kontrol grubu olarak septoplasti ameliyatý olan 20 hasta ( 19 - 47 yaþlarý arasý, 12’si erkek ve 8’i kadýn ) olmak üzere toplam 50 hastanýn aðýz çene açýklýðý dijital kumpas aleti ile ameliyattan 1 saat önce, 4 saat sonra, 1 hafta sonra ve 1 ay sonra olmak üzere ölçüldü.
Bulgular: Adenoidektomi ve/veya tonsillektomi yapýlan hastalarda operasyon sonrasý 4.saat, 1 hafta sonrasý ve 1 ay sonrasý aðýz açýklýðý ölçümlerindeki deðiþim istatistiksel olarak anlamlý bulunmuþtur (p=0,001; p<0,01). Septoplasti yapýlan hastalarda ise operasyon sonrasý 4.saat, 1.hafta sonrasý ve 1 ay sonrasý aðýz açýklýðý ölçümlerindeki deðiþim istatistiksel olarak anlamlý bulunmamýþtýr (p>0,05). Her iki gruptaki aðýz açýklýðý ölçümlerinin yaþ ile iliþkisine bakýldýðýnda; yaþla beraber aðýz açýklýðýndaki artýþýn da % 57,5 düzeyinde korelasyon gösterdiði saptanmýþtýr (r: 0,575; p=0,001; p<0,01).
Sonuç: Adenoidektomi ve/veya tonsillektomi gibi aðýz ekartörü kullanýlarak yapýlan ameliyatlarda; aðýz açýklýðý ve TME fonksiyonu ameliyat süresi ve hastanýn yaþýna baðlý olarak etkilenebilmektedir. Ancak; örneklem sayýsýnýn küçük ve takip süresinin kýsa olmasý çalýþmanýn kýsýtlýlýklarýdýr.

The aim of this study was to investigate the effects of mouth gag
used in adenoidectomy / tonsillectomy on temporomandibular
joint (TMJ) function and mouth opening with using digital dial
type caliper. Mouth opening distance and TMJ function of a total
of 50 patients including 30 patients (6-43 yrs, 17 men, and
13 women) who had undergone adenoidectomy / tonsillectomy
and 20 patients (19-47 yrs, 12 men and 8 women) of the control
group who had undergone septoplasty between November
2015 and November 2016 at ENT Department of tertiary medical
center were measured using digital dial type caliper one hour before,
and one week, and one month after the operation. Changes
in the distance of mouth opening at 4th hour, 1 week and
1 month postoperatively in the adenoidectomy / tonsillectomy
group were statistically significant (p=0.001, p<0.01). Changes in
the distance of mouth opening at 4th hour, 1 week and 1 month
postoperatively in the septoplasty group were not statistically
significant (p>0.05). There is 57.5% positive correlation between
patients’ age, and range of mouth opening in two groups
(r: 0.575, p=0.001, p<0.01). As a conclusion; mouth opening and
TMJ function might be effected by mouth gag in adenoidectomy
/ tonsillectomy surgeries depending on the duration of surgery
and age of the patient. Small sample size and short follow-up
period were limitations of the study.

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Giriþ: Preseptal ve orbital selülit çocuklarda eriþkinlere kýyasla sýk görülmektedir. Orbital selülit tedavisiz býrakýldýðýnda görme kaybý veya hayatý tehdit eden durumlarla sonuçlanabilen daha ciddi bir enfeksiyondur, preseptal selülitten erken ayýrt edilmesi doðru yaklaþým ve tedavinin bir an önce baþlatýlmasý açýsýndan kritiktir. Bu çalýþmada preseptal ve orbital selülitin ayýrt edici özellikleri vurgulanarak hekimin ayýrýcý tanýyý erken yapmasýna yardýmcý olmak amaçlandý.
Gereç ve Yöntemler: Ocak 2011 ve Haziran 2015 tarihleri arasýnda hastaneye preseptal veya orbital selülit tanýsý ile yatýrýlan 62 çocuðun týbbi kayýtlarý retrospektif olarak incelendi.
Bulgular: Bu seride preseptal sellülit (%81) orbital selülite (%19) kýyasla daha sýktý. Orbital selülitli olgularda medyan yaþ preseptal selülitli olgulara göre daha büyüktü (7.75 'e karþýn 4.25 yýl, p=0.009). Orbital selülitli olgularýn %58'inde oftalmopleji ve proptozis görüldü. En sýk predispozan faktör sinüzitti. Daha önce bilgisayarlý tomografi ile preseptal selülit tanýsý alan üç olguda manyetik rezonans görüntüleme subperiostal apseler olduðunu gösterdi. Ampisilin-sulbaktam tek baþýna veya seftriakson ile beraber verildi, hastalarýn %95.2'sinde baþarýlý oldu. Orbital selülitte daha uzun süreli tedavi gerekti (ortalama 14 güne karþýn, 29 gün p<0.001). Ýki orbital selülit olgusunda sinüs drenajý, bir preseptal selülit olgusunda apse drenajý gerekti. Hastalarýn ayaktan takibinde herhangi bir komplikasyon gözlenmedi.
Sonuç: Orbital selülitin erken tanýsý ve doðru tedavisi aðýr komplikasyonlarý önler, orbital selülitin sadece klinik bulgular ile preseptal selülitten ayýrt edilmesi güç olduðunda orbital MRI yardýmcý olabilir.

Preseptal and orbital cellulitis are relatively more common in
children than adults. If left untreated orbital cellulitis is more
serious, and can cause vision loss and life-threatening conditions.
Thus, it’s early differentiation from preseptal cellulitis is
critical for initiating prompt treatment. In this study, contrasting
features of preseptal and orbital cellulitis are highlighted to aid
physicians in the management of these infections. Medical records
of 62 children admitted to hospital with the diagnosis of
preseptal or orbital cellulitis between January 2011 to July 2015
were retrospectively evaluated. In this series, preseptal cellulitis
(81%) was observed more commonly than orbital cellulitis (19%).
The average age of the patients with orbital cellulitis was higher
than that of the cases with preseptal cellulitis (8.1±4 v.s 4.8±3
years, p=0.009). Ophthalmoplegia and proptosis were observed
in the 58% of the patients with orbital cellulitis. Sinusitis was the
most common predisposing factor. Orbital magnetic resonance
imaging (MRI) revealed subperiostal abscesses in three cases
who were previously diagnosed as preseptal cellulitis by orbital
computerized tomography (CT). Antibiotherapy with ampicillinsulbactam
with or without ceftriaxone was successful in 95.2%
of the patients. The longer treatment period was required for
orbital cellulitis when compared to preseptal cellulitis (median
duration of 14 vs 29 total antibiotic days, respectively, p<0.001).
Sinus abscess drainage was needed in two cases of orbital cellulitis
and abscess drainage in one case of preseptal cellulitis.
During follow-up, any serious complications were not observed.
Accurate diagnosis and prompt treatment of orbital cellulitis can
prevent its serious complications, MRI can aid in difficult cases so
as to differentiate orbital cellulitis from preseptal cellulitis.

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Giriþ: Bu çalýþmada sarkoidozlu hastalarda Pozitron Emisyon Tomografisi/ Bilgisayarlý Tomografi (PET/BT) bulgularýnýn deðerlendirilmesi amaçlandý.
Gereçler ve yöntem: Hastanemiz sarkoidoz polikliniðinde sarkoidoz tanýsý ile takip edilen 930 olgunun dosyalarý retrospektif olarak incelendi, PET/BT’si mevcut olan 53 olgu çalýþmaya alýndý. Malignite þüphesiyle PET/BT çekilen ve histopatolojik olarak sarkoidoz tanýsý konulan hastalarýn özellikleri ve PET/BT bulgularý kaydedildi.
Bulgular: Olgularýn yaþ ortalamasý 51, kadýn/erkek oraný 4.3 bulundu. PA grafiye göre evrelendirildiðinde en sýk evre 1 görüldü. Hastalarýn ortalama ACE düzeyi 52 U/L idi. BAL yapýlan olgularda CD4/CD8oraný: 3.4 olarak bulundu. Olgularýn tümüne histopatolojik olarak sarkoidoz tanýsý konuldu, en sýk taný koyma yöntemi mediastinoskopi oldu (%62). Bilateral mediastinal lenf nodu pozitifliði saptanan 48 olguda mediastinal LAP ortalama SUDmax: 9.1(0-22.7) ve pulmoner lezyon SUDmaks: 7.6 (0-25.5) olarak raporlandý. 30 olguda akciðer parankimi, 4 olguda karaciðer tutulumu, 4 olguda dalak, 2 olguda meme tutulumu saptandý, hiçbir olguda kemik tutulumuna veya kardiyak tutuluma rastlanmadý. Karaciðer ve dalakta difüz tutulum olabildiði gibi nodüler lezyon da görüldü, ortalama SUDmaks karaciðerde 4.7, dalakta ise 6.6 bulundu. Memede tutulum görülen iki olguda ise ortalama SUDmaks: 7.4 bulundu, meme biyopsisi ile sarkoidoz tanýsý doðrulandý.
Sonuç: PET/BT malignite sarkoidoz ayrýmýnda yardýmcý olmamýþ, tüm hastalarda sarkoidoz tanýsý histopatolojik olarak doðrulanmýþtýr. PET/BT’ nin yüksek maliyeti ve radyasyon dozu da göz önüne alýndýðýnda ancak seçili vakalarda ekstrapulmoner tutulumunu göstermede ve biyopsi yerini saptamada yararlý olabileceði görülmüþtür.

In this study, we aimed to evaluate the Positron Emission Tomography/
Computed Tomography (PET/CT) findings in patients with
sarcoidosis. The results of 930 patients followed up with diagnosis
of sarcoidosis were retrospectively analyzed and 53 cases
with PET/CT examination findings were included in the study.
Characteristics and PET/CT findings of patients whose PET/CT
scans were performed with suspicion of malignancy and diagnosed
as sarcoidosis histopathologically were recorded. The mean
ACE level was 52 U/L. CD4/CD8 ratio was found as 3.4 in patients
who were investigated with BAL. Diagnosis of all patients
were made by histopathologically. Sixty-two percent of the cases
were diagnosed using mediastinoscopy. PET-CT showed bilateral
mediastinal lymph node positivity in 48 patients, and mean mediastinal
LAP SUVmax was reported as 9.1 (0-22.7) and SUVmax
of pulmonary lesion as 7.6 (0-25.5). Lung parenchyma (n=30),
liver (n=4), spleen (n=4), and breast (n=2) was affected in respectively
number of cases. Bone or cardiac involvement was not
seen in any case. Nodular lesions were seen as well as diffuse
involvement in the liver and spleen, mean SUDmax values were
estimated as 4.7 in liver and 6.6 in spleen. In the two cases of
breast involvement, the mean SUDmax was found to be 7.4, and
breast biopsy confirmed the diagnosis of sarcoidosis. PET/CT did
not help to distinguish sarcoidosis from malignancy and the diagnosis
of sarcoidosis was confirmed histopathologically in all patients.
Considering high cost and radiation dose of PET/CT, only in
selected cases it can be useful in demonstrating extrapulmonary
involvement and detecting the location of biopsy.

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Bu çalýþmanýn amacý kardiyovasküler hastalýk açýsýndan risk faktörü olmayan erken baþlangýçlý androgenetik alopesili (AGA) erkek hastalarda karotis intima media kalýnlýðýnýn (KÝMK) biyokimyasal parametrelerle birlikte deðerlendirilmesi ve hastalarda elektrokardiyografide P dalga ve QT dispersiyonu bakýlarak erken baþlangýçlý AGA ile kardiyak aritmi, ateroskleroz, metabolik sendrom arasýndaki iliþkinin ortaya konulmasýydý.
Bu çalýþma dermatoloji polikliniðine saç dökülmesi yakýnmasý ile baþvuran 18-35 yaþ arasý 40 hasta ile saðlýklý 50 kontrolden oluþmaktadýr. Tüm bireyler çalýþma konusunda bilgilendirildi ve aydýnlatýlmýþ onamý alýndý. Çalýþmadan dýþlanma kriterleri akut koroner sendrom ile baþvurmak, diyabetesmellitus, hipertansiyon, malignite öyküsü, hepatik ve renal yetersizlik öyküsünün bulunmasýydý. Tüm katýlýmcýlara ekokardiyografi, karotis doppler ultrasonografi yapýldý, elektrokardiyografi çekildi, dinlenme halinde tansiyon ölçüldü ve hemogram, açlýk kan þekeri, insülin düzeyi, lipit profili parametreleri bakýldý.
Baþvuruda bulunan AGA’lý grubun karotis intima media kalýnlýðý (KIMK) ortalamasý 0,63±0,12 cm kontrol grubunun ise 0,51±0,1 cm olup istatistiksel olarak anlamlýydý (p=0,01). AGA’lý hastalarýn yaþ ortalamasý 28,03±4,95/yýl olup kontrol grubunun ise 28,95±5,03 yýl idi ve istatistiksel açýdan anlamlý deðildi (p>0,05). Elektrokardiyografide bakýlan QT ile P dalga dispersiyonlarý açýsýndan yapýlan deðerlendirmede istatistiksel açýdan anlamlý fark oluþmadý(p>0,05). Ýnsülin direnci için bakýlan Homeostatic Model Assessment- ÝnsulinResistance (HOMA-IR) AGA’lý grupta 2,35±1,97 kontrol grubunda ise 1,85±1,65 bulunup istatistiksel açýdan anlamlýydý (p=0,036).
KIMK, HOMA-IR ile erken baþlangýçlý AGA arasýnda iliþki saptanmasý bu hastalarda prematür ateroskleroz baþlamasý anlamýna gelebilir. Bununla beraber aterosklerozun klinik tablolarý erken baþlangýçlý AGA’lý hastalarda genç yaþlarda ortaya çýkabileceðinden uygun tarama yöntemleri kullanýlmalýdýr.

Purpose of this study was to evaluate of carotid intima media thickness (CIMT) with biochemical parameters in early-onset androgenetic alopecia (AGA) male patients without risk factors for cardiovascular disease and to reveal the relationship between early-onset AGA and cardiac arrhythmia, atherosclerosis, metabolic syndrome in patients with P wave and QT dispersion in electrocardiography.
40 men with early onset AGA and 50 healty men without AGA in theage of 18-35 were included in this study.We compared the biochemical values, blood pressure, carotid intima media thickness (CIMT), echocardiographic(echo) and electrocardiographic (ECG) parameters.
The mean age was 28,03±4,95/years and the mean CIMT was 0,63±0,12 cm in the group with early onset AGA. The mean age was 28,95±5,03 /years and the mean CIMT was 0,51±0,1 cm in the control group. CIMT were correlated with AGA (p<0,05).
The mean HOMA-IR was 2,35±1,97 in the patients group and the mean of healty group was 1,85±1,65. HOMA-IR is related with early onset AGA (p<0.05). On the other hand, echo and ECG parameters were not correlated with early onset AGA.
The relationship between CIMT, HOMA-IR and early onset AGA may indicate that premature atherosclerosis is presence in these patients. However, since clinical conditions of atherosclerosis may appear in early onset AGA, appropriate screening methods should be used.

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Bu çalýþmanýn amacý, endometriyal örneklemin histopatolojik sonuçlarla iliþkisini deðerlendirmek ve farklý yaþ gruplarýndaki spesifik patolojileri tanýmlamaktýr.
Hastanemizde 2013-2014 yýllarý arasýnda çeþitli nedenlerle endometrial örnekleme yapýlan patoloji arþivlerinde yer alan 1374 olgunun histopatolojik sonuçlarý deðerlendirildi. Biyopsi endikasyonlarý; menometrorrhagia (% 80,5), postmenopozal kanama (% 6,8), myoma uteri (% 1,7), servikal polip (% 2,4), infertilite (% 0,2) ve hiperplazi-malignite (% 8.4) idi. Histopatolojik tanýlar endometrial polip (% 37,2), proliferasyon / sekresyon / menstrüel faz (% 29,3), düzensiz çoðalma endometriyumu (% 8.4), yetersiz biyopsi materyali (% 8.4), endometrit (% 5.8) (% 4.2), iyatrojenik deðiþiklikler (% 1.4), atrofik endometrium (% 1.2), malignite (% 0.1) ve endometriyum hiperplazisi (% 4) izlendi. Servikal polip bulunan hastalardaki 33 endometriyal küretajýn 14'ünde endometrial polip tespit edildi. Myoma uteri nedeniyle histerektomi planlanan olgularda yapýlan endometriyal örneklemelerde en sýk görülen normal siklik paterndi (% 50) idi. Çalýþmamýzda en sýk görülen taný endometrial polip olarak tanýmlandý. Servikal polipin ön tanýsý konan vakalarda endometriyumun da deðerlendirilmesi gerektiði sonucuna varýldý.

The aim of this study was to evaluate the relationship between
histopathological results and endometrial sampling and to identify
specific pathologies in different age groups. The histopathological
results of 1374 cases registered in our pathology archives,
in whom endometrial sampling was performed in our hospital for
various reasons between 2013 and 2014 were evaluated. Biopsy
indications included menometrorrhagia (80.5%), postmenopausal
bleeding (6.8%), myoma uteri (1.7%), cervical polyp (2.4%),
infertility (0.2%), and hyperplasia/malignancy (8.4%). Histopathological
diagnoses in order of frequency included endometrial
polyp (37.2%), proliferation/secretion/menstrual phase (29.3%),
irregular proliferative endometrium (8.4%), insufficient biopsy
material (8.4%), endometritis (5.8%), stroma-glandular breakdown
(4.2%), endometrial hyperplasia (4%), iatrogenic changes
(1.4%), atrophic endometrium (1.2%), and malignancy (0.1%).
Endometrial polyps were detected in 14 of 33 patients with cervical
polyps In endometrial samplings performed in patients in
whom hysterectomy was planned due to myoma uteri, the most
frequent diagnosis was a normal cyclic pattern (50%). In conclusion,
in the present study, the most frequent biopsy indications
of endometrial sampling were menometrorrhagia, and the most
frequent histopathological diagnosis was endometrial polyp. Endometrial
polyp was also identified concomitantly in endometrial
sampling of 14 out of 33 patients with cervical polyps. Thus, we
concluded that in patients with an initial diagnosis of cervical
polyp, the endometrium should also be evaluated.

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Tuberculosis (TB) is a common granulomatous disease especially in endemic regions. The rarity is further accentuated if the
pathology arises primarily from the breast. The diagnosis is arduous even upon complete triple assessment. These conditions
often give a diagnostic dilemma mimicking malignancy which ultimately requires surgical intervention. We report a series of
six cases of TB-related breast pathology with a variety of unusual presentations, our management strategies and review of the
literature.

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Kültür ve felsefeyi iki alternatif kutup olarak deðerlendiren görüþ, kültürel farklýlýklardan baðýmsýz evrensel bir ahlakýn varlýðýný kabul eder. Bu çalýþma kültürel konularý göz ardý eden ahlak teorilerinin ve “evrensel” prensiplerin uygulanabilirliðini sorgulamaktadýr. Sosyal bilimler, teorik yaklaþýmlarla kültürel gerçekler arasýndaki uyumluluðu soruþturmaya yardým edebilir. Özerklik kavramý kültürler arasýnda ihtilaflý bir konudur ve bu husus ortak bir etik yaklaþýmýn uygulanabilirliðini etkileyebilir. Türkiye perspektifinin incelenmesi, bir kültürel ortam örneði olarak bilgi verebilir. Teorik bir çerçevenin uygulanabilirliði kültürel þartlarý göz önüne alan bir yoruma baðlýdýr. Tek bir “evrensel” standart uygulanabilirlikten uzak olacaktýr.

The thought that considers philosophy and culture as two alternative
poles assumes a universal morality which is independent
from cultural differences. This paper investigates applicability of
moral theories disregarding cultural issues and ‘universal’ principles.
Social sciences may help investigating the compatibility
between theoretical approaches and cultural facts. The concept
of autonomy may be a contentious issue between cultures and
this may affect applicability of an approach. An investigation of
the perspective of Turkey may provide information as an example
of cultural setting. Applicability of a theoretical framework depends
on an interpretation which takes into consideration the
cultural conditions. One universal standard will be far from being
applicable.

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Hastanýn solunum fonksiyonlarýný deðerlendirmek için sýklýkla arteriyel oksijen satürasyonu (SpO2), end-tidal karbondioksit (PetCO2), solunum sayýsý (SS) ve kalp hýzý (KH) parametreleri kullanýlmaktadýr. Bu parametrelerden elde edilen verilerin yorumlanmasý özellikle solunum monitörizasyonu konusunda deneyimli olmayan saðlýk çalýþanlarý için önemli bir problem oluþturur. Entegre pulmoner indeks (EPÝ) monitörizasyonu ise ventilasyon ve oksijenasyonu kolayca deðerlendirebilmek için tek bir deðer sunabilmektedir. Bu yöntemde SpO2, PetCO2, SS ve KH deðerleri matematiksel bir modelde kombine edilerek bir indeks deðer – EPÝ – elde edilir. Bu indeks deðer monitörde sayýsal veri ya da bir dalga formu þeklinde devamlý olarak takip edilebilmektedir. EPÝ literatüre bakýldýðýnda, daha çok sedasyon altýnda yapýlan iþlemlerde (gastroskopi, kolonoskopi, kardiyoversiyon, diþ çekimi gibi), yoðun bakýmlarda (mekanik ventilatör ayarlarýnýn yapýlmasý, ventilatör/hasta uyumunun deðerlendirilmesi, weaning sürecinin takibi için) ve koroner arter bypass greft cerrahisi uygulanan hastalarýn postoperatif takibinde (solunumsal problemlerin tespit edilmesi ve weaning sürecinin deðerlendirilmesi için) kullanýldýðýný görmekteyiz. Sonuç olarak EPÝ monitörizasyonu, non-invazif, dinamik ve gerçek zamanlý bir ölçüme imkan vermesi, solunum durumunu yüksek spesifite ve sensitivite ile yansýtmasý ve solunum problemlerinin daha erken dönemde fark edilmesini saðlayabilmesi nedeniyle dikkatleri üzerine çekmiþtir. Ayrýca özellikle anestezist olmayan hekimlerin hastanýn solunum durumunu kolay ve hýzlý bir þekilde deðerlendirmesine olanak vermesi bu yönteme önemli bir avantaj saðlamaktadýr.

Assessments of the respiratory functions of patients are frequently
based on measurements of arterial oxygen saturation (SpO2),
end-tidal carbon dioxide (PetCO2), respiratory rate (RR), and
heart rate (HR). Interpreting the data derived from the measurements
of these parameters can be highly problematic for health
care workers, especially those who are inexperienced in monitoring
the respiratory functions. However, the integrated pulmonary
index (EPI) monitorization can offer a single value for easy evaluation
of ventilation and oxygenization. This method combines
the SpO2, PetCO2, RR, and HR values in a mathematical model to
obtain an index value, EPI. This value can be continuously monitored
as either a numerical value or a waveform displayed on
the monitor. In reviewing the literature on EPI, we noted that
the EPI has been used more frequently in procedures performed
under sedation, such as gastroscopy, colonoscopy, cardioversion,
and tooth extraction, and in intensive care units, for adjusting
settings and modes of mechanical ventilation, evaluating the
compliance of the patient to the mechanical ventilation therapy,
and monitoring the weaning process, and during the postoperative
follow-up of patients who have undergone coronary bypass
surgery, to detect respiratory problems and evaluate the weaning
process. In conclusion, using the EPI to monitor respiratory
function has attracted considerable attention because it ensures
noninvasive, dynamic, and real-time measurements, reflects the
respiratory states of patients with higher specificity, and sensitive,
and enables earlier recognition of respiratory problems. In
addition, an important advantage of this system is that it allows
physicians, in particular those who are not anesthesiologists, to
use the EPI index to evaluate the respiratory states of patients
rapidly and easily

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Otoimmün poliglandüler sendromlar (OPS), birçok organýn otoimmün kökenli bozukluklarý ile karakterizedir. OPS tip1, 2, 3, 4 olarak 4 alt gruba ayrýlýr. OPS tip 3 nadir görülür ve A, B, C, D olarak 4 gruba ayrýlýr. OPS tip 3A’de otoimmün tirodite tip 1 diyabetes mellitus eþlik ederken tip 3B’ye ise pernisiyöz anemi eþlik eder. Burada latent autoimmune diabetes in adults (LADA) ile prezante olan nadir bir OPS tip 3A+3B olgusu bildirilmiþtir.

Autoimmune polyglandular syndromes (APS) are characterized
by autoimmune disorders of multiple organs. APS is divided into
4 subgroups as type 1, 2, 3, and 4. APS type 3 is rare and divided
into 4 groups as A, B, C, and D. While in APS type 3A autoimmune
thyroiditis is accompanied by type 1 diabetes mellitus, in
APS type 3B autoimmune thyroiditis is associated with pernicious
anemia. We report a rare case of APS type 3A-3B presented with
latent autoimmune diabetes in adults (LADA).

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Bu vaka epizyotomi skarýnda meydana gelen tekrarlayan derin endometriozisli hastayý sunmaktadýr. Bir yýl önce epizyotomi skarýnda oluþan endometriozis nedeniyle opere olan hasta ayný bölgede baþlayan, özellikle menstruasyon döneminde olan þiþlik ve aðrý þikayeti ile polikliniðimize baþvurdu. Epizyotomi skarýnda lokalize olan, yüzeyden 2,5 cm derinde gömülü kitleye ulaþýldý ve çepeçevre eksize edildi. Patolojik incelemede fibroadipoz doku içine gömülü endometriozis ile uyumlu doku tespit edildi.
Prostoglandin E2 aracýlýðýyla seviyeleri artan steroidogenik akut regulatuar protein ve aromataz enzimleri lokal hiperestrogenizm ile vajinal doðum sýrasýnda implante olan endometriotik hücrelerin devamlýlýðýný saðlar. Genetik yatkýnlýk muhtemelen endometriotik lezyonlarýn tekrarlamaya eðilimini arttýrýr. Bu ikisi bu vaka için olasý mekanizmalardýr.

The present case reported a patient having with recurrent endometriotic lesion which occurred in the episiotomy scar.
The patient who was operated due to episiotomy scar endometriosis one year ago applied to our outpatient clinic with cyclic pain and swelling especially during menstrual periods which started on the same area. The mass ingrained approximately 2.5 cm deep from the surface, which localized on the episiotomy scar, was reached and circumferentially excised. In the pathological examination, tissue which embedded into the fibro-adipose tissues which was consistent with endometriosis, was detected.
Increased steroidogenic acute regulatory protein production by Prostoglandin E2 receptor and the level of aromatase provide continuity of the endometriotic cells which were implanted during the vaginal birth with local hiperestrogenism. The genetic predisposition probably increases the tendency of recurrence of endometriotic lesions. This two mechanisms may be considered responsible for current case.

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Böbrek nakilli hastalarda kronik allograft nefropatisi riskini azaltmak amacýyla serin treozin kinaz (sirolimus, everolimus) kullanýmý önerilmektedir. Bu ilaçlarýn da proteinüri, ödem, hiperlipidemi, bozulmuþ yara iyileþmesi, aðýzda yaralar, anemi, interstisyel pnömoni gibi yan etkileri vardýr. Ýnterstisyel pnömoni bunlar içinde en ciddi olan yan etkidir ve sýklýkla sirolimusa baðlý görülmektedir. Son zamanlarda literatürde everolimusa baðlý interstisyel pnömoni olgularý bildirilmektedir. Biz de bu vaka sunumu ile bu sorunu güncel bilgiler eþliðinde gündeme getirmek istedik.

Amiloidoza baðlý son dönem böbrek yetmezliði nedeni ile 15 ay önce eþinden böbrek nakli yapýlan 48 yaþýndaki erkek hasta, ateþ, öksürük ve nefes darlýðý ile acile baþvurdu. Fizik muayenesinde, ateþ: 38°C, akciðerlerinde bilateral ince raller vardý. Kalsinörin toksisitesi nedeni ile 5 ay önce everolimus kullanmaya baþlamýþtý. Ayný zamanda azathioprin, prednizolon ve kolþisin kullanýyordu. Laboratuar testlerinde, Hg: 7.8 g/dl, C-reaktif protein: 4.5 mg/L, serum kreatinin: 2.8 mg/dl ve everolimus düzeyi: 4.2 ng/ml idi. PA AC grafide bilateral interstisyel infiltrasyon, alveolar opasiteler, yüksek rezolusyonlu akciðer tomografisinde ise saðda daha belirgin olmak üzere her iki akciðer alt lob posterobazal segmentlerde sentri-asiner nodüller ile birlikte yamasal buzlu cam alanlarý, interlober septal kalýnlaþmalar ve komþu plevral yüzeylerde retiküler çizgilenmeler izlendi. Kan, idrar ve balgam kültürlerinde üreme olmadý. sitomegalovirus ve mikobakteri PCR negatifti. Hastaya bronkoalveolar lavaj sývýsýnda hemosiderin yüklü makrofajlar saptandý Tüm semptom ve bulgularýn everolimusa baðlý olabileceði düþünülerek everolimus kesildi. Hasta herhangi bir komplikasyon olmadan hýzla düzeldi.

Daha önce düþünülenin aksine, everolimusun interstisyel pnömoni ve alveolar hemorajiye neden olabilmektedir. Yüksek mortalitesi nedeni ile erken taný konulup tedavi edilmelidir. Böbrek nakilli hastalarý takip eden klinisyenlerin bu yan etkinin farkýnda olmalarý gereklidir.

Use of serin-threonine kinase inhibitors, sirolimus and everolimus
are recommended to decrease the potential development
of chronic allograft nephropathy during chronic phase in renal
transplant patients. Although these drugs have serious side effects
such as proteinuria, edema, hyperlipidemia, impaired wound
healing, mouth ulcers, anemia and proteinuria, among them
the most important one is interstitial pneumonitis which is frequently
related to sirolimus use. Hovewer, in the literature a few
cases of everolimus-induced interstitial pneumonitis (EIP) have
been reported recently. We wanted to revive this issue with this
caase presentation under the light of current information.A 48-
year-old man was admitted with complaints of cough, fever and
bloody sputum. He had living-donor kidney transplantation from
his spouse 15 months ago. The etiology of end-stage renal disease
was amyloidosis due to familial Mediterrenean fever. On physical
examination, he had fever ( 38°C), and bilateral basal fine crackles
were detected. Everolimus was started 5 months ago because of
the calcineurin inhibitor toxicity. He has also been on azathioprin,
methylprednisolone and colchicine therapy. His remarkable laboratory
findings were as follows: Hg: 7.8 g/dl, C-reactive protein:
4.5 mg/l, and creatinine: 2.8 mg/dl. Everolimus blood trough level
was 4.2 ng/ml.I On chest X-ray, bilateral interstitial infiltrates, reticular
images and alveolar opacities were observed especially in
the mid and lower zones. High-resolution pulmonary computedtomography
revealed centri-acinar nodules with patchy areas
of ground glass opacities in posterobasal segments of the both
lungs being more pronounced in the right lower lobe, interlobar
septal thickening and reticular lines in the adjacent pleural surfaces.
Cultures of blood, urine, sputum and blood, were negative
for cytomegalovirus and mycobacterium PCR. Hemosiderin laden
macrophages were observed in his bronchoalveolar lavage. Then
symptoms and signs of the patient were suggestively related to
everolimus, and this drug was discontinued. Contrary to previous
assumptions, everolimus can induce development of interstitial
pneumonia, and alveolar hemorrhagia. Because of higher rates
of mortality associated with this condition, the patients should
be diagnosed, and treated at an early stage. This side effect of
the drug should be kept in mind.

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Triküspid protezi olan hastalarýnda pacemaker implantasyonu zor bir durumdur. Bu hastalarda, pacemaker elektrodunu triküspit kapaktan geçirmek mümkün deðildir. Bu nedenle, ventriküler uyarý, ancak epikardiyal veya endokardiyal sol ventriküler stimülasyon ile elde edilebilir. Epikardiyal uyarý için, elektrodun implantasyonu, tranasvenöz yol ile koroner sinüse veya cerrahi yöntemle yapýlabilir. Bu yazýda, triküspid kapak replasmaný sonrasýnda geliþen tam kalp bloðunun, koroner sinüs yoluyla epikardiyal stimülasyon elde edilerek tedavi edildiði bir hastayý sunuyoruz. Triküspid kapak replasmaný sonrasý tam kalp bloðu geliþen hastalar koroner sinüs yolu ile implante edilen kalýcý kalp pili ile tedavi edilebilirler. Bu teknik, hem minimal invaziv bir yaklaþým hem de protez triküspid kapak nedeniyle sað ventriküllerine eriþilemeyen hastalarda etkili bir uyarý saðlar.

Pacemaker implantation in patients with tricuspid prosthesis is
a challenging situation. It is not possible to pass the pacing lead
through tricuspid valve in these patients. Therefore, ventricular
pacing can be achieved either epicardial or endocardial left ventricular
stimulation. For epicardial pacing, lead implantation can
be done transvenously via coronary sinus or surgically. In this
paper, we present a patient who had complete atrioventricular
block (CAVB) following tricuspid valve prosthesis implantation
and treated with epicardial pacing via coronary sinus. In patients
who develop CAVB after tricuspid valve replacement, can
be treated with permanent pacemaker implantation via CS. This
technique enables a minimally invasive approach and effective
stimulus in patients with inaccessible right ventricle because of
the presence of prosthetic tricuspid valve.

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Suicide is one of the significant problem seen in schizophrenia. In our case of placing a large piece of a spoon through the mouth and throat into trachea and right main bronchus is, as a modality and means of commiting suicide is unique in literature so far, and that no similar case has been described.
We report a very rare case of large dimensions metal foreign body (FB) aspiration. Our patient tried to commit suicide by placing a piece of spoon into the respiratory tract. When hospitalized, the patient was in good general condition. The chest X-ray revealed a metal FB a 11-cm-long in distal part of trachea and right main bronchus, representing the handle of the metal spoon. After the rigid bronchoscopy successful extraction of the FB, the control check of the bronchial tree was performed, and the findings were normal.
Every suicide is a tragedy and major public health problem. Suicides are preventable and should be given high priority with regard to prevention and research. Removal through the rigid endoscope is the reccommended and safe method in FB aspiration cases.

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