ÖZ
Çocuklarda, manyetik rezonans görüntüleme (MRG) sýrasýnda sedasyon uygulamak genellikle tercih edilen bir uygulamadýr. Propofol ve midazolam en çok tercih edilen ilaçlardýr ve sinerjistik etkileri nedeniyle önerilmektedir. Ancak bu uygulama sýrasýnda karþýlaþýlabilecek komplikasyonlar için geniþ populasyonlu gözlemsel çalýþma azdýr. Çalýþmamýzda, propofol-midazolam sedasyonu ile MRG yapýlan 865 çocuk hastadaki etkinlik, yan etki ve komplikasyonlarýn deðerlendirilmesi amaçlanmýþtýr. Ocak 2010-Aralýk 2015 tarihleri arasýnda MRG için sedasyon uygulanan 865 pediatrik hastanýn anestezi formlarý retrospektif olarak analiz edildi. Hastalara standart sedasyon protokolü uygulandý. Demografik veriler ve komplikasyonlar kaydedildi. Sonuçlar literatür eþliðinde tartýþýldý. Hastalarýn ortanca yaþ deðeri 3.01 idi. ASA II-III sýnýflandýrmasý olan hastalar populasyonun %89,2’i idi. Hastalarýn %79,9’nun nörolojik hastalýðý vardý. Solunum depresyonu, bradikardi, alerjik reaksiyonlar ve hýçkýrýk gibi yan etkiler % 1,9 hastada görüldü. Desatürasyon en sýk görülen solunum komplikasyonu idi. Bu çalýþmada, çocuk hasta populasyonunda standart olarak uygulanmýþ propofol-midazolam kombinasyonu ile %98’lere ulaþan etkinlik ve düþük komplikasyon oranlarý gösterilmiþtir. Allerjik reaksiyonlar ve hýçkýrýk gibi komplikasyonlar çok az görülmüþtür. ASA risk sýnýflandýrmasýnýn MRG için sedasyon uygulanýp uygulanmayacaðý açýsýndan karar verdirici olmadýðý çalýþmamýza göre söylenebilir.

Implementation of sedatives during magnetic resonance imaging (MRI) in pediatric patients is often preferred. Propofol and midazolam are mostly chosen drugs, and it is suggested that these drugs have synergistic affects. However, studies with large populations in order to observe the possible complications of this combination are very few. In this study we aimed to evaluate the effectiveness, side effects, complications of 865 children undergoing MRI with propofol-midazolam sedation. Anesthesia charts of 865 children sedated for MRI between January 2010 and December 2015 were analyzed retrospectively. Standardized sedation protocol was used. General features, demographic parameters and complications were recorded. Results were compared and discussed with literature. Median age of patients was 3.01, 2% of the patients were classified in ASA II-III risk groups. 79,9% of the patients had neurological impairment. Respiratory depression, bradycardia, allergic reactions and hiccup were recorded, and the complication rate was 1,9%. Respiratory depression was the most seen in all complications. In pediatric patients usage of a standard propofol and midazolam regime is a very effective method with few complication rate. Effectiveness was nearly 98%. Allergic reactions and hiccup were very rare. When compared with literature, it seems that complication rates and types will increase with escalating number of patients. We can also pronounce that ASA risk classification is not a predictive factor to decide for MRI examination under anesthesia.

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Kardiyak otonomik iþlevler klinik uygulamada kalp hýzý toparlanma (KHT) indeksi ile dolaylý yoldan ölçülebilir. Bu çalýþmada inflamatuvar bir hastalýk olan kronik idyopatik ürtikerli bireylerde KHT indeksininin araþtýrýlmasý amaçlandý.
Çalýþmaya kronik idyopatik ürtiker hastasý olan 50 olgu ile 30 saðlýklý kontrol dahil edildi. Tüm katýlýmcýlara Bruce protokolü kullanýlarak tredmill egzersiz testi uygulandý.Temel klinik ve demografik özelliklerine göre, her iki grubun yaþlarý, açlýk kan þekeri ve kolesterol düzeyleri benzerdi. Ýki grup arasýnda sistolik veya diyastolik kan basýncý veya istirahat kalp hýzlarýnda anlamlý bir fark gözlenmedi. Tüm hastalar ve kontrol grubu katýlýmcýlarý sinüs ritmine ve dinlenmede normal 12 derivasyonlu EKG sonucuna sahipti. Tüm katýlýmcýlar ritim anormallikleri, iskemik deðiþiklikler veya diðer komplikasyonlar olmadan yorgunluk ile egzersiz testini tamamladý. Egzersiz stres testi sýrasýnda maksimal kalp hýzý ve metabolik eþdeðere ulaþma ürtiker ve kontrol grubunda benzer bulundu. Birinci, ikinci, üçüncü ve beþinci dakikadaki KHT indeksleri ürtikerli hastalar ile kontrol grubunda benzerdi Otonomik sinir sisteminin bir göstergesi olan ve egzersiz testi ile ölçülen KHT indeksi kronik idyopatik ürtikerli bireylerde etkilenmemiþtir.

Objective: Autonomic cardiac functions can be measured indirectly by heart rate recovery index. In this study, it was aimed to investigate heart rate recovery index in patients with chronic idiopathic urticaria, an inflammatory disorder.
The study included 50 patients with chronic idiopathic urticaria and 30 healthy individuals as controls. All participants underwent treadmill exercise testing with Bruce protocol. According to baseline clinical and demographic characteristics, age, fasting blood glucose and cholesterol levels were similar among groups. No significant differences were observed in systolic and diastolic blood pressures as well as resting heart rate between groups. All patients and controls had normal 12-lead ECG result and sinus rhythm during rest. All participants completed exercise testing without rhythm abnormality, ischemic changes or other complications. During exercise testing, maximum heart rate and metabolic equivalent were found to be similar in the patient and control groups. Heart rate recovery indices on minutes 1, 2, 3 and 5 were similar in the patient and control groups. Heart rate recovery index, a marker for autonomic nervous system, wasn't affected in patients with chronic idiopathic urticaria, which is measured by exercise testing.

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Farelerde oluþturduðumuz deneysel yara modellerinde, Prunus Spinosa L. metanollü meyve ekstresini kullanarak, bu ekstrenin yara iyileþmesindeki etkisini araþtýrdýk. 32 adet C57/Black fare ile 4 deney grubu oluþturuldu. 1.grup kontrol grubu, 2. grup taþýyýcý (gliserin) grup, 3. grup Prunus spinosa, 4.grup madecassol grubu idi ve her bir grupta farelerin sýrtýnda eksizyonel yara modeli oluþturularak Prunus Spinosa L. ve madecassol 10 gün boyunca uygulandý. 10.gün sonunda yara bölgeleri histolojik takip için alýndý, yara dokularý hematoksilen-eosin ve immunohistokimyasal (TGF-β, COL1A1) boyalarla boyanarak, yara iyileþmesi için epidermal ve dermal rejenerasyon, granülasyon doku oluþumu, anjiogenezis (yeni damar oluþumu), immunohistokimyasal boyalarla yeni oluþan kollajen yapýlanmasý ve TGF β artýþý deðerlendirilerek skorlandý. Prunus spinosa L’nin yara dokusunda iyileþme oranlarýný, granülasyon dokusunu, epidermal rejenerasyonu ve anjiogenezisi artýrarak gösterdiði yine immünohistokimyasal boyamalarda kollajen ve TGF β oranlarýnda istatistiksel olarak anlamlý bir artýþýn olduðu gözlendi. Yine 4.günün ve 10. günün sonunda yara kontraksiyonunda ve yara yerinin reepitelizasyonunda ilaç ve madecassol grubunda kontrol grubuna kýyasla anlamlý bir artýþ gözlenmiþtir. Bulgularýmýz, Prunus spinosa L’nin yara iyileþmesini desteklediðini göstermiþtir. Prunus spinosanýn antiinflamatuar, antioksidan ve antibakteriyel etkisi ile, kollajen sentezini artýrarak ve inflamatuar hücre sayýsýný azaltarak yara iyileþmesinin tedavisinde kullanýlabileceðini düþündürdü.

We investigated the wound healing efficacy of the Prunus Spinosa L. using an excisional cutaneous wound model in mice. For this purpose methanol extracts of fruits prepared. We used 32 number C57/Black mice in total; equally divided into four groups. Group 1 control, group 2 vechile (Glycerine), group 3 Prunus Spinosa L., group 4 madecassol. Prunus Spinosa L.and madecassol were applied for 10 days by creating a excisional wound model on the back of each mouse in each group. At the end of the 10th day, wound areas were taken for histologic follow-up, scoring with hematoxylen-eosin and immunohistochemical (TGF-β, COL1A1) staining. Wound healing was scored by newly formed collagen structure, TGF β increase and epidermal and dermal regeneration, granulation tissue thickness, angiogenesis (new vessel formation). Prunus spinosa L. promotes wound healing rates with granulation tissue increase, epidermal regeneration and angiogenesis. In addition there was a significant increase in collagen and TGF [beta] ratios in immunohistochemical staining. At the end of the 4 and 10 days after treatment, a significant increase was observed in wound contraction and re-epithelialization in both Prunus spinosa and madecassol treated groups compared to the control and vehicle group. Our findings support the beneficial effects of Prunus spinosa for augmenting wound healing. The anti-inflammatory, antioxidant and antibacterial activities of Prunus spinosa increased collagen synthesis and decreased the number of inflammatory cells during wound healing and may be useful for treating skin wounds.

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Amaç: Bu çalýþma kadýn hastalýklarý ve doðum kliniði tarafýndan takip edilen gebelerin dermatoloji konsültasyonlarýný retrospektif olarak inceleyerek dermatolojik problemleri deðerlendirmeyi amaçlamaktadýr.
Yöntem: Eylül 2011-Mayýs 2017 tarihleri arasýnda kadýn hastalýklarý ve doðum kliniði tarafýndan dermatoloji konsültasyonu istenen gebe kadýnlara ait veriler retrospektif olarak tarandý. Verilerinde eksiklik saptanmayan 61 hasta çalýþmaya dahil edildi.
Bulgular: Yaþlarý 19-43 arasýnda deðiþen 61 olgunun yaþ ortalamasý 30.66±6.61 yýl idi. Gebelik haftalarý 5-40 hafta arasýnda deðiþen gebelerin 29’u (%47.5) primigravid, 32’si (%52.5) multigravid olup, beþ hasta (%8.2) postpartum dönemdeydi. Ýki gebede konsültasyon istenme nedeni gebeliðin fizyolojik deðiþikliðiydi. 16 hastada (%26.2) gebeliðe özgü dermatoz mevcut olup, bunlardan 11’i gebeliðin polimorf erüpsiyonu, dördü gebeliðin intrahepatik kolestazý ve biri pemfigoid gestasyonis tanýsý aldý. Gebeliðe özgü dermatoz tanýsý alan gebelerin 14’ü üçüncü trimestýrda, ikisi postpartum dönemde idi. Konsültasyon istemi yapýlan gebe ve postpartum dönemdeki kadýnlarýn 45’inde (%75) kaþýntý veya kaþýntýnýn eþlik ettiði döküntü mevcuttu. Plansýz gebelik ve ilaç kullanýmý nedeniyle konsültasyon istemi yapýlan C, D ve X gebelik kategorisinde ilaç kullanan üç gebe mevcuttu.
Sonuç: Konsültasyon istemi yapýlan gebelerdeki en sýk þikayet kaþýntýydý. Anne ve bebek saðlýðýný etkileyebilecek enfeksiyon ve ilaç kullanýmý konsültasyon istem nedenleri arasýnda dikkat çekiciydi.

Objective: To evaluate the dermatologic problems of pregnants followed by obstetrics and gynecology clinic by analyzing dermatology consultations, retrospectively.
Materials and Methods: The data, ýncluding dermatology consultations requested by obstetrics and gynecology clinic for pregnants between September 2011- May 2017 was screened. 61 patients without any deficiency in information were taken into the study.
Results: The mean ages were 30.66±6.61 years (19-43 years). Gestational weeks were changing between 5-40 weeks and 29 patients (47.5%) were primigravid, 32 patients (%52.5) were multigravid and five patients (%8.2) were in postpartum period. The reason for asking for two pregnancy consultations was the physiological change of pregnancy. 16 patients (26.2%) had pregnancy specific dermatosis; 11 patients diagnosed with polymorphic eruption of pregnancy, four patients diagnosed with intrahepatic cholestasis of pregnancy and one patient had pemphigoid gestations. 45 patients (75%) had pruritis or a rash accompanied by an itch. There were three pregnant women who used drugs in the C, D and X pregnancy categories for consultation because of unplanned pregnancy and drug use.
Conclusion: Pruritis was detected as the most frequent complaint. Infection and drug use that could affect maternal and infant health were attracting attention among the reasons for consultation request.

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Analjezik-antipiretik ilaç olarak kullanýlan dipironun; özellikle COX-3 inhibisyonu olmak üzere santral prostaglandin sistemi, opiaterjik ve kannabinoid sistemler, sitokin düzeyleri, TRP kanallarý ve inici serotonerjik-noradrenerjik yolaklar gibi çeþitli mekanizmalar üzerinden etkilerini gösterdiði ortaya konmuþtur. Duygu durum bozukluklarýnda da tüm bu mekanizmalarýn fonksiyonu olduðu belirlenmiþtir. Ayrýca aðrý ve depresyonun çoðu olguda birlikte görüldüðü bilinmektedir. Bu bilgiler ýþýðýnda çalýþmamýzda dipironun antidepresan benzeri etkisi ve depresyonda kullanýlan ilaçlarýn etkisini artýrýcý özelliði olup olmadýðýný araþtýrmayý amaçladýk.
Deneylerde depresyon benzeri etki, erkek fareler kullanýlarak zorunlu yüzdürme testinde incelendi. Silindir þeklindeki, cam kapta altý dakika yüzdürülen hayvanlarýn suda hareketsiz kalma süreleri ölçüldü. Bu süre depresyon-benzeri etkinin göstergesi olarak kabul edildi. Kullanýlan ilaçlarla bu sürenin azalmasý antidepresan-benzeri etki olarak yorumlandý. Deneylerde dipiron 150, 300 ve 450 mg/kg ip ve Fluoksetin 20 mg/kg dozunda oral gavaj yoluyla uygulandý. Çalýþmamýzda, dipironun farklý üç dozunun uygulandýðý farelerin suda hareketsiz kalma süreleri, kontrol grubuyla karþýlaþtýrýldýðýnda anlamlý olarak azaldýðý görüldü. Dipironun 150 mg/kg dozundaki etkisinin, Fluoksetin 20 mg/kg dozuyla ayný olduðu tespit edildi. Her iki ilacýn birlikte kullanýlmasýyla oluþan etki, tek baþýna kullanýldýklarýnda elde edilen etkiden farklý deðildi.
Bu çalýþmada, dipironun zorunlu yüzme testinde fluoksetin gibi antidepresan-benzeri etki gösterdiði tespit edildi. Ýki ilacýn birlikte kullanýlmalarý sonucu fluoksetinin etkisinin deðiþmediði görüldü. Bütün bu bulgular, dipironun antidepresan-benzeri etkisinin olduðunu telkin etmektedir. Dipironun antidepresan-benzeri etkisinin diðer testlerle ve ilaçlarla karþýlaþtýrýlarak araþtýrýlmasý ve etki mekanizmasýnýn aydýnlatýlmasý gerekmektedir. Bu bulgularýn, gelecekte depresyon ve aðrýnýn birlikte seyrettiði olgularýn tedavilerine yeni katkýlar saðlayacaðý düþünülmektedir.

Dipyrone is an analgesic-antipyretic drug which have shown proven effects of COX-3 inhibition on central prostaglandin system, opiate and cannabinoid systems, inflammatory cytokine levels, TRP channels and inverse serotonergic-noradrenergic pathways. These systems have roles in mood disorders. It is known that pain and depression are frequently seen together. In our study we aimed to investigate whether dipyrone has an antidepressant-like effect and if it has an antidepressant-medication-enhancing feature.
Forced swimming test was utilized to measure depression like effect using male mice. Immobility time of the animals was considered indicative of the depression-like effect on animals which were flogged for six minutes in cylinder shaped glass containers. The reduction in the immobility duration of the drugs used was explained as an antidepressant-like effect. In the experiments dipyrone was administered by intraperitoneal at doses of 150, 300 and 450 mg / kg and Fluoxetine 20 mg / kg oral gavage. It was observed that the immobility time of the mice in which all doses of dipyrone were administered decreased significantly when compared with the control group. The effect of 150 mg / kg doses of dipyrone was determined to be the same with fluoxetine. When the two drugs were used together, the effects of the drugs did not differ from using the drugs individually.
In this study, it was determined that dipyrone showed antidepressant-like effects in the same ratio as fluoxetine did and when both drugs were used together the effect of fluoxetine in forced swimming test.
All these findings suggest that dipyrone has an antidepressant-like effect. Antidepressant like effects of dipyrone in comparison with other drugs should be observed with further testing. It is thought that this finding will contribute to treatment protocols of combined depression and pain situations.

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Several outcome measures are in use for dizzy patient to assess change of symptoms, balance performance and disabling effects of dizziness on everyday life. However, yet none of these questionnaires exist in validated Malay version, except for Malay Version of Vertigo Symptoms Scale (MVVSS). Therefore, researcher decided to translate and validate the Malay version of Dizziness Handicap Inventory (myDHI) for use in Malay speaking population. This is a cross sectional design study and it was done to perform translation and validation of the myDHI. In this study, 15 non-dizzy subjects were recruited for validation phase and 14 patients with dizziness (associated with vestibular disorder), aged between 18 and 60 years old was recruited for reliability test. The internal consistency of myDHI was estimated using Cronbach’s alpha coefficient (α). Standard translation process (forward and backward) was done and it was successful. Validation process consist of two which are content validity and face validity and it showed that myDHI has good content and face validity. At the reliability test, 14 patients filled out the myDHI within the time provided. Statistical analysis was performed using Statistical Package for Social Science, SPSS version 21 for reliability test using Cronbach’s alpha coefficient. The myDHI showed acceptable value of internal consistency. As a conclusion, the myDHI demonstrated good validity, acceptable reliability and is recommended as a measure of disability in patients with dizziness and unsteadiness.

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Bu çalýþmanýn amacý Graf sýnýflandýrmasýna göre fizyolojik inmatür (tip 2a) yenidoðanlarda femur baþý ekojenitesini ölçmek ve matür tip 1a olan olgular ile karþýlaþtýrmak, fizyolojik inmatür kalçalar tanýsýnda femur baþý ekojenitesinin deðerini ortaya koymaktýr. Bu çalýþma radyoloji kliniðinde Graf sýnýflamasýna göre 65 tip 1a matür ve 65 tip 2a fizyolojik inmatür kalçasý olan yenidoðandan oluþmaktaydý. Yaþdan kaynaklanabilecek farklýlýklarýn önüne geçebilmek için sadece 8 haftalýk yenidoðanlar çalýþmaya dahil edildi. Her yenidoðana graf yöntemine göre kalça eklemi ultrasonografisi ve ultrason cihazýnda var olan yazýlým ile femur baþý ekojenitesi ölçüldü. Tip 1a grubunda femur baþý ekojenitesi histogram deðeri 69,44 ±2,87 iken, Tip 2a grubunda 57,55 ±2,92 bulunmuþ olup her iki grup arasýnda anlamlý farklýlýk saptanmýþtýr (p<0,05). Tip 2a’nýn alt gruplarý olan 2a (+) ve 2a (-) ekojenite deðerleri sýrasý ile 59,30 ±1,70 ve 54,34 ±1,69 bulunmuþ olup her iki grup arasýnda anlamlý farklýlýk saptanmýþtýr (p<0,05). Kalça eklemi alfa açýlarý ile femur baþý ekojenite histogram deðerleri arasýnda pozitif korelasyon saptandý (r=0,953, p<0,001). Tip 2 a fizyolojik inmatür yenidoðanlarda, tip 1a matür grup ile karþýlaþtýrýldýðýnda femur baþý ekojenitesi B mod histogram yöntemi ile anlamlý olarak düþüktür. Alfa açýlarý ile femur baþý ekojenitesi arasýnda anlamlý pozitif korelasyon mevcut olup fizyolojik inmatüritenin bir göstergesi olduðunu düþünmekteyiz.

The purpose of this study is to measure femur head echogenicity in newborns by physiologic immature hips (type 2a), to compare it with cases with mature type 1a hips and to reveal the value of femur head echogenesis in physiological immature hips. This study consisted of 65 type 1a and 65 type 2a physiologic immature hip joints in the radiology clinic according to the Graf classification. Only 8 weeks of newborns were included in the study in order to avoid differences from the age. Femoral head echogenicity was measured by software available on the ultrasonic device and hip joint ultrasound according to each newborn graph method. Femur head echogenicity histogram value was 69.44 ± 2.87 in type 1a group, 57.55 ± 2.92 in type 2a group and there was a significant difference between both groups (p <0,05). The subgroups of Type 2a (2a (+) and 2a (-)) echogenicity values were 59.30 ± 1.70 and 54.34 ± 1.69, respectively, and there was a significant difference between the two groups (p <0,05 ). A positive correlation was found between the hip joint alpha angle and femoral head echogenicity histogram values (r = 0.953, p <0.001). Type 2a physiologic immature neonates have significantly lower femoral head echogenicity with the B mode histogram method compared with the type 1a maturation group. We think that there is a significant positive correlation between alpha angle and femoral head echogenicity and a sign of physiological immaturity.

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Bu çalýþmanýn amacý, bölünmüþ-bolus intravenöz kontrast madde kullanýlarak yapýlan 64 kesitli BT ile pankreatik artýþý ve radyasyon
dozunu kantitatif olarak deðerlendirmektir. Pankreatik bir hastalýðý olmayan 37 hastaya (kadýn: 18, erkek: 9, ortalama yaþ: 66,1±14,2 yaþ, aralýk 17-80 yaþ) göðüs ve abdomen tek geçiþ bölünmüþ-bolus MDBT uygulandý. Pankreas baþý, gövdesi ve kuyruðundaki ilgili bölgeler deðerlendirildi ve standart MDBT protokolünün pankreatik parankimal faz (PPF) için ortalama zayýflama deðerleri ve bölünmüþ-bolus dozlarý ölçüldü. P<0.05 deðeri istatistiksel olarak anlamlý kabul edildi. Bölünmüþ-bolus uygulamasýnýn ortalama efektif dozu ölçüldü. Tüm MDBT incelemelerinde bölünmüþ-bolus protokolü kaliteli görüntülere izin verdi. Ortalama panreatik artýþ PPF için bölünmüþ-bolus uygulamasýnda standart trifazik MDBT e göre daha yüksekti (131,35 HU±20,63 vs 126.1 HU±20.01). bölünmüþ bolus dozlu MDBT ‘de dozda azalma yaklaþýk olarak %17 idi. Sonuç olarak, bölünmüþ-bolus protokollü MDBT optimal pankreatik artýþ saðlar, pankreatik parankimal faz için özellikle standart MDBT deðerlendirmesine göre önemli ölçüde üstünlük saðlar ve pankreas tümörlerinin belirlenmesi ve evrelemesi için avantajlýdýr.

The aim is to assess quantitatively pancreatic enhancement by split-bolus intravenous injection of contrast material at 64-slice CT and radiation dose. Single-pass split-bolus MDCT of the chest and abdomen was performed in 37 patients without pancreatic disease. Regions of interest were evaluated in the pancreatic head, body and tail of the pancreas and mean attenuation values for pancreatic parenchymal phase (PPP) of the standard MDCT protocol and split-bolus were calculated. P <0.05 was considered statistically significant. Mean effective dose by split-bolus was measured. In all MDCT examinations split-bolus protocol allowed images of quality. Mean pancreatic enhancement was higher by split-bolus respect to pancreatic parenchymal phase of standard triphasic MDCT (131.35 HU ± 20.63 vs 126.1 HU ± 20.01). Reduction of dose was approximately 17%. In conclusion MDCT split-bolus protocol provides an optimal pancreatic enhancement, significantly greater than the enhancement of standard MDCT on PPP, involving an advantage for pancreatic tumors detection and staging.

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Poland sendromu nadir görülen konjenital bir sendromdur. Major pektoral kasýn yokluðuna deðiþik düzeylerde eþlik eden toraks ve/veya üst ekstremite anomalileri ile karakterizedir. Ýç organ anomalileri ve malignite birlikteliði nedeniyle dikkatli ve uzun süreli takip edilmelidir.

Poland syndrome is a rare congenital syndrome. It is characterized by absence of the pectoralis major muscle variably associated with thoracic and/or upper limb anomalies. It should be followed carefully and for a long time due to internal organ anomalies and malignancy association.

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Background: Chronic balance is one of the common problems that will affect people quality of life. The longer the problem will lead to the more severe quality of life and daily activities impairment.
Case Report: A case of a 44-year old female patient, who suffered from a 1-year chronic balance disorder associated with the psychological symptom. Dizziness becomes worsening 3 months ago with severe restriction of daily activities such as cooking, house cleaning and using a stair. Experienced having the chronic balanced disorder, imbalance, floating and spinning sensation, right ear tinnitus. Her main difficulty was when doing daily activities with the movement of head and phobia of crowded and small place. Balance assessment was done before and after the intervention. Malay version Vertigo symptom scale, Beck Anxiety Inventory-Malay and Beck Depression Inventory- Malay were done before and after rehabilitation. The patient then underwent home based video module for balance rehabilitation that named as BAL EX combined with physiotherapist follow up. All clinical balance assessments were normal, but positive findings were found in Fukuda test and GAN SOP test. Malay version of vertigo symptom scale (MVVSS) analysis showed that her imbalance level was in a severe range.
Conclusions: In a case of chronic balance disorders patients, a combination of home-based and intensive physical vestibular rehabilitation can result in rapid recovery of balance symptoms. Further research needs to be done among different type and duration and chronic balance problem in order to have a better understanding of this finding.

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Raynaud fenomeni ve Pektus ekskavatum birlikteliði oldukça nadir görülebilecek bir durumdur.
Raynaud fenomeni tanýsý olan 19 yaþýnda erkek olgu þikâyetlerinin þiddetinde artýþ olmasý nedeni ile kliniðimize baþvurdu. Fizik muayenede her iki elde trofik bozukluk lehine yorumlanan cilt incelmesi ve Pektus ekskavatum tespit edildi. Olguya ayný seansta öncelikle bilateral endoskopik torakal sempatektomi (T2-T3) ve sonrasýnda Nuss yöntemi uygulandý. Olgu 6 aylýk klinik takibin sonunda her iki hastalýk açýsýndan asemptomatiktir.
Raynaud hastalýðý ve Pektus ekskavatum birlikteliði ayný seansta yapýlan torakoskopik giriþimlerle baþarýlý bir þekilde tedavi edilebilir.

Concomitance of Raynaud's phenomenon and Pectus excavatum is a rare condition.
A 19-year-old male patient diagnosed with Raynaud's phenomenon presented to our clinic, stating that there was an increase in the severity of the complaints. Physical examination revealed thinning of the skin on both hands that was considered as trophic disorder and Pectus excavatum. Patient underwent, in the same session, bilateral endoscopic thoracic sympathectomy (T2-T3) and Nuss procedure. At 6-month follow-up, the patient was asymptomatic with regard to both diseases.
Concomitance of Raynaud's phenomenon and Pectus excavatum can successfully be treated by thoracoscopic interventions in the same session.

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Akciðer tüberkülozu (TB), Ýnsan immun yetmezlik virüsü (HIV) pozitif bireylerde mortaliteye neden olabilmekte ve ayrýca hastalýðýn progresyonunu hýzlandýrýp AIDS tablosunun geliþimine yol açabilmektedir. Antiretroviral (ART) tedavi ve anti-tüberküloz tedavi birlikte alýnmasý nedeniyle ilaç etkileþimi riski artmaktadýr. Çoklu ilaç kullanýmýna baðlý ilaç uyumu azalmaktadýr. Ayrýca her iki hastalýk da immunsupresyonu artýrmaktadýr. Bu faktörler nedeniyle HIV pozitifliði ve TB birlikteliði önemlidir. Bu vaka sunumunda, HIV pozitifliði nedenli takip edilen, konstitüsyonel semptomlarla hastanemize baþvuran ve sonuçta akciðer TB tanýsý alan bir hasta sunuldu. HIV pozitif olgularýn klinik gidiþatý yakýndan takip edilmeli ve akciðer grafilerindeki deðiþiklikler TB açýsýndan dikkatlice deðerlendirilmelidir

Pulmonary tuberculosis (TB) can cause mortality in human immunodeficiency virus (HIV) positive patients and can also lead to HIV converting to AIDS. Antiretroviral (ART) and anti-tuberculosis treatment increased the risk of drug interaction with each other. Because of using multi-drug, compliance of patient medication decreases even more. Immunosuppression also increase in both diseases. Due to these factors, combination of HIV positive and TB is important. In this case report, a patient who has HIV positive, applied to our hospital with constitutional symptoms, and then diagnosed pulmonary TB was presented. Clinical course of HIV-positive patients should be monitored closely and their radiological changes should be carefully evaluated for TB.

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Uhl's Anomalisi (UA)sað ventrikülde parsiyel ya da total miyokard yokluðu ile tanýmlanan nadir bir konjenital malformasyondur.UA sýklýkla aritmojenik sað ventrikül displazisi veya Ebstein's Anomalisi ile karýþtýrýlýr.UA nýn ayýrýcý tanýsýnda kardiyak magnetik rezonans görüntüleme, altýn standart taný tekniðidir. Burada nadir olarak 62 yaþýnda Ebstein's anomalisi yanlýþ tanýsý almýþ bir UA olgusunu takdim edeceðiz.

Uhl's anomaly (UA) is a rare congenital malformation described as the partial or complete absence of the myocardium of the right ventricle. UA is commonly confused with arrhythmogenic right ventricular dysplasia or Ebstein’s anomaly. Cardiac magnetic resonance imaging (MRI)is the gold standard diagnostic tecnique for the differential diagnosis of UA.Here, we report a rare case of UA which had been misdiagnosed as Ebstein’s anomaly in a 62 years old female.

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