GÝRÝÞ ve AMAÇ: Konvülsif olmayan absans epilepsi ve konvülsif epilepsi nöbet tiplerinin ayný hastada bulunmasý çok nadir olarak görülmektedir. Yapýlan çalýþmalarda genetik absans epilepsili modellerde konvülsif nöbetlerin geliþmesine karþý bir direnç olduðu gösterilmiþtir. Çalýþmamýzda her iki nöbet aktivitesinin karþýlýklý etkileþiminde önemli bir beyin bölgesi olan substantia nigra pars retikulata'nýn (SNR) SNRanterior ve SNRposterior alt bölümlerinde yer alan GABAerjik nöronlardaki glutamik asit dekarboksilaz (GAD) immünoreaktivitesinin incelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmamýzda eriþkin, erkek, epileptik olmayan Wistar sýçanlar ile genetik absans epilepsili sýçanlar kullanýldý. Her iki deney grubu konvülsif epilepsi nöbetlerinin geliþtiði kindling modeli için elektriksel uyarý aldý. Bu amaçla, hayvanlarýn basolateral amigdala bölgelerine stereotaksik yöntemle elektriksel uyarý elektrodu ve elektroensefalogram kaydý için kortekse kayýt elektrodu yerleþtirildi. Ýmmünohistokimya reaksiyonunda SNR içeren sagittal kesitler kullanýldý. Kesitler anti-GAD67 antikoru ile inkübe edildi. GAD67 immünreaktif nöronlarýn sinyal yoðunluklarý fotoðraflar üzerinden densitometrik olarak analiz edildi. Elde edilen ölçüm sonuçlarýnýn istatistiksel analizinde tek yönlü ANOVA ve Bonferroni posthoc testi kullanýldý.
BULGULAR: Kontrol grubu Wistar sýçanlar ile kontrol grubu genetik absans epilepsili sýçanlarýn her iki SNR alt bölgesindeki GAD67 immünoreaktivitesi arasýnda bir fark bulunmadý. Kindling uyarýsý alan Wistar hayvanlarýn SNRposterior bölgesindeki GAD67 immünreaktivitesinde artýþ olduðu halde, uyarý alan GAERS’lerde SNRposterior bölgesindeki GAD67 immünreaktivitesinde azalma izlendi. Bu iki grup arasýnda GAD67 immunoreaktivitesinde saptanan farkýn istatistiksel olarak anlamlý oduðu tespit edildi (p<0.05).
TARTIÞMA ve SONUÇ: Konvülsif olmayan absans epilepsi nöbetleri ve konvülsif epilepsi nöbetleri arasýndaki karþýlýklý etkileþimde SNRposterior alt bölgesinde sentezlenen GABA düzeyi önemli bir rol oynamaktadýr.

INTRODUCTION: Nonconvulsive absence epilepsy and convulsive epilepsy seizures are rarely seen in the same patient. It has been demonstrated that there is a resistance to development of convulsive seizures in genetic absence epilepsy models. The present study investigated glutamic acid decarboxylase (GAD) immunoreactivity in the brain region related to the interaction of these two seizure types, namely substantia nigra pars reticulata (SNR) subregions, SNRanterior and SNRposterior.
METHODS: Nonepileptic adult male Wistar rats and Genetic Absence Epilepsy Rats from Strasbourg (GAERS) were used. Experimental groups of Wistar and GAERS were electrically stimulated for kindling model to induce convulsive epileptic seizures. An electrical stimulation cannula was stereotaxically implanted to the basolateral amygdala and recording electrodes were placed on the cortex. Sagittal sections of SNR were used to evaluate immunohistochemical reaction. Sections were incubated with anti-GAD67 antibody. Densitometric analysis of GAD67 immunoreactive neurons was performed using photographs of stained sections. One-way analysis of variance and post hoc Bonferroni test were used for statistical analysis of the data.
RESULTS: There was no difference in GAD67 immunoreactivity of SNR subregions of control Wistar and control GAERS. An increase in GAD67 immunoreactivity was detected in SNRposterior subregion of stimulated Wistar rats, whereas there was a decrease in GAD67 immunoreactivity in SNRposterior of stimulated GAERS. The difference in GAD67 immunoreactivity between these two groups was statistically significant.
DISCUSSION AND CONCLUSION: Level of synthetized gamma-aminobutyric acid in SNRposterior subregion plays an important role in the interaction of nonconvulsive absence epilepsy seizures and convulsive epilepsy seizures.

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GÝRÝÞ ve AMAÇ: Kronik hepatit B (KHB) son derece önemli bir saðlýk problemidir. Hepatit B virüsü (HBV) enfeksiyonunun sonuçlarý HLA-DPA1 alellerindeki varyasyonlarla iliþkilidir. Bu çalýþmanýn amacý, HLA-DPA1 alellerinin tedavi yanýtý ve HBeAg serokonversiyonu ile olasý iliþkisinin araþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: HLA-DPA1 alellerinin tedavi yanýtý, siroz geliþimi, HBeAg serokonversiyonu ve HBeAg kaybý sonrasýnda hastalýðýn nüksetmesi ile iliþkilerinin araþtýrýlmasý amacýyla 246 KHB hastasýnýn 8 farklý HLA-DPA1 aleli sekans spesifik primerler kullanýlarak polimeraz zincir reaksiyonu ile dizilenmiþtir.
BULGULAR: HLA-DPA1 alelleri ile tedavi yanýtý, siroz oluþumu ve HBeAg serokonversiyonu arasýnda anlamlý bir iliþki mevcut deðildir. Fakat, HLA-DPA1*04: 01 aleli HBeAg serokonversiyonu sonrasýnda hastalýðýn tekrar yüksettiði hastalarda daha sýk görülmektedir (100% vs 36.8%, Fisher’in kesin testine göre p = 0.037).
TARTIÞMA ve SONUÇ: HLA-DPA1*04: 01 aleli HBeAg serokonversiyonu sonrasýnda hastalýðýn tekrar nüksetmesinde bir risk faktörü olarak görülebilir.

INTRODUCTION: Chronic hepatitis B (CHB) is a major health problem. The outcome of hepatitis B virus (HBV) infection is associated with variations in HLA-DPA1 alleles. The aim of this study was to investigate possible associations of HLA-DPA1 alleles with treatment response and with hepatitis B virus e antigen (HBeAg) seroconversion.
METHODS: Eight different HLA-DPA1 alleles from 246 CHB patients were genotyped by polymerase chain reaction with sequence-specific primers at high resolution to investigate the association of HLA-DPA1 alleles with treatment response, development of cirrhosis, HBeAg seroconversion, and disease reoccurrence upon HBeAg loss.
RESULTS: There was no significant association between HLA-DPA1 alleles and treatment response, development of cirrhosis, or HBeAg seroconversion. However, HLA-DPA1*04: 01 allele was significantly more frequently found in patients who redeveloped disease upon HBeAg seroconversion (100% vs 36.8%: p=0.037; Fisher’s exact test).
DISCUSSION AND CONCLUSION: HLA-DPA1*04: 01 allele may be a risk factor for reoccurrence of CHB after HBeAg seroconversion.

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GÝRÝÞ ve AMAÇ: Sepsis, günümüzde modern týp alanýnda yapýlan taný ve tedavideki geliþmelere raðmen halen önemli morbidite ve mortalite nedenlerinden biridir. Bu nedenle tanýyý destekleyecek doðru ve hýzlý sonuç veren laboratuvar incelemelerine gereksinim vardýr. Bu çalýþma, prokalsitonin ve sTREM-1 gibi immünolojik göstergelerin, sepsis ve SIRS olgularýnýn ayýrýcý tanýsýndaki deðerini ölçmek ve sepsisli hastalarýn prognozunu belirlemedeki deðerini araþtýrmak amacýyla planlanmýþtýr.

YÖNTEM ve GEREÇLER: Prospektif olarak yapýlan çalýþma kapsamýna 20-92 yaþ arasý 38 SIRS ve 52 sepsis olmak üzere toplam 90 hasta alýnmýþtýr. Hastalardan yatýþ sýrasýnda ve takipte iki kan örneði alýnmýþtýr. sTREM-1 ELISA yöntemi (MyBioSource, Italy), procalcitonin miniVIDAS B.R.A.H.M.S PCT® assay (BioMerieux®, France) ile ölçülmüþtür. Ayrýca hastalar klinik olarak APACHE II skorlama sistemi ile deðerlendirilmiþtir.
BULGULAR: Yoðun bakýma yatýþ günü alýnan örneklerde sTREM-1, PCT seviyeleri ve APACHE II skoru sepsis grubunda SIRS grubuna göre anlamlý olarak yüksektir (p=0.001;p=0.01;p=0.001). sTREM-1 düzeyleri ve APACHE II skoru kan kültürü pozitif olanlarda negatiflere göre daha yüksek bulunmuþtur (p=0.002; p= 0.006). PCT, CRP ve sTREM-1 seviyeleri, hayatýný kaybedenlerde anlamlý olarak yüksektir. Sepsis SIRS ayrýmýnda sTREM için cut-off deðeri ≥ 133 pg/ml alýndýðýnda duyarlýlýk %71.1 özgüllük %76.3, PCT 1.57 alýndýðýnda duyarlýlýk %67.3 ve özgüllük %65.79 olarak bulunmuþtur.
TARTIÞMA ve SONUÇ: Sepsis düþünülen hastalarda APACHE II ve SOFA gibi skorlama sistemlerine ek olarak sTREM-1 ve PCT kullanýlabilir. Ancak bulgularýmýzýn daha geniþ serili çalýþmalarla desteklenmesi uygun olacaktýr.

INTRODUCTION: Sepsis is still major cause of morbidity and mortality, despite improvements in diagnosis and treatment in modern medicine. Therefore, laboratory examinations that provide correct and rapid results are needed to support the diagnosis. This study was conducted to investigate value of immunological indicators procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in differential diagnosis of patients with sepsis and systemic inflammatory response syndrome (SIRS), as well as to assess their importance in determining prognosis of patients with sepsis.
METHODS: Total of 90 patients, 38 with SIRS and 52 with sepsis, who were between the ages 20 to 92, were included in this prospectively planned study. Blood sample was collected from the patients during hospitalization and again in follow-up visit. Enzyme-linked immunosorbent assay (MyBioSource, Inc., San Diego, CA, USA) was used to measure sTREM-1, and PCT was measured using mini VIDAS B.R.A.H.M.S PCT assay (Biomerieux, S.A., Marcy-l’E'toile, France). In addition, patients were clinically assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system.
RESULTS: On day of intensive care unit admission, sTREM-1 and PCT levels, as well as APACHE II score were significantly higher in sepsis group than SIRS group (p=0.001, p=0.01, p=0.001, respectively). Values of sTREM-1 and APACHE II score were higher in the patients with positive blood cultures than those with negative culture results (p=0.002, p=0.006, respectively). PCT, C-reactive protein, and sTREM-1 levels were significantly higher in nonsurviving group. In differentiation of SIRS from sepsis, sTREM-1 cut-off value ≥133 pg/mL and PCT cut-off value of 1.57 ng/mL yielded sensitivity of 71.1% and 67.33%, and specificity of 73.3% and 65.79%, respectively.
DISCUSSION AND CONCLUSION: In patients with suspected sepsis, sTREM-1 and PCT can be used as indicators, in addition to scoring systems such as APACHE II and Sepsis-related Organ Failure Assessment score. However, it would be appropriate to support present findings with studies of larger series.

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GÝRÝÞ ve AMAÇ: Inflamatuar Barsak Hastalarýnda (IBH) yaþlý tanýmý icin net olarak kabul edilmiþ bir yaþ yoktur ancak son yayýnlarda 60 yaþ yaygýn kullaným bulmaktadýr. IBH yaþlý popülasyonda genç eriþkinden daha farklý seyirler göstermektedir. Klinik daha hafif seyirli olmakta ve yaþ, komorbid hastalýklar; ilaç etkileþimleri ve organ yetersizlikleri gibi nedenlerden dolayý tedavi seçenekleri kýsýtlanmaktadýr. Yaþlý popülasyonda Crohn Hastalýðý ile ilgili sinirli sayýda yayýn mevcuttur. Burada ülkemizden bu konu ile ilgili ilk verileri bildiriyoruz.
YÖNTEM ve GEREÇLER: Hastanemiz IBH polikliniðinde 1996 ve 2015 yýllarý arasýnda takip ve tedavi edilen toplam 3125 hastadan Crohn Hastalýðý tanýsý olan 95 hasta çalýsmaya alýndý. Veriler hasta kayýtlarý ve özel dosya sisteminden elde edilerek toplandý.
BULGULAR: Ortalama yas 66 ve K/E oraný 1.6 olarak saptandý. Hastalarýn %48.4'unde kolonik hastalýk, %37.9'unda ileokolonik tutulum ve %13.7'sinde sadece ince barsak tutulumu saptandý. Hastalarýn %23.1'inde cerrahi gereksinimi ki cogunlukla sag hemikolektomi ve ilerotransversostomi saptandý. Hastalarýn büyük cogunlugu mesalazin ve azatiyoprin almaktaydý. %12.6'sinda en sýk koroner arter hastalýðý olmak üzere 2 ya da daha fazla komorbid hastalýk bulunmaktaydý.
TARTIÞMA ve SONUÇ: Verilerimiz literatürde daha önce saptanan veriler ile paralellik göstermektedir. Bu yayýn ülkemizden geriatrik popülasyonda Crohn Hastalýðý ile ilgili olarak tatmin edici hasta sayýsý ile birlikte ilk veridir.

INTRODUCTION: There is no precise consensus at present on age to define elderly patients with inflammatory bowel disease (IBD), but recently, age of more than 60 years has been widely accepted. Characteristics of IBD in the elderly are somewhat different from what is seen in younger patients. The elderly have milder disease activity, and therapeutic options are fewer because of their age and features such as comorbidities, drug interactions, and loss of organ function. There are few reports on Crohn’s disease in the elderly. Herein, first report on this topic with respect to population of this country is presented.
METHODS: Characteristics of 95 patients with Crohn’s disease, who were over age 60 from 3125 patients with IBD treated in our clinic between 1996 and 2015 were analyzed. Research was performed using patient files, and outpatient clinic visits, when possible.
RESULTS: Median age of the group was 66 years, and male: female ratio was 1.6. Of the total, 48.4% of the patients had colonic disease, 37.9% had ileocolonic disease, and 13.7% had small bowel disease. Data indicated that 23.1% of patients had undergone surgical procedures, which were primarily right hemicolectomy and ileotransversostomy. Disease was most often managed with mesalazine or azathioprine. It was also determined that 12.6% patients had 2 or more comorbidities, and findings indicated coronary heart disease and hypertension were most prevalent.
DISCUSSION AND CONCLUSION: Analysis revealed similar features in characteristics of disease compared with recent knowledge reported in the literature. This is the first report from our country to describe Crohn’s disease in the elderly population, and the number of patients is sufficient to provide general information about this group.

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GÝRÝÞ ve AMAÇ: Bu çalýþma 2011 yýlýnda Sri Lanka’da geliþtirilen hemþirelik hizmetleri ve ilgili hastane hizmetlerinin kalitesine dair hasta algýlarý ölçeðinin Türk hastalarda geçerlilik ve güvenilirliðini test etmek amacýyla yapýldý.
YÖNTEM ve GEREÇLER: Metodolojik tipteki araþtýrma, etik onay ve kurum izinleri alýndýktan sonra Ýstanbul ilinde yer alan bir týp fakültesi hastanesinde tedavi olmak üzere en az 3 gün yatan, 180 eriþkin hastaya taburculuklarý sýrasýnda Kasým 2013-Kasým 2014 tarihleri arasýnda uygulandý. Ölçeðin dil geçerliði yapýldýktan sonra geçerlik ve güvenirlik analizleri yapýldý. Ýçerik geçerliliði, içerik geçerliliði indeksi, yapý geçerliliði, açýklayýcý faktör analizi, güvenirliði Cronbah’s alpha ve madde toplam korelasyonu ile incelendi.
BULGULAR: Ýçerik geçerliliði indeksi ortalamasý 0.95 ile beklenen deðerin üzerinde bulundu. Açýklayýcý faktör analizi sonucunda Hemþirelik Bakýmý ve Ýlgili Hastane Hizmetlerinin Kalitesine Dair Hasta Algýlarý Türkçe ölçeðinde, toplam varyansýn 82.40’ýný açýklayan, öz deðeri 1’in üzerinde olan 4 faktör saptandý. Her bir ifadenin faktör yükünün ≥ 40 olduðu saptandý. Alt boyutlarda Cronbah alpha deðerleri 0.84 to 0.98 arasýnda, toplamda ise 0.98 bulundu. Madde toplam korelasyon deðerinin tüm grupta 0.56-0.83 arasýnda deðiþtiði ve beklenen sýnýrýn üzerinde olduðu görüldü.
TARTIÞMA ve SONUÇ: Dört alt boyut ve 36 maddelik Hemþirelik Bakýmý ve Ýlgili Hastane Hizmetlerinin Kalitesine Dair Hasta Algýlarý Türkçe ölçeðinin Türk toplumu için geçerli ve güvenilir olduðu sonucuna varýldý.

INTRODUCTION: This study aimed to test the validity and reliability of a version of the tool developed in Sri Lanka in 2011 to assess patient perceptions of the quality of nursing care and related hospital services created for use with Turkish patients.
METHODS: This methodological study was conducted between November 2013 and November 2014 after obtaining ethical approval and organizational permission. Data was collected during discharge from 180 adult patients who were hospitalized for at least 3 days at a medical school hospital located in Istanbul. After language validation, validity and reliability analyses of the scale were conducted. Content validity, content validity index (CVI), construct validity, and exploratory factor analysis were assessed and examined, and reliability was tested using the Cronbach’s alpha coefficient and item-total correlations.
RESULTS: Mean CVI was found to be 0.95, which is above expected value. Exploratory factor analysis revealed 4 factors with eigenvalues above 1, which explained 82.4% of total variance in the Turkish version of the tool to measure patient perceptions of nursing care and other hospital services. Factor loading for each item was ≥.40. Cronbach’s alpha coefficient of sub-dimensions and total scale were found to be 0.84-0.98 and 0.98, respectively. Item-total correlations ranged from 0.56 to 0.83 for the entire group, which was above expected values.
DISCUSSION AND CONCLUSION: The Turkish version of the scale to assess patient perceptions of the quality of nursing care and related hospital services, which comprised 4 sub-dimensions and 36 items, was found to be valid and reliable for use with the Turkish population.

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GÝRÝÞ ve AMAÇ: Timoma tipik bir epitelyal tümördür. Nadir görülmekle birlikte ön mediyastinal kitlelerin %50’sini oluþtururlar. Prognozu etkileyen faktörler net deðildir. Timomaya eþlik eden immün hastalýklar çok çeþitli olup, Myastenia Gravis (MG) en sýk eþlik eden paraneoplastik sendromdur. Timomanýn tedavisinde en etkili yöntem komplet cerrahi rezeksiyondur. Bu çalýþmada timomalý olgularda MG varlýðýnýn prognozu ne yönde etkilediði incelenmistir.
YÖNTEM ve GEREÇLER: Kliniðimizde Ocak 2003- Eylül 2016 tarihleri arasýnda timoma tanýsýyla opere edilen 61 olgu retrospektif olarak incelendi. Olgular MG’nin eþlik ettiði ve etmediði timoma olarak iki gruba ayrýldý. Yaþ, cinsiyet, þikayet, lezyon lokalizasyonu, giriþim yolu, yapýlan rezeksiyon, histopatolojik taný, evre, ve uzun dönem takip sonuçlarý açýsýndan deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilen toplam 58 olguda ortalama yaþ 48 olup bu olgularýn 37’i erkek, 21’i kadýn idi. 24 olguya MG eþlik ederken, 34 olguya MG eþlik etmiyordu. Olgularýn izlem süresi 1 ay ile 155 ay arasýnda deðiþmekteydi.
TARTIÞMA ve SONUÇ: MG’nin eþlik ettiði grupta 5 yýllýk saðkalým % 87.5 iken MG’nin eþlik etmediði grupta %82.4 olarak saptandý. MG’in eþlik ettiði timoma olgularýnýn sað kalým süresi daha uzun olmasýna raðmen iki grup arasýnda anlamlý bir istatistiksel farklýlýk saptanmadý (p=0.311).

INTRODUCTION: Thymoma is a standard epithelial tumor. Though it is rare, it constitutes 50% of anterior mediastinal masses. Variety of immunological diseases may accompany thymoma; however, myasthenia gravis (MG) is the most frequently associated paraneoplastic syndrome. Most effective treatment for thymoma is complete surgical resection. In this study, impact of MG on prognosis of thymoma cases was examined.
METHODS: Records of 61 patients who underwent surgery with diagnosis of thymoma between January 2003 and September 2016 were retrospectively reviewed. All cases were analyzed for data related to age, gender, complaint, localization of lesion, surgical procedure, histopathological diagnosis, stage, MG, and long-term follow-up results.
RESULTS: Total of 58 cases were included in the study. Of those, 37 patients were male and 21 were female. Mean age was 48 years. While 24 cases of thymoma were accompanied by MG, 34 cases were not. Duration of follow-up ranged from 1 month to 155 months.
DISCUSSION AND CONCLUSION: It was found that in group with MG, 5-year survival rate was 87.5% while it was 82.4% in group without MG. Despite longer duration of survival in group of thymoma associated with MG, there was no significant statistical difference between groups (p=0.311).

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GÝRÝÞ ve AMAÇ: Osteoporoz kemik yoðunluðunun azalmasý ve kemik yapýsýnýn bozulmasý ile karekterize ilerleyici metabolic kemik hastalýðýdýr. Çift enerji X-ýþýný absorpsiyometre (DXA) kemik mineral yoðunluðu ölçümünde yaygýn kullanýlan güvenilir ölçüm tekniðidir. Çalýþmamýzýn amacý sol proksimal tibia kemik mineral yoðunluðunun normal aralýðýný belirlemektir.
YÖNTEM ve GEREÇLER: Çalýþma 25-69 yaþlarý arasýndaki 55 kadýnda yapýldý. Lumbal vertebra ve sol proksimal tibianýn DXA kullanýlarak kemik mineral yoðunluklarý ölçüldü. Sol proksimal tibia alt-bölgelerin kemik mineral yoðunluðu deðerleri ile total lumbal vertebra BMD deðeri arasýnda anlamlý korelasyon vardý (r=0.111-0.766). Normal populasyonda total lumbal vertebra (L1-L4) ortalama KMY deðerine götüren lineer regresyon formülüyle yaþ ile uyumlu sol proksimal tibia bölgelerinin ortalama KMY deðeri hesaplandý. Bundan yeni simüle edilmiþ T skorlarý ölçüldü.
BULGULAR: Proksimal tibia alt-bölgelerinin yeni simüle edilmiþ T skorlarý ile total lumbal vertebra T skoru arasýnda istatistiksel olarak anlamlý bir fark yoktu (p>0.05).
TARTIÞMA ve SONUÇ: Proksimal tibianýn osteoporozda KMY ölçümü için ideal yeni bir deðerlendirme alaný olduðunu düþünmekteyiz.

INTRODUCTION: Osteoporosis is progressive metabolic bone disease that decreases bone density and features deterioration of bone structure. Dual-energy X-ray absorptiometry (DXA) is commonly used and reliable method to measure bone mineral density (BMD). Aim of this study was to determine normal ranges of BMD in left proximal tibia.
METHODS: Fifty-five females were included in this study. BMD was measured at the lumbar spine and the left proximal tibia using DXA. BMD value of subregions in the left proximal tibia was significantly correlated with BMD value of the total lumbar spine (r=0.111–0.766). New average BMD values of the left proximal tibia were calculated according to age using linear regression formula, leading to average BMD value for the total lumbar spine (L1-L4) in normal population. New simulated T-scores for proximal subregions of the tibia were then calculated.
RESULTS: T-scores for proximal subregions were not different from T-scores of total lumbar spine (p>0.05).
DISCUSSION AND CONCLUSION: It was concluded that proximal tibia is an ideal region for measurement of BMD in osteoporosis.

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GÝRÝÞ ve AMAÇ: Postoperatif üriner retansiyon (POÜR) spinal anestezi sonrasý sýk karþýlaþýlan bir komplikasyondur. Ultrason anestezi öncesi ve cerrahi sonrasý mesane hacminin hesaplanmasýnda, miksiyon sonrasý rezdüel volümün tahmininde kolayca kullanýlabilen non-invaziv bir yöntemdir. Çalýþmanýn primer amacý spinal anestezi uygulanacak hastalarda operasyon öncesi ve sonrasý ölçülen mesane hacminin, postoperatif üriner retansiyonun öngörülmesi üzerindeki etkisinin araþtýrýlmasýdýr. Sekonder amaç, üretral kateter kullanýmýnýn gerekliliðini ve sondaya baðlý üriner enfeksiyon riskini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya spinal anestezi altýnda elektif unilateral artroskopik diz cerrahisi geçirmesi planlanan 80 hasta dahil edildi. Duysal ve motor blok oluþma süreleri ve seviyeleri, preoperatif, derlenme odasýna alýnýrken ve çýkýþta mesane hacimleri, üretral sonda kullanýmý ve üriner enfeksiyon görülme oranlarý kaydedildi.
BULGULAR: Hastalarýn %28.7’sinde postoperatif üriner retansiyon geliþirken %71.3’ünde üriner retansiyon görülmedi. Duysal bloðun L2 seviyesine gerileme süreleri idrar retansiyonu geliþmeyen hastalarda anlamlý olarak düþük bulundu (p=0.012). Üriner retansiyon geliþen 23 hastadan 3 hasta mesane hacmi 600 ml’nin altýnda olmasýna raðmen spontan idrar yapamadý. Mesane hacmi 600 ml’nin üzerinde olup idrar yapamayan hasta sayýsý 20’ydi. Üriner retansiyon geliþen ve geliþmeyen gruplarda preoperatif mesane hacimleri arasýnda farklýlýk bulunmazken postoperatif derlenme odasýna kabulde üriner retansiyon geliþen hastalarýn mesane hacimleri anlamlý olarak yüksek bulundu (p= 0.023). Postoperatif dönemde üretral kateterizasyona baðlý 5 hastada aðrý ve sýk idrar yapma þikayetleri görüldü. Bu hastalarýn bir tanesinde üriner enfeksiyon geliþti. Üretral kataterizasyon yapýlan ve yapýlmayan hastalarda üriner enfeksiyon geliþimi açýsýndan anlamlý farklýlýk yoktu.
TARTIÞMA ve SONUÇ: Artroskopik diz cerrahisi geçirecek olan hastalarda mesane hacminin ultrason ile ölçümü POÜR geliþimini öngörmede kullanýlabilir. Elektif üriner kataterizasyondan kaçýnmak üriner sistem enfeksiyonlarýný azaltabilir.

INTRODUCTION: Postoperative urinary retention (POUR) is a common complication after spinal anesthesia. Ultrasound (US) is a simple, non-invasive method to estimate bladder volume before and after surgery. Primary aim of the present study was to investigate utility of bladder volume measured before and after surgery in prediction of POUR risk. Secondary aim was to investigate necessity of urethral catheter use and risk of urethral catheter-related infections.
METHODS: Eighty patients who received spinal anesthesia for arthroscopic knee surgery were included in the study. Level and duration of sensory and motor block; bladder volume measured preoperatively, in post-anesthetic care unit (PACU), and when discharged from PACU; use of urethral catheter; and incidence of urinary tract infection data were recorded.
RESULTS: POUR was observed in 28.7% of patients. Length of time for sensory block regression was significantly shorter in patients without POUR (p=0.012). Spontaneous urination was not observed in 3 of 23 patients with POUR, although bladder volume was less than 600 mL. Bladder volume over 600 mL without urination was recorded in 20 patients. There was no statistical difference in preoperative bladder volume between patients who did or did not develop POUR. Bladder volume on admission to PACU was higher in patients with POUR (p=0.023). Urgency and dysuria were observed in 5 patients who required urethral catheterization during postoperative period. Urinary tract infection developed in 1 patient. There was no statistical difference in development of urinary tract infection between patient groups who did and did not undergo urethral catheterization.
DISCUSSION AND CONCLUSION: Assessment of patient bladder volume with US before arthroscopic knee surgery may be used to foresee development of POUR. Avoiding elective urinary catheterization may reduce urinary infections.

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GÝRÝÞ ve AMAÇ: Kanser hastalarý yoðun bakým ünitelerinde; kanser iliþkili veya tedaviye baðlý komplikasyonlar nedeniyle takip edilmektedir. Bu çalýþmada; genel yoðun bakým ünitesinde yatan kanserli olgularýn analizi amaçlandý.
YÖNTEM ve GEREÇLER: Çalýþmamýzda; 01 Ocak 2011 ile 31 Aralýk 2012 tarihleri arasýnda Dr. Lütfi Kýrdar Kartal Eðitim ve Araþtýrma Hastanesi Reanimasyon Ünitelerinde takip edilen kanser hastalarý retrospektif olarak tarandý. Kanser hastalarýnýn demografik verileri ile malignite türü hazýrlanan formlara kaydedilerek incelendi.
BULGULAR: 2011-2012 yýllarýnda çalýþmaya dâhil edilen 2240 yoðun bakým hastasýndan 482 kanser hastasý tespit edildi. Yoðun bakýmda kanserli hasta oraný %23,9 olarak bulundu. Kanser hastalarýnýn yaþ aralýðý 3-93 yýl, yaþ ortalamasý 59,9 ve erkek/kadýn oraný: 1,55 olarak bulundu. En sýk görülen ilk üç kanser: kolorektal (%19,7), akciðer (%15,7) ve mide kanserleri (%11,6) olarak tespit edildi. Reanimasyon ünitelerimize yatan kanser hastalarý için mortalite oraný: %46,6 olarak saptandý. Yapýlan deðerlendirme sonucunda larenks, akciðer, mesane, deri, rektosigmoid, hematolojik, böbrek malignite türleri erkek baðýmlý iken özofagus ise kadýn baðýmlý malignite türü olarak tespit edildi. Diðer taraftan, mide, beyin, pankreas ve sýnýflandýrýlmamýþ tümörler herhangi bir cinsiyetle iliþkili olmayan malignite türleri olarak bulundu.
TARTIÞMA ve SONUÇ: Yoðun bakým ünitemizde, kadýn ve erkeklerde en çok rektosigmoid tümör tanýsý nedeniyle yatýþý olanlar hastalar bulunmaktadýr. Cinsiyetle iliþkilendirilmiþ kanserler dýþýnda, cinsiyetlerin birbirine oraný açýsýndan; özofagus kanserlerinin kadýn, larenks kanserlerinin ise erkek cinsiyetle baðýmlý olduðunu saptadýk.

INTRODUCTION: The present study is an analysis of cancer patients who received follow-up treatment for either can-cer-related complications or treatment-associated side effects while hospitalized in the intensive care unit (ICU).
METHODS: Records of cancer patients treated at Dr. Lütfi Kýrdar Kartal Training and Research Hospital ICU between January 1, 2011 and December 31, 2012 were retrospectively reviewed. Demographic data and type of cancer were recorded in prepared forms and subsequently analyzed.
RESULTS: Among 2240 ICU patients treated and hospitalized between January 1, 2011 and December 31, 2012, 482 cancer patients were identified and included in the study. Percentage of cancer patients in ICU was 23.9%. Male to female ratio was determined to be 1.55. First 3 most common cancers found were colorectal (19.7%), lung (15.7%), and stomach cancers (11.6%). Mortality rate of cancer patients hospitalized in ICU was 46.6%. Larynx, lung, urinary bladder, skin, rectosigmoid, hematological, and kidney cancer were more prevalent in male patients, whereas esophageal cancer was seen in more female patients than male patients. Incidence of stomach, brain, and pancreatic cancers, as well as unclassified tumors, was found to be unrelated to gender.
DISCUSSION AND CONCLUSION: Rectosigmoid cancer was most common type of cancer observed in our ICU. Esophageal cancer was observed in more females than males, while larynx cancer was more frequently present in males.

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Leiomyomlar düz kas bulunan tüm dokulardan geliþebilen benign neoplasmlardýr. Overin primer leomyomasý, over dokusu içindeki düz kas hücrelerinden köken alan oldukça nadir soliter yapýlý tümörlerdir. Günümüze dek ortalama 70 vaka bildirilmiþtir. Genellikle premenopozal kadýnlarda görülür. Bu yazýda, postmenopozal bir hastada sol overden kaynaklanan primer ovaryan leiomyom vakasý sunulmuþtur.

Leiomyomas are benign neoplasms that can develop wherever smooth muscle is present. Primary leiomyomas of the ovary originate from smooth muscle cells of ovarian tissue and are rare, solitary tumors. Approximately 70 cases have been reported. They usually present in premenopausal women. The present case is a report of left ovarian leiomyoma in a postmenopausal woman.

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Þilotoraks süt rengi plevral aspiratta yüksek trigliserid ve düþük kolesterol düzeyleri ile karakterli nadir rastlanan bir klinik durumdur. Genellikle travma ya da maligniteler durumunda torasik kanalýn etkilenmesi ile plevral boþluða þili sýzmasý sonucu oluþur. Tüberküloz lenfadenite baðlý þilotoraks literatürde çok az sayýda vaka þeklinde bildirimi yapýlmýþ çok nadir bir durumdur. Patogenez kesin olarak bilinmemekle birlikte, büyümüþ mediastinal ve hiler lenf nodlarýnýn sisterna þili ve torasik kanala basý oluþturmasý ile torasik kanal sistemi ve azygos, interkostal venler arasý kolleteral anastamozlarýn açýlmasý ile iliþkili olduðu düþünülmektedir. Burada mediastinal tüberküloz lenfadenit basýsýna baðlý olduðunu düþündüðümüz þilotorakslý bir hastanýn antitüberküloz tedavi sonrasý plevral effüzyonunun tamamen gerilediðini bildirmek istedik.

Chylothorax is a rare clinical condition characterized by high triglyceride and low cholesterol levels in milky pleural aspirate. Generally, it occurs through leakage of chyle as result of trauma or malignancy. Chylothorax due to tuberculous lymphadenitis is very rare clinical condition that has only been documented in a few cases. Although precise pathogenesis is not known, enlarged mediastinal and hilar lymph nodes are thought to be associated with opening of collateral anastomosis between thoracic duct and the azygos and intercostal veins by creating pressure on thoracic duct and cisterna chyli. Presently described is case of chylothorax thought to be due to compression from mediastinal tuberculous lymphadenitis, and which had complete remission after antituberculosis treatment.

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Benign paroksismal pozisyonel vertigo (BPPV) en yaygýn periferik vertigo nedeni olup KBB ve nöroloji kliniklerinin önemli bir hasta bölümünü oluþturmaktadýr. Çeþitli manevralarla oluþan özgün nistagmus bulgularýyla sorumlu kanal hakkýnda bilgi edinilirken, yine farklý manevra türleriyle tedavileri yapýlabilmektedir. Çoklu kanal patolojileri hem tanýsal hem de tedavi basamaklarý açýsýndan farklý zorluklar içermektedir. Bu makalede travmatik etiyoloji sonrasý ortaya çýkan ve tedavi manevralarýna dirençli bir çoklu kanal patolojili BPPV olgusu sunuldu.

Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo and is seen in a significant number of patients who present at neurology and ear, nose, and throat clinics. Various maneuvers may be used to determine the affected canal based on observation of specific nystagmus signs, and may also be used for treatment. Multiple canal pathology can make diagnosis and treatment more difficult. Presently described is case of BPPV with multiple canal pathology and traumatic etiology that was resistant to treatment.

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Fibromiyalji sendromu (FMS), tedavisinde çeþitli farmakolojik veya non-farmakolojik modaliteler önerilen yaygýn bir romatolojik hastalýktýr. Son kýlavuzlarda, FMS için pregabalin ilk basamak tedavi olarak önerilmektedir. Pregabalinin iyi bilinen yan etkileri somnolans, baþ dönmesi, periferik ödemdir, ancak mastalji çok nadiren görülür. Bu yazýda, pregabalin tedavisi altýnda mastalji ve hiperprolaktinemi geliþen FMS'li bir olgu sunulmuþtur.

Several pharmacological and non-pharmacological modalities have been proposed for the treatment of fibromyalgia syndrome (FMS), a common rheumatic disease. Pregabalin is suggested as a first-step medication for FMS in the newest guidelines. Drowsiness, dizziness, and peripheral edema are well-known side effects of pregabalin; however, mastalgia is rarely seen. Presently described is a case of FMS in a patient who developed mastalgia and hyperprolactinemia (HPL) while taking pregabalin.

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Ýnkomplet yapýlmýþ apandektominin nadir komplikasyonu olan güdük apandisit remnant apandiks dokusunun akut inflamasyonudur. Akut batýn tablosu ile ortaya çýkabilir, apandektomi hikayesi tanýda gecikmeye sebep olabiilir. Ýnkomplete apandektomi, apandektomi hikayesi olan hastalarda ayýrýcý tanýda yer almalýdýr. Bu makalede apandektomiden 6 ay sonra geliþen güdük apandisit olgusunu sunduk. Apandektomi uygulanan hasta postoperatif 7. günde komplikasyonsuz taburcu edildi.

Stump appendicitis is an acute inflammation of remnant appendix, a rare complication of incomplete appendectomy. It may present as acute abdomen with history of appendectomy, which may cause delay in diagnosis. Therefore, incomplete appendectomy should be considered as a differential diagnosis of acute abdomen in patients with medical history of appendectomy. The present case is one of stump appendicitis 6 months after appendectomy. Stump appendectomy was performed and the patient was discharged 7 days after the operation without any complication.

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