GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý; hipertansif hastalarda diabetin sol ventrikül diastolik fonksiyonu üzerine etkisini araþtýrmaktýr
YÖNTEM ve GEREÇLER: Temmuz 2007-temmuz 2008 tarihleri arasýnda Saðlýk Bakanlýðý Ýstanbul Göztepe Eðitim ve Araþtýrma Hastanesi 7. ve 8. dahiliye polikliniklerine baþvuran ≥ 40 yaþ, bilinen koroner arter hastalýðý olmayan, hipertansiyonu veya hipertansiyon ve diabeti olan hastalar çalýþmaya alýndý. Yapýlan efor testi (+) saptanan ve/veya transtorasik ekokardiografisinde EF ≤ %50 olan hastalar çalýþma dýþý býrakýldý. Ortalama yaþlarý 60.78 (Std. Dev.: 10.627) olan, 42 si erkek (%38.2) 68 si kadýn (%61.8), toplam 110 hasta çalýþmaya dahil edildi. Ýstatistiksel analizler için SPSS 12.0 programý ve verilerin karþýlaþtýrýlmasýnda Chi Square testi kullanýldý.
BULGULAR: Diastolik disfonksiyon diabetiklerde (%81.25), diabetik olmayanlarla (%62.9) karþýlaþtýrýldýðýnda anlamlý olarak daha yüksek sýklýkta saptandý (p < 0.05). Erkeklerde, DM(+) grupta %35.9 ve DM(-) grupta %41.1; kadýnlarda, DM(+) grupta %64.1 ve DM(-) grupta %58.29 diastolik disfonksiyon vardý. Cinsiyete göre yapýlan deðerlendirmede kadýn ve erkek arasýnda anlamlý fark saptanmadý (p > 0.05).
TARTIÞMA ve SONUÇ: Hipertansiyona diabet eklendiðinde sol ventrikül diastolik fonksiyonlarý olumsuz olarak etkilenir. Bu etki, kadýnlarda ve erkeklerde benzer görünmektedir.

INTRODUCTION: The aim of this study was to analyse the impact of diabetes mellitus on left ventricular diastolic function in patients with arterial hypertension.
METHODS: Between July 2007 and July 2008, we enrolled applicant 7.-8. internal medicine polyclinics of Goztepe Education and Training Hospital who had ≥ 40 years hypertensive patients with or without type 2 diabetes mellitus unknown history of coronary artery disease. Transthoracic echocardiography was used to asses the diastolic function.If patients with positive treadmill effort test and/or EF≤%50 in transthoracic echocardiography were excluded.
RESULTS: A total 110 patients were included in the analysis. Of these, 62 patients had hypertension without diabetes and 48 patients had diabetes and hypertension. Mean age was 60.78 (std. Dev. 10.627). Diastolic dysfunction was significantly more prevalent in diabetes (81.25 %) than in without diabetes group(62.9 %) (p < 0.05). In men, 35.9 %in the DM(+) group and 41.1 %in the DM(-) group had diastolic dysfunction; In women, 64.1 %in the DM(+) group and 58.29 %in the DM(-) group had diastolic dysfunction. The difference between men and women was not significant (p > 0.05).
DISCUSSION AND CONCLUSION: The addition of diabetes to hypertension has a negative effect on left ventricular diastolic function. This effect appears similar in men and women.

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GÝRÝÞ ve AMAÇ: Skrotumda ani geliþen þiþlik, kýzarýklýk ve aðrý ile ortaya çýkan bir grup hastalýk akut skrotum patolojilerini oluþturmaktadýr. Çocuklarda akut skrotumun en sýk nedenleri epididimit/epididimoorþit/orþit, testis torsiyonu, appendiks testis torsiyonu, boðulmuþ kasýk fýtýðý, travmatik hidro/hematosel’dir. Bu çalýþmada; kliniðimizde boðulmuþ kasýk fýtýðý dýþýndaki akut skrotum nedeniyle interne edilen olgularýn deðerlendirmesi amaçlandý.
YÖNTEM ve GEREÇLER: Haziran 2010- Haziran 2014 tarihleri arasýnda akut skrotum nedeniyle interne edilen hastalarýn tüm özellikleri geriyedönük olarak deðerlendirildi. Boðulmuþ kasýk fýtýðý tanýlý hastalar çalýþma dýþýnda býrakýldý.
BULGULAR: 4 yýllýk süreçte akut skrotum nedeniyle interne edilen 114 olgunun yaþ ortalamasý 7,6± 4,577 yaþ (min: 1ay-max: 18yaþ) idi. Doppler US ile kan akýmý deðerlendirilmesi 112 olguda yapýlýrken, 2 hastada mesai dýþý müracaat nedeniyle Doppler US yaptýrýlmadan acil cerrahi müdahale yapýldý. Hastalarýn 83’ü (%72,8) epididimoorþit, 24’ü (%21,1) testis torsiyonu, 2’si (% 1,8) appendiks testis torsiyonu, 5’i (%4,4 ) ise travmaya sekonder kontüzyon, hidro/hematosel tanýsý almýþtý. Testis torsiyonu tanýsý alan 18 hastada (%75) detorsiyon yapýlýrken, 6 hastada (%25) orþiektomi yapýldý. Orþiektomi olgularýnýn histopatolojik deðerlendirmelerinde; hemorajik nekroz, hemorajik infarktüs ve iskemik deðiþiklikler saaptandý. Detorsiyone edilen testislerin kontrol Doppler US’lerinde 11 olgunun (%61,1) testis boyutlarý ve kanlanmalarý normal bulundu. Kanlanmasý olmayan ve tamamen atrofiye giden 7 olguda ( %38,9) geç orþiektomi yapýldý.
TARTIÞMA ve SONUÇ: Erken müracaat eden akut skrotum olgularýnda Doppler US ayýrýcý taný için çok yararlý olmakla beraber, Doppler US yaptýrmak zaman kaybýna yol açacak ise hastanýn doðrudan ameliyata alýnmasý testis kaybýný azaltabilir.

INTRODUCTION: A group of diseases in the scrotum setting forth by the sudden swelling, and redness, and pain consist of acute scrotal pathologies. The most common causes of acute scrotum in children are epididymitis / epididymoorchitis / orchitis, testicular torsion, torsion of the appendix testis, incarcerated inguinal hernia, traumatic hydro / hematocele. In this study; we aim that to evaulate of patients with acut scrotal pathologies which interned to our department.
METHODS: All hospital datas of cases which interned at our deparment due to acute scrotum in between June 2010-June 2014 were evaluated retrospectively. Cases with incarcerated inguinal herni were excluded in this study
RESULTS: In 4-year period 114 cases were interned to our department with acute scrotum. Mean age was 7,6±4,577years (min: 1m-max: 18yrs). Doppler US was performed in 112 patients to evaluate the blood flow while in 2 patients applied on-Call without Doppler US. Two patients were operated under circumstance emergency surgical intervention. Diagnosis was made in 83 cases (%72,8) with epididymitis/ epididymoorchitis/ orchitis, and in 24 cases (%21,1) with testicular torsion, and in 2 cases (%1,8) with torsion of the appendix testis and in 5 cases (%4,4) with traumatic hydrocele/ hematocele. While detorsion was made in 18 cases (%75) with testicular torsion, orchiectomy was performed in 6cases (%25). Histopathological evaluation of orchiectomy specimens were revealed hemorrhagic necrosis and hemorrhagic infarction or ischemic changes. Normal testicular size and vascularity were detected in 11cases (%61,1) with the detorsioned testis by follow-up Doppler US; late orchiectomy was performed in 7cases (%38,9) with complete atrophy due to lack of blood supply.
DISCUSSION AND CONCLUSION: Although Doppler US is very helpful for differential diagnosis of patients with acute scrotum who applied early period; If Doppler US will lead to a waste of time, direct surgery to be done would be reduced the loss of the testicles.

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GÝRÝÞ ve AMAÇ: AMAÇ: Ýç hastalýklarý yoðun bakým ünitesine yatan hastalarýn demografik özelliklerini deðerlendirmek, mortalite sýklýðýný ve mortalite üzerinde etkili parametreleri belirlemek.
YÖNTEM ve GEREÇLER: YÖNTEMLER: Çalýþmaya Ýstanbul Medeniyet Üniversitesi Göztepe Eðitim ve Araþtýrma Hastanesi Ýç Hastalýklarý yoðun bakým ünitesinin açýlýþ tarihi olan 2 Mayýs 2012 ile 1 Ocak 2013 tarihleri arasýnda yatýþý olan 18 yaþ ve üzeri 111 hasta (53 kadýn, 58 erkek, yaþ ortalamasý 73.79± 14.73, ortalama yatýþ süresi 9.1±10.7, geriatrik hasta sýklýðý % 77.5) alýndý. Mortalite sýklýðý, en sýk yatýþ tanýlarý, komorbidite sýklýðý, invaziv mekanik ventilasyon (ÝMV) uygulanan hasta sýklýðý, hematolojik ve biyokimyasal veriler ve bunlarýn mortalite ile iliþkisi deðerlendirildi.
BULGULAR: En sýk yatýþ nedenleri; hemodinamik bozukluk (%48.6), solunum yetmezliði (%27.9) ve sepsis (%15.3), en sýk eþlik eden komorbiditeler; hipertansiyon (%46.8), kalp yetmezliði (%32.4) ve diabetes mellitus (%25.2) idi. Mortalite sýklýðý % 52.3 (ilk 15 gün içerisinde % 79.3), ÝMV ihtiyacý sýklýðý %44.1, IMV desteði alan hastalarda mortalite sýklýðý % 85.7 idi. ÝMV ihtiyacý olmasý, artmýþ ferritin ve vitamin B12 düzeyleri mortalite ile iliþkili idi (tümü için p<0.01).
TARTIÞMA ve SONUÇ: SONUÇ: Bu çalýþmada Ýç hastalýklarý yoðun bakým ünitesine yatan hastalarda mortalite sýklýðýnýn yüksek bulunduðu görülmüþtür. Bunda geriatrik hasta sýklýðýnýn, eþlik eden komorbiditelerin ve ÝMV ihtiyacý olan hasta sýklýðýnýn yüksek bulunmasýnýn rolü olabilir.

INTRODUCTION: OBJECTIVE: The aim of this study is to evaluate the demographic characteristics of critically ill patients and to determine intensive care unit (ICU) mortality and its predictors.
METHODS: This study was undertaken in the Istanbul Medeniyet University Göztepe Training and Research Hospital Medical ICU. Between May 2012 and January 2013, 111 patients (53 female, 58 male; mean age was 73.79± 14.73, mean ICU lenght stay was 9.1±10.7; prevalence of geriatric patients was 77.5% ) were admitted to the ICU. The common indications for ICU admission, prevalence of mechanical ventilation support, hematological and biochemical parameters and their effects on mortality were assessed.
RESULTS: The common indications for ICU admission were hemodynamic instability (48.6%), respiratory failure (27.9%) and sepsis (15.3%). Hypertension (46.8%) was the most common comorbidity. Heart failure and diabetes mellitus prevalance were 32.4% and 25.2% respectively. Mortality rate was 52.3% in all patients. Approximately 80% of all mortality was observed in first fifteen-day. In additon, mortality rate (85.7%) was prominent within patients in need of the mechanical ventilation support. Mechanical ventilation requirement, increased ferritin and vitamin B12 levels were independent risk factors for mortality in critically ill patients (p<0.01, for all)
DISCUSSION AND CONCLUSION: CONCLUSION: Mortality rate was higher in medical ICU. Herein, increased prevalence of geriatric population, concomitant comorbidities and mechanical ventilation requirements may play role.

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INTRODUCTION: In Africa, there is critical shortage of surgeons. Majority of the surgeons work in urban centers, there is almost none working in the rural side. This study documents surgical interventions performed in Guinea-Bissau by Doctors Worldwide Turkey.
METHODS: A group of surgeons from the Doctors Worldwide Turkey performed various procedures in the Simao Mendes, Gabu and Bafata community hospitals. Demographics, surgical methods, anesthesia techniques, and complications were recorded.
RESULTS: Sixty four procedures were undertaken between 5-16 february 2010 and 6-11 may 2011. Mean age was 44,5 (range: 6-81) for 47 male (85,5%) and 10 female (17.5%) patients. Five cases were emergency. Hartmann procedure for rectal carcinoma; modified radical mastectomy for breast carcinoma; 2 right total thyroidectomy, 1 bilateral subtotal thyroidectomy; 2 incisionel hernia repairs with mesh, 1 breast lumpectomy, 3 mass excisions, and 2 keloidectomies, various techniques of hernia repair for 35 inguinal hernias (4 bilateral, 3 strangulated and 2 coexisting with hydrocele), Winkelman procedure for 5 hydroceles (1 bilateral), and unilateral orchiectomy for 1 bilateral hydrocele were recorded. Sixteen patients (28,1%) had general, 24 (42,1%) spinal, l5 (8,8%) epidural, 10 (17,5%) local, and 2 patients (3,5%) had IM ketalar anesthesia. There was no mortality.
DISCUSSION AND CONCLUSION: Surgical diseases, majority of which are hernias, are threatening public health in underdeveloped regions of Africa. Blitz surgery may be an efficient temporary solution.

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GÝRÝÞ ve AMAÇ: Toxoplasma gondii, Rubella, Cytomegalovirus (CMV) ve Herpes simplex, fetüste konjenital enfeksiyonlara en sýk neden olan mikroorganizmalar olup “TORCH” kýsaltmasý ile anýlýrlar. Ülkemizde doðurgan yaþtaki kadýnlarýn TORCH enfeksiyonlarý açýsýndan taranmasý yüksek maliyeti sebebiyle halen tartýþmalý birkonudur. Bir testin tarama amaçlý uygulanmasý için o hastalýðýn ya da etkenin o toplumdaki prevalansýnýn bilinmesi gerekir. Bu çalýþmanýn amacý Ýstanbul’da bir eðitim ve araþtýrma hastanesine baþvuran gebelerdeki TORCH seroprevalansýnýn araþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Bu çalýþma, Eylül 2013- Ocak 2015 tarihleri arasýnda Ýstanbul Anadolu Kuzey Kamu Hastaneleri Birliði Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi, Kadýn Hastalýklarý ve Doðum Kliniði, Gebe Polikliniði’ne ayaktan baþvuran toplam 1101 hastanýn laboratuvar kayýtlarýnýn retrospektif taranmasýyla yapýlmýþtýr. TORCH grubu enfeksiyöz ajanlarýna karþý geliþen IgM ve IgG anitkorlarýnýn seropozitiflik oranlarý araþtýrýlmýþtýr.
BULGULAR: Çalýþmaya alýnan hastalarýn yaþlarý 17 ile 47 yaþ arasýnda deðiþmekte olup, yaþ ortalamasý 30.3±5.8 olarak bulunmuþtur. Çalýþma populasyonunun % 99.5’i anti-CMV Ig G (+), %94.2’si anti-Rubella Ig G (+), %31’i ise anti-Toxoplasma IgG (+)’tir. Anti-Ig M seropozitifliði sýrasýyla CMV için % 0.5, Rubella için ise % 0.2’tür.
TARTIÞMA ve SONUÇ: Toxoplasma gondii’nin toplumdaki seroprevalansý düþük olduðu için antenatal taranmasý önerilebilir. CMV’nin yüksek seroprevalans oranlarý sebebiyle taranmasý anlamlý deðildir. Rubella seroprevalansý da yüksektir ancak; Ulusal aþýlama programýndan önce doðan 20 yaþ üstü kadýnlarda prekonsepsiyonel tarama, gebelik öncesi aþýlama yapýlmasý için önerilebilir.

INTRODUCTION: Toxoplasma gondii, Rubella, Cytomegalovirus and Herpes simplex viruses are microorganism that make congenital infections, and they all called briefly as TORCH. There is an ongoing argument for the screening of reproductive age women due to the high cost of tests. For a test to be used in screening, prevalence of disease in this population should be known. The aim of this study was to investigate TORCH seroprevalence among women attending a teaching hospital Ýn Istanbul.
METHODS: A total of 1101 patients was attending outpatient Obstetric Care Clinic of Haydarpaþa Training and Research Hospital of Istanbul Anatolia North Public Hospital Association, between September 2013 to January 2015, and their laboratory data were evaluated retrospectively. We investigated Ig G and M seropositivity rates against TORCH.
RESULTS: The age of the patients ranges between 17-47 years with a mean age of 30.3±5.8 years. Pregnant population had 99.5% anti-CMV Ig G (+), %94.2 anti-Rubella Ig G (+), %31 anti-Toxoplasma IgG (+). Seroprevalence for Anti IgM was 0.5% for CMV, 0.2% for rubella.
DISCUSSION AND CONCLUSION: The screening of Toxoplasma gondii may be suggested since the prevalence is not high in the population. The screening of CMV is not meaningful, due to high seroprevalence. Although seroprevalence of rubella is also high, it may be suggested for preconception vaccination especially in women above 20 years of age and birth date prior to National Vaccine programme

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý elektif laparoskopik kolesistektomi ameliyatlarýnda trokar yeri herni oluþumunu tetikleyen faktörleri irdelemek ve bunu önlemek için ne yapýlmasý gerektiðini tartýþmak.
YÖNTEM ve GEREÇLER: 2011-2013 yýllarý arasýnda laparoskopik kolesistektomi ameliyatý yapýlan olgular deðerlendirildi. Ameliyat sonrasý 12.ay deðerlendirmek için kontrole çaðrýldý. Kontrolde hastalara fizik muayene ve ultrasonografi yapýldý. Trokar yeri hernisi tespit edilen hastalarýn hangi kolaylaþtýrýcý etkenlere baðlý olarak geliþtiði incelendi
BULGULAR: Çalýþma dönemide 190 elektif laparoskopik kolesistektomi yapýldý. Postop 12.ay kontrolde deðerlendirilen 132 hasta çalýþmaya alýndý. Bu hastalarýn yaþ ortalamasý 50,64±11,86 (18-76) olup kadýn erkek oraný beþ idi. Dört tane hastada umblikal trokar yeri hernisi gözlendi. Herni geliþen bir hastada kronik obstrüktif akciðer hastalýðý, diðer iki hastada diyabet ve üç hastada ise obezite mevcut idi. Trokar yeri hernisi tespit edilen hastalarda ileri yaþ ve obesite varlýðý istatistiki olarak anlamlý bulundu (p deðeri sýrasýyla 0,007, 0,008).
TARTIÞMA ve SONUÇ: Laparoskopik ameliyatlarda trokar yeri hernisi geliþimini engellemek için defektlerin onarýmý ileri yaþ ve obezite gibi bazý risk faktörleri göz önünde tutularak yapýlmalýdýr. 

INTRODUCTION: Main aim of this study is to evalute risk factors of development of trocar site hernia after elective laparoscopic cholecystectomy operation, and to discuss what needs to be done to prevent it.
METHODS: The patients operated with laparoscopic cholecystectomy between 2011 and 2013 were evaluated. Patients were informed for follow-up at 12 month after operation. Physical examination and ultrasound were performed at follow-up. Factors that facilitate herni development were evaluated by the help of patients who diagnosed as trocar site hernia.
RESULTS: One-hundred-ninty patients were operated in study period. One-hundred-thirty-two patients who have been examined at follow-up period were included into study. Mean age of patients was 50,64±11,86 (18-76), and female male ratio was five. Trocar site herni was detected in four patients at umblical trocar site. One of these patients had chronic lung disease, other two of them had diabetes, and three of them had obesity. Advanced age and obesity were found to be significant in patients having trocar site hernia (p value: 0,007, 0,008, respectively).
DISCUSSION AND CONCLUSION: Development of trocar site hernia after laparoscopic surgery may be prevented by repair of trocar site in patients who have risk factors such as advanced age and obesity.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada yaþlý diz osteoartritli (OA) hastalarda fiziksel aktivite düzeyinin yaþam kalitesi, depresyon, uyku kalitesi ve fonksiyonel kapasite üzerine etkilerini incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya altmýþbeþ yaþ üstü diz osteoartritli 55 hasta (yaþ aralýðý 65-84) alýndý. Hastalar Uluslar Arasý Fiziksel Aktivite Anketi ile deðerlendirilerek yetersiz aktivite grubu (IAG) ve fiziksel aktif grup (PAG) olarak iki gruba ayrýldý. Kellgren-Lawrence skalasý ile radyolojik OA evrelemesi yapýldý. Hastalar Short-Form 36 (SF-36) anketi, Beck Depresyon Ölçeði (BDÖ), Pittsburgh Uyku Kalite Ölçeði(PSQI) ve Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) ile deðerlendirildiler.
BULGULAR: Yaþ ortalamalarý, vücut kitle indeksleri, ortalama aðrý skorlarý ve cinsiyet daðýlýmý açýsýndan iki grup benzerdi. WOMAC fiziksel fonksiyon skorlarý fiziksel aktif grupta düþük bulundu (p=0,01). Ortalama PSQI skorlarý arasýnda istatistiksel olarak anlamlý bir fark bulunmadý (p=0,242). PAG’un ortalama BDÖ skoru IAG’a göre anlamlý düzeyde düþüktü (p=0,015). Fiziksel aktif grubun ortalama SF-36 fiziksel fonksiyon (p=0,044), fiziksel rol (p=0,008) ve fiziksel komponent (p=0,016) skorlarý yetersiz aktivite grubuna göre anlamlý düzeyde yüksekti.
TARTIÞMA ve SONUÇ: Ýleri yaþtaki diz osteoartritli hastalarda fiziksel aktivite düzeyinin yüksek tutulmasý depresyon olasýlýðýný azaltmakta, hastalarýn yaþam kalitesi ve fonksiyonel kapasitelerini artýrmaktadýr.

INTRODUCTION: In the present study, we aimed to investigate the effects of physical activity level on the quality of life, depression, sleep quality and functional capacity in elderly patients with knee osteoarthritis (OA).
METHODS: Fifty-five patients over 65 years of age (age range: 65-84 years) with knee osteoarthritis were enrolled in the study. Patients were divided into two groups including Insufficient Activity Group (IAG) and Physically Active Group (PAG) according to their responses to the International Physical Activity Questionnaire. Radiological OA grading was performed using Kellgren-Lawrence classification system. Patients were evaluated using Short-Form 36 (SF-36) questionnaire, Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
RESULTS: Mean age, body mass index, mean pain scores and gender distribution were comparable between the two groups. WOMAC physical function scores were lower in the Physically Active Group (p=0.01). Mean PSQI scores did not differ statistically significantly between the two groups (p=0.242). Mean BDI score of PAG was significantly lower compared to that of IAG (p=0.015). Mean SF-36 physical function (p=0.044), physical role (p=0.008) and physical component (p=0.016) scores of the Physically Active Group were significantly higher versus Insufficient Activity Group.
DISCUSSION AND CONCLUSION: Maintaining a high physical activity level reduces the possibility of depression and improves the quality of life and functional capacity in geriatric patients with knee osteoarthritis.

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GÝRÝÞ ve AMAÇ: Boyun apseleri, acil müdahale edilmezse ciddi morbidite ve mortalitelere sebep olabilen hastalýklardýr. Bu çalýþmamýzda kliniðimizde boyun apsesi tanýlý olgular retrospektif olarak incelenerek literatür eþliðinde sunuldu.
YÖNTEM ve GEREÇLER: Kliniðimizde Ocak 2008 ile Ocak 2015 arasýnda yatarak tedavi gören 79 boyun apseli olgunun yaþ daðýlýmý, enfeksiyon kaynaðý, sistemik hastalýðý, tanýda kullanýlan görüntüleme yöntemleri, drenaj esnasýnda tercih edilen anestezi, apse lokalizasyonu, apse materyalinin kültür sonuçlarý, tedavi sürecinde görülen komplikasyonlar, baþvuru öncesi antibiyoterapi alýp almadýðý ve hastanede yatýþ süreleri incelenmiþtir
BULGULAR: Çalýþmamýzdaki olgular 1 ile 79 yaþlarý arasýnda(ortalama28,3yýl) olup 43’ü kadýn,36’sý erkekten oluþmaktadýr. Olgularýn 19’unda sistemik hastalýk saptandý. Sistemik hastalýklarýndan en sýk diyabetis mellitus saptandý. Apse lokalizasyonu en çok peritonsiller alan olarak saptandý ve tüm boyun apselerini 13’ünde apse birden çok lokalizayonda iken müdahale edilmiþtir. 74 olguya lokal anestezi altýnda drenaj uygulanýrken 5 olguya genel anestezi altýnda drenaj uygulandý. Bu 5 olgunun 4’ü retrofarengeal apse ile sýnýrlýyken 1 olguda birden çok alanda yaygýn apse mevcuttu. Kültür sonuçlarýnda en sýk stafilokokkus aures saptandý. 3 yetiþkin olguda mediastinit geliþmesi üzerine yoðun bakým koþullarýnda takip edildi. Bu 3 olgunun 1’inde sepsis nedeniyle kaybedildi. Yetmiþ dokuz olgunun hastanede kalýþ süreleri 2 ile 21 gün arasýnda(ortalama7,64 gün) izlendi. Sistemik hastalýðý olan 19 olgunun yatýþ süresinin ortalama 9,47 gün olduðu (p<0,05) ve istatiksel olarak sistemik hastalýðý olmayanlara göre daha uzun süre yatýþ süresine sahip olduðu saptandý.
TARTIÞMA ve SONUÇ: Boyun apseleri, ciddi komplikasyonlara sebep olabileceðinden erken teþhis edilip cerrahi drenaj ve parenteral tedavi uygulanmalýdýr.

INTRODUCTION: Neck abscess is a disease that might cause severe morbidities and mortalities if it’s not treated immediately. In our study, patients that get neck abscess diagnosis in our clinic were analyzed retrospectively and presented with literature.
METHODS: In our clinic, age distribution, enfection source, systemic disease, imaging methods that were used in diagnosis, prefered anaesthesia during drainage, abcsess localization, culture results of abscess metarial, complications during treatment procedure, any antibiotic treatments before admittance and duration of hospitalization of 79 cases with neck abscess between January 2008 and January 2015 were assessed.
RESULTS: Cases in our study were aged between 1-79 (mean 28.3) and 43 of them were females and 36 were males. Systemic diseases were determined in 19 of the cases. The most common systemic disease was diabetes mellitus. Abscess localization was mostly peritonsillar and 13 of the cases were interfered when abscess were in multipl localizations. In 74 of the cases, drainage was performed under local anaesthesia and in 5 cases it was performed under general anaesthesia. 4 of that 5 cases were limited with retropharyngeal abscess and 1 of them had multipl exessive abscess. Staphylococcus aereus was the most detected in culture results. 3 adult cases were fallowed up in intensive care because of mediastinitis. Exitus occured in 1 of that 3 cases because of sepsis. The hospitalization periods of 79 cases were between 2-21 days (mean 7.64 days). Hospitalization period of 19 cases with systemic diseases were 9.47 days (p<0.05) and statistically, they had more hospitalization period than those with no systemic disease.
DISCUSSION AND CONCLUSION: Neck abscess must be diagnosed early and treated with surgical drainage and parenteral therapy because it might cause severe complications.

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Þilotoraks, plevral boþlukta lenfatik sývýnýn veya þilöz karakterde mayinin birikmesidir. Þilotoraks tedavisinde plevral drenaj, enteral beslenmenin kesilmesi, total parenteral nutrisyon, orta zincirli trigliserid ile beslenme gibi konservatif yaklaþýmlar ve duktus torasikus ligasyonu, pleuro-peritoneal þant veya plörodesis gibi cerrahi yöntemler kullanýlmaktadýr. Günümüzde konservatif yaklaþýmlarla sonuç alýnamayan olgularda, oktreotid tedavisi ile baþarýlý sonuçlar bildirilmektedir. Konjenital kalp hastalýðý nedeni ile cerrahi iþlem sonrasý þilotoraks geliþen ve intravenöz oktreotid verilerek baþarý ile tedavi edilen bir olgu sunuldu.

Chylothorax is defined as the accumulation of lymphatic fluid or chyle in the pleural space. Chylothorax treatment is composed of conservative; pleural drainage, termination of enteral feeding, total parenteral nutrition and supplementation with medium- chain triglycerides and surgical therapies; ductus thoracicus ligation, pleuroperitoneal shunts or pleuredesis. Nowadays, for cases among which conservative therapies fail, treatment with octreotide has been reported to be beneficial with promising results. A neonate with chylothorax developing after surgery for congenital heart disease was treated successfully with octreotide.

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Etanersept antiinflamatuar etkiye sahip tümör nekrozis faktör alfa (TNF- α) antagonistidir. Romatoid artrit, poliartriküler juvenil romatoid artrit, psoriatik artrit ve ankilozan spondilit gibi romatolojik ve dermatolojik hastalýklarda kullanýlmaktadýr. Bununla birlikte Etanersept kullanýmýna baðlý kutanöz ve sistemik yan etkiler ortaya çýkmaktadýr. Ankilozan spondiliti olan hastamýzda etanersept kullanýmýndan sonra gövde ve palmoplantar bölgede yaygýn püstüler erüpsiyon gözlendi. Burada ankilozan spondiliti olan hastada etanersept kullanýmýna baðlý nadir geliþen püstüler erüpsiyon tartýþýlmaktadýr.

Etanercept has anti-inflammatory effects of tumor necrosis factor alpha (TNF-α) antagonist. It is used in rheumatologic and dermatologic diseases such as rheumatoid arthritis, polyarticular juvenile rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. However cutaneous and systemic side effects arises with the use of etanercept. After the use of etanercept in ankylosing spondylitis patient generalized pustular eruption was observed on the trunk, palms and soles. We discussed pustular eruption that is a rare side effect induced by etanercept in ankylosing spondylitis patient in here.

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Amaç:
Kliniðimizde duodenal atrezi ön tanýsý ile opere edilen ve kombine atrezi saptanan olguyu sunmak.

Olgu:
Prenatal duodenal atrezi þüphesi olan olgunun yapýlan laparatomisinde duodenum ikinci kýsýmda atretik segment ve bunun da distalinde web saptandý. Olguya web eksizyonu ve duodenoduodenostomi yapýldý. Olgunun ek baþka bir anomalisi bulunmamaktaydý.

Sonuç:
Duodenal atrezi çocuk cerrahlarýnca iyi bilinen bir patoloji olmasýna karþýn nadir de olsa klasik sýnýflama dýþý olgularla karþýlaþýlabilir. Bu nedenle ikincil atrezi olasýlýðý akýlda tutulmalý ve duodenoduodenostomi yapýlmadan önce mutlaka duodenumun distal ve proksimal segmentleri ve intestinal pasaj atrezi açýsýndan araþtýrýlmalýdýr.

Aim:
Our aim is to present a case with non-classified type duodenal atresia operated in our clinic.

Case:
A patient with prenatally suspected to be duodenal atresia was explored. At laparotomy type 3 duodenal atresia was found between 2nd and 3rd parts of duodenum; in addition a web under the atresia was determined in non-dilated distal part. Diamond shape duodenoduodenostomy was performed with together web excision.

Conclusion:
Sometimes a non-classified type duodenal atresia could be seen; even mostly duodenal atresia very well known pathology by pediatric surgeons. Due to possibilityo a second atresia proximal and distal segments of duodenum and intestinal passage must be explored carefully before the duodenoduodenostomy.

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Yutulan yabancý cisimlerin büyük kýsmý sindirim sisteminde komplikasyon oluþturmadan spontan olarak atýlýr. Psikiyatrik hasta grubunda yutulan cisimler çok sayýda olabilir ve bu grupta tanýda gecikme ve komplikasyon oranýnda artma ile sonuçlanýr. Uzun ve sert cisimler pilordan geçmeyerek; obstrüksiyon, ülser, kanama ve perforasyon oluþturabilir. Endoskopi bu tür olgularda efektif olarak kullanýlýr. Multipl sigara çakmaðý yutma nedeniyle; gastrik çýkýþ obstrüksiyonu geliþen þizofreni tanýlý 28 yaþýndaki erkek hastaya yapýlan endoskopide yabancý cisimlerin çýkarýlamamasý üzerine gastrotomi yapýlarak 10 adet çakmak mideden, bir adet çakmak inen kolondan saðýlarak anal kanaldan çýkarýlmýþtýr. Bu olgu sunumu ile yabancý cisim yutma nedeniyle cerrahi yapýlan psikiyatrik hastalarda karþýlaþýlan zorluklar irdelenmeye çalýþýldý.

The majority of ingested foreign bodies thrown spontaneously without causing complications in the digestive system. Ingested foreign bodies may be a large number in psychiatric patients resulting delay diagnosis and an increase of the complication rate. Long and hard objects cannot pass through the pylorus, and may cause obstruction, ulceration, bleeding and perforation. Endoscopy is used as an effective method in such cases. An exploratory laparatomy was performed after unsuccessful endoscopic removal in a 28-year-old schizophrenia patient with gastric outlet obstruction due to multiple cigarette lighter swallowing. Ten lighters were removed from stomach with gastrotomy and one more lighter was removed from descending colon by milking through the anus. The aim of this paper is to argue encountered difficulties in psychiatric patients who underwent surgery due to ingestion of foreign bodies.

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Literatüre bakýldýðýnda SSRI kullanýmý ile geliþen yüzden fazla EPS olgusu varken SNRI lar ile EPS geliþen olgu bildirimi oldukça az sayýdadýr (3). Duloksetin SNRI grubundan, 2004 yýlýndan beri major depresyon endikasyonu ile kullanýlan seratonin ve noradrenalin gerialýmýný bloke ederek etkinlik gösterdiði bilinen çift etkili bir antidepresandýr (1, 6). Duloksetin D2 reseptörüne afinitesi düþük olmasý nedeniyle ekstrapramidal sisem üzerinden yan etki beklenmemektedir. Bu olguda major depresyon nedeni ile duloksetin kullanýmý olan hastada geliþen parkinsonizm tablosu sunulmaktadýr. Duloksetin ile ilgili böyle bir tablonun bildirilmemesi nedeniyle literatüre katkýda bulunacaðý düþünülmüþtür.

Ýn the literature there are more than one hundred cases of extrapyramidal symptoms (EPS) associated with selective serotonin reuptake intibitors (SSRI) whereas serotonin noradrenaline reuptake inhibitors (SNRI) induced EPS case reports are in a relatively small number (3). An SNRI group drug duloxetine that is used for indication of major depression since 2004 is a double acting antidepressant that acts as serotonin and noradrenaline inhibitor (1,6). Side effects of duloxetine on extrapyramidal system are not expected due to low affinity on D2 receptors. Ýn this case a patient developing parkinsonism by using duloxetine for major depression is presented. Since any duloxetine induced EPS case has not reported before, this case can contribute to the literature.

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Hipoterapi terapistin bir atýn karakteristik hareketlerini kademeli motor ve duysal uyarý saðlamak için kullandýðý fiziksel, eðitici ve dil terapisi formudur. Günlük hayatýmýzda çeþitli aktivitelerde nörolojik fonksiyon ve duysal süreçleri iyileþtirmek amacý esas alýnmaktadýr. Hipoterapide, terapötik at binmekden farklý olarak (burada spesifik at binme teknikleri öðretilmektedir), atýn hareketi bir tedavi hedefi olmanýn dýþýnda bir tedavi strajedisi olarak fayda saðlamaktadýr.

Hipoterapi otizm, serebral palsi, artrit, multipl skleroz, kafa travmasý, inme, spinal kord hasarý, davranýþ bozukluklarý ve psikiyatrik bozukluklar gibi nörolojik veya diðer engellilikleri bulunan hastalarýn tedavisi için kullanýlmaktadýr. Hipoterapinin çok sayýdakÝ endikasyonlarýndaki etkinliði net deðildir ve daha fazla sayýda araþtýrmaya ihtiyaç vardýr. Burada pek çok hekim ve saðlýk çalýþaný tarafýndan yeterince bilinmeyen hipoterapi hakkýnda bilgi vermeyi amaçlamaktayýz.

Hippotherapy is a form of physical, occupational and speech therapy in which a therapist uses the characteristic movements of a horse to provide carefully graded motor and sensory input. A foundation is established to improve neurological function and sensory processing, which can be generalizedto a widerange of dailyactivities. Unlike therapeutic horse backriding (where specific riding skills ar etaught), the movement of thehorse is a meansto a treatment goal when utilizing hippotherapy as a treatment strategy.
Hippotherapy has been used to treat patients with neurological or other disabilities, such as autism, cerebral palsy, arthritis, multiple sclerosis, head injury, stroke, spinalcord injury, behavioral disorders and psychiatric disorders. The effectiveness of hippotherapy for many of these indications is unclear, and more research has been recommended. Here, we purpose to give information about hippotherapy which is not enough known by many clinicians and health workers.

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