AMAÇ: Proksimal femoral ekstrakapsüler geriatrik kýrýklarýn tedavisinde kliniðimizde kullanýlan iki deðiþik yöntemle elde edilen sonuçlar karþýlaþtýrýlarak prognoza etkili faktörler belirlendi.
YÖNTEMLER: 2001-2006 yýllarý arasýnda 70 yaþ üzeri pertrokanterik kýrýk nedeniyle dinamik kayýcý kalça çivisi (Grup I, n=46; 18 erkek, 28 kadýn; ort. yaþ 80,1; daðýlým 70-95) ve proksimal femur çivisi ile tedavi edilen hastalar (Grup II, n=33; 12 erkek, 21 kadýn; ort. yaþ 78,8; daðýlým 70-92) geriye dönük olarak deðerlendirildi. Kýrýk sýnýflamasýnda AO/OTA sýnýflamasý kullanýldý.
BULGULAR: Ortalama takip süreleri Grup I’de 43,5 ay (daðýlým 14-71), Grup II’de 23 aydý (daðýlým 18-31). Ameliyat sonrasý erken dönemde ve son kontrollerde çekilen grafilerde kollodiafizer açý ölçüldü. Reoperasyon oraný Grup I’de 3 hasta (%6,5) Grup II’de 2 hasta (%6); bir yýl içinde mortalite Grup I’de 6 hasta (%13), Grup II’de 2 hastaydý (%6). Parker-Palmer mobilite skoru son kontrolde Grup I’de 5 (daðýlým 3-9), Grup II’de 6,5 (daðýlým 4-9) bulundu. Mann-Whitney U testi ile, Singh indeksi, kollodiyafizer açý ve uç-tepe mesafesi ölçümlerinde iki grup arasýnda anlamlý fark bulunmadý. Ýki gruptaki kötü sonuçlu olgularýn geriye dönük incelemesinde, tekniðe uygun ameliyat yapýlmadýðý için yetmezliklerin geliþtiði gözlemlendi.
SONUÇ: Kendi tecrübemizden elde ettiðimiz çýkarým, asýl önemli sorunun implant seçimi deðil, seçilen implantýn uygun cerrahi teknikle yapýlýp yapýlmadýðýdýr.

OBJECTIVE: The results of two different methods used in our clinic in the treatment of proximal femoral geriatric fractures were compared and prognostic factors were determined.
METHODS: During 2001-2006, patients over 70 years old treated with either dynamic hip screw (Group I, n=46; 18 males, 28 females; mean age 80.1; range 70 to 95 years) or proximal femoral nail (Group II, n=33; 12 males, 21 females; mean age 78.8; range 70 to 92 years) for pertrochanteric fractures were retrospectively evaluated. AO/OTA classification system was used.
RESULTS: The mean follow-up period was 43.5 months (14-71) for Group I and 23 months (18-31) for Group II. Reoperation was necessary in 3 (6.5%) patients in Group I and in 2 (6%) patients in Group II. Mortality rate in the first postoperative year was 13% (n=6) in Group I and 6% (n=2) in Group II. Parker-Palmer mobility scores in Group I and in Group II at the last assessment were 5 (3-9) and 6.5 (4-9), respectively. No statistical difference was noted between the two treatment methods with respect to Singh index scores, collodiaphyseal angles and tip-apex measurements with the Mann-Whitney U test. Retroscopic evaluation of the poor results of both methods proved that unsatisfactory surgical technique resulted in implant failures.
CONCLUSION: Our conclusion is that the question to be asked is not “which implant?”, but “how good is the surgical technique?”.

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AMAÇ: Bu çalýþmada, elektif histerektomi ameliyatý geçirecek hastalarda epidural levobupivakain ve bupivakainin etkilerinin karþýlaþtýrýlmasý amaçlandý.
YÖNTEMLER: ASA I-II grubundaki 50 hasta çalýþmaya dahil edildi. Grup B hastalara 17 ml (85mg) izobarik bupivakain, Grup L hastalara 17 ml (85 mg) izobarik levobupivakain epidural aralýktan uygulandý. Hemodinamik parametreler, epidural blok öncesi, epidural blok baþlangýç, 5., 10., 15., 30., 45., 60., 90. ve 120. dk, ameliyat bitimi, ameliyat sonrasý 15. dk ve 30. dk’lar izlenerek kaydedildi. Duyusal blok seviyesi “pin-prick” ve buz testi ile, motor blok seviyesi ise modifiye Bromage skalasý ile, lokal anestezik verilmesi sonrasý her iki dakikada bir deðerlendirildi. Her iki ilaç için duyusal blok baþlama ve gerileme, duyusal bloðun T6’ya ulaþma süreleri, motor blok baþlama ve gerileme süresi, ilk analjezik gereksinim süresi, ameliyat süresi ve yan etkiler kaydedildi. Cerrahi iþlem baþladýktan sonra aðrý þiddetini belirlemek amacýyla vizüel analog skala (VAS) kullanýldý.
BULGULAR: Gruplar arasýnda demografik özellikler, ASA sýnýflamasý ve hemodinamik parametreler açýsýndan istatistiksel olarak anlamlý bir farklýlýk yoktu (p>0,05). Duyusal ve motor blok baþlama, gerileme süresi, ilk analjezik ihtiyacý süresi açýsýndan istatistiksel olarak anlamlý fark gözlenmedi (p>0,05).
SONUÇ: Benzer özelliklere sahip olmasý nedeniyle epidural anestezi uygulamalarýnda levobupivakainin bupivakaine uygun bir seçenek olabileceði düþünüldü.

OBJECTIVE: We aimed to compare the effects of bupivacaine and levobupivacaine applied by an epidural catheter in elective hysterectomies.
METHODS: Fifty patients, ASA I-II class, were included in this study. Patients were divided into two groups randomly as bupivacaine (Group B) or levobupivacaine (Group L). Group B received 17 ml (85 mg) bupivacaine and Group L received 17 ml (85 mg) levobupivacaine. Hemodynamic parameters were recorded before achievement of epidural block, at the beginning of block and at the 5th, 10th, 15th, 30th, 45th, 60th, 90th, and 120th minute, at the end of the operation, and at the postoperative 15th and 30th minute. Sensorial level was evaluated by loss of sensation to both cold (ice test) and pinprick test and motor block intensity was assessed bilaterally with modified Bromage scale every two minutes. The onset of sensorial block and motor blockade, time to reach T6 sensorial blockade, time to regression of motor and sensorial block, duration of postoperative first analgesic requirement, side effects, and operation time were recorded. The visual analog scale (VAS) was used to assess the intensity of pain during surgery.
RESULTS: There were no statistically significant differences between the two groups according to the demographic-hemodynamic data and ASA physical status (p>0.05). There was also no statistically significant difference between the two groups according to the onset of and time to regression of sensory and motor blocks, duration of the postoperative first analgesic requirement and duration of the surgery (p>0.05).
CONCLUSION: In view of the determined similarities, we concluded that levobupivacaine seems to be a suitable alternative to bupivacaine in epidural anesthesia.

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AMAÇ: Bu çalýþmada, ürtiker geliþimine neden olabilecek faktörlerin görülme oranlarýnýn saptanmasý ve bu doðrultuda baþvuran hastalarýn bilgilendirilmesi amaçlandý.
YÖNTEMLER: Ý.Ü. Cerrahpaþa Týp Fakültesi Dermatoloji Anabilim Dalýna, Ekim 2007 ile Mart 2008 tarihleri arasýnda baþvuran ve ürtiker tanýsý konulan 60 hasta çalýþmaya alýndý. Veriler yaþ, cinsiyet, hastalýk süreleri ve hastalarýn ifadesi ile ürtiker oluþumuna neden olan gýda veya diðer faktörleri de içeren 22 soruluk anket ile 21 sorudan oluþan Beck depresyon ölçeði kullanýlarak elde edildi. Verilerin istatistiksel incelenmesinde, SPSS for Windows 16.0 istatistik paket programý ve ki-kare testi kullanýldý.
BULGULAR: Çalýþlmada hastalarýn %75’inin kadýn olduðu, hastalarýn %55’inin 6 haftadan daha az süredir ürtikeri olduðu, %45’inin ise ataklarýnýn 6 haftadan daha uzun süre devam ettiði saptandý. Etyolojik faktörler incelendiðinde, ürtikerli hastalarýn atak geliþiminden önceki son 24 saat içerisinde %50’sinin peynir, %46,7’sinin çikolata ve meyve, %45’inin ise turþu yediði saptandý. Hastalarýn %33,3’ünün atak geçirmeden önce çeþitli gruplardan ilaç
içtiði öðrenildi. Araþtýrmaya alýnan hastalarýn %21,7’sinde hekim tarafýndan bir enfeksiyon odaðý saptandý.
SONUÇ: Uygulanan Beck depresyon ölçeði sonucunda hastalarýn tamamýnýn depresyonda olduðu ortaya çýkmýþtýr. Hastalarda ürtikere neden olan faktörler araþtýrýlýrken emosyonel durum da göz önünde bulundurulmalýdýr.

OBJECTIVE: The aim of this study was to determine the occurrence rate of factors that possibly cause urticaria in order to appropriately inform patients.
METHODS: Sixty patients who were referred to the Dermatology Department of Cerrahpasa Faculty of Medicine between October 2007 and March 2008 were enrolled in the study. Data were obtained by a questionnaire containing 22 items regarding age, sex, duration of illness, and food or other factors that might have caused urticaria and the 21-item Beck depression scale. Statistically, data were evaluated using the standard SPSS for Windows 16.0 program and chi-square test.
RESULTS: Seventy-five percent of the cases were female; 55% had urticaria for less than 6 weeks and 45% for more than 6 weeks. Etiological factors included consumption of cheese in 50% of patients, chocolate and fruit in 46.7%, and pickles in 45% in the last 24 hours before the attack. Thirty-three percent of patients had taken some sort of medication before the attack. An infectious focus was discovered by the physician in 21.7% of all patients.
CONCLUSION: The Beck depression scale revealed depression in all patients. While searching for an etiological factor for urticaria, the patient’s emotional status should also be considered.

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AMAÇ: Meme kanserinde aksiller lenf nodlarýnýn durumu önemli bir prognostik belirleyicidir. Standart histopatolojik yöntemlerle aksiller lenf nodu negatif olarak rapor edilen hastalarýn aslýnda mikrometastazlarý olabilir. Çeþitli yöntemlerle bugüne kadar yapýlan çalýþmalarda %9-33 oranýnda mikrometastaz saptanmýþtýr. Bu çalýþmada, aksiller lenf nodlarý hem kesit sayýsý arttýrýlarak hem de immmünohistokimyasal (‹HK) yöntemle daha da ayrýntýlý incelendi.
YÖNTEMLER: Aksiller lenf nodu metastazý olmayan 31 invaziv meme kanserli hasta çalýþma kapsamýna alýndý. Toplam 458 lenf nodunu içeren 113 parafin bloktan 300 mikrometre arayla iki kesit alýndý ve her bir kesit hematoksilen-eozin (H-E) ve ÝHK yöntemle sitokeratin AE1-AE3 antikoru ile boyandý.
BULGULAR: Otuz bir olgunun 6’sýnda (%19,3) mikrometastaz saptandý. Belirlenen mikrometastazlarda, 3’ünün çapý 0,2-2 mm arasýnda olup, diðer 3’ü izole tümör hücreleri þeklinde daðýlým göstermekteydi. Mikrometastaz ile lenfovasküler invazyon arasýnda ileri düzeyde anlamlý bir iliþki bulundu (p<0,05).
SONUÇ: Standart histopatolojik yöntemlerle deðerlendirilen ve aksiller lenf nodlarý negatif olarak taný alan meme kanserli hastalarda, lenf nodlarýnýn H-E ile boyalý kesit sayýsýnýn arttýrýlmasý ve ÝHK gibi ek inceleme yöntemleriyle deðerlendirilmesi metastaz saptama olasýlýðýný arttýrmaktadýr. Standart histopatolojik yöntemlerle lenf nodu mikrometastazlarý belirlenememektedir.

OBJECTIVE: The status of axillary lymph nodes has prognostic significance in breast cancer. In fact, patients diagnosed as axillary lymph node-negative by standard histopathological methods may have micrometastases. To date, 9-33% of cases were determined as having micrometastases in many studies using variable methods. In this study, axillary lymph nodes were investigated by increasing the sections and with immunohistochemical staining.
METHODS: Thirty-one patients with invasive breast cancer but without axillary lymph node metastases were included in this study. One hundred and thirteen paraffin blocks of 458 lymph nodes were sectioned at 300 micrometer intervals. Every section was stained with hematoxylin and eosin (H&E) and immunohistochemically by AE1-AE3 antibody.
RESULTS: Micrometastases were discovered in 6 (19.3%) of the 31 patients. Three of the discovered micrometastases were 0.2-2 mm in diameter and the other three were distributed as isolated tumor cells. There was an advanced meaningful association between lymphovascular invasion and micrometastases.
CONCLUSION: In patients with breast cancer who were evaluated by standard histopathological methods and were lymph node-negative, the possibility of discovering metastases may increase by increasing the lymph node sections and with H&E and immunohistochemical staining. Lymph node micrometastases can not be determined by standard histopathological methods.

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AMAÇ: Bu çalýþmada, hastanemiz polikliniklerinde hipertansiyon tanýsýyla takip edilen kadýn olgularýn yaþ gruplarýna göre hipertansiyon sýnýflamasý, lipit panelleri arasýndaki iliþki ve geriatrik gruptaki olgularla karþýlaþtýrýlmasý amaçlandý.
YÖNTEMLER: Hastanemizde 2008’de kayýtlý 1100 hipertansif kadýn olgunun, biyokimya laboratuvarýndaki verileri kesitsel olarak deðerlendirildi. Trigliserit düzeyleri ≥400 mg/dl, ilaç yazdýrma ve/veya farklý þikayetle baþvuruda bulunan olgular çalýþmaya dahil edilmedi. Olgular (n=198), ESH/ESC 2007 ve NCEPATPIII kýlavuzlarýna göre deðerlendirildi. Verilerin analizinde ortalama, standart sapma, Student t, ki -kare, Oneway Anova ve Fisher kesin testleri uygulandý. Sonuçlar %95’lik güven aralýðýnda, anlamlýlýk p<0,05 düzeyinde deðerlendirildi.
BULGULAR: Olgularýn yaþ ortalamasý 62,44 ± 12,27, kan basýncý ortalamalarý 164,9 ± 26,1 / 94,5 ± 15,1 mmHg idi. 40-50 yaþ %13,13 (n=26), 51-60 yaþ %28,28 (n=56) olgu vardý. 40-50 yaþ arasý 1. derece, >51 yaþ olgular 2. derece hipertansiyondu. Tüm yaþ gruplarýnda dislipidemi bulunmasýna raðmen trigliserit, kolesterol, HDL-C ve LDL-C ortalamalarý arasýnda anlamlý farklýlýk görülmedi (p>0,05). Geriatrik ve <65 yaþ olgularýn kan basýncý deðerleri, kolesterol, HDL-C ve LDL-C düzeyleri arasýnda istatistiksel olarak anlamlý farklýlýk yok iken (p>0,05), trigliserit düzeyleri geriatrik olgularda anlamlý düzeyde düþüktü (p<0,01).
SONUÇ: Tedaviye raðmen vizit sýrasýnda hipertansiyon saptanmasý ve dislipidemi sýklýðý, kardiyovasküler risk açýsýndan bireysel deðerlendirmenin önemini göstermektedir. Menapoz dönemine özgün deðiþiklikler göz ardý edilmemelidir.

OBJECTIVE: The aims of this study were to classify hypertension according to age groups, to determine the relation between their lipid panels and to compare results with the geriatric cases.
METHODS: A cross-sectional study of 1100 hypertensive females registered at the biochemistry laboratory in 2008 was done. Cases with triglyceride ≥400 mg/dl, prescribed repetitions and other applications were excluded. Cases (n: 198) were evaluated according ESH/ESC 2007 and NCEP ATPIII guidelines. Mean, SD, Student-t, chi-square, one-way ANOVA and Fisher’s exact tests were applied. Results were evaluated in 95% confidence interval, and significance was set at p<0.05.
RESULTS: The mean age of cases was 62.44±12.27 and mean blood pressure was 164.9±26.1 / 94.5±15.1 mmHg. Twenty-six cases (13.13%) were 40-50 years and 56 cases (28.28%) were 51-60 years. Cases 40-50 years were found to have grade 1 hypertension, and >51 years were found to have grade 2 hypertension. Although dyslipidemia was present in all age groups, no significant differences were found between triglyceride, cholesterol, and high- and low-density lipoprotein cholesterol (HDL-C, LDL-C) levels (p>0.05). While there was no significant difference between blood pressure, cholesterol, HDL-C and LDL-C levels in geriatric cases and cases <65 years (p>0.05), triglyceride levels were significantly lower in geriatric patients (p<0.01).
CONCLUSION: Presence of hypertension and high rate of dyslipidemia in spite of medication shows the importance of individual cardiovascular risk assessment. Menopausal changes should not be ignored.

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Direkt laringoskopi kullanýlarak yapýlan trakeal entübasyon, cerrahi hastalarýn anestezi yönetiminde önemli bir yer teþkil etmektedir. Olgularýn çoðunda larinks ve glottis direkt laringoskopi ile kolaylýkla görülebilmektedir. Bununla birlikte anestezistler, olgularýn azýnda beklenmedik bir anda zor entübasyonla karþý karþýya kalabilirler. Zor veya baþarýsýz entübasyon, anesteziye baðlý morbidite ve mortalitenin en sýk nedenidir. Bu yazýda, laringeal kitleli 56 yaþýndaki erkek hastanýn genel anestezi indüksiyonu sýrasýnda karþýlaþýlan zor havayolu sunuldu.

Tracheal intubation using direct laryngoscopy has become an essential part in the anesthesia management of the surgical patient. In the majority of cases, the larynx and glottis are easily visualized by direct laryngoscopy; however, in a few cases, the anesthesiologist unexpectedly faces difficult intubation. Difficult or failed intubation is a common cause of mortality and morbidity related to anesthesia. We report a case of difficult airway in a 56-year-old man with a laryngeal mass during induction of general anesthesia.

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Skrotal kese içinde testiküler ve ekstratestiküler kitleler saptanabilir. Tunica albuginea kistleri genelde insidental saptanmalarýna raðmen hastalar aðrý, þiþlik ve iðne baþý büyüklüðünde sert bir kitle ile baþvurabilirler. Bu kistlerin mezotelyal orijinli olduklarý düþünülmektedir. Sol skrotal kitle ile baþvuran 57 yaþýnda erkek hasta olgusunu sunuyoruz.

Testicular and extratesticular masses can be determined in the scrotal sac. Although cysts of the tunica albuginea are usually incidental findings, patients may present with pain, swelling and firm pinhead-sized mass. These cysts are thought to be of mesothelial origin. We report a case of a 57-year-old man who presented with left scrotal mass.

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Ýki yaþýndaki hasta ASA I, 12,5 kg aðýrlýðýnda bir kýz çocuðu idi. Fizik muayenesinde, doðuþtan iki taraflý abdusens paralizisi ve sol fasyal paralizi saptandý. Manyetik rezonans görüntüleme incelemesinde papil ödemi, tümör veya kafa içi basýnç artýþý saptanmadý. Oral muayenede, Mallampati III olarak deðerlendirildi ve hastaya genel anestezi altýnda ameliyat planlandý. Premedikasyon uygulanmayan olguya, sevorane %8 indüksiyonu ile üç kez derin soluk aldýrýlarak hipnoz saðlandý. Kas gevþemesi için vekuronyum 0,1 mg.kg -1 uygulandý. Fentanil 1 mcq.kg -1 ile analjezi saðlandý. Ýlk iki deneme baþarýsýzlýðýndan sonra entübasyon üçüncü denemede ayný hekim tarafýndan baþarýldý. Anestezi idamesinde %40/60 O2/N2O ve sevorane %2 kullanýldý. Ameliyat süresince kardiyak ve hemodinamik parametreler stabil seyretti. Ameliyat sonucunda sorunsuz ekstübe edilen hasta derlenme odasýna alýndý. Kardiyak ve solunumsal parametreler stabil edildikten sonra ilgili klini¤e devredildi. Sonuç olarak, Mobius sendromunun vücutta çoklu sistemleri tutabilen ve orofasyal anomali nedeniyle zor entübasyona neden olabilen bir sendrom olduðu hatýrlanmalýdýr.

We report the case of a two-year-old female with Mobius syndrome, ASA-I, weighing 12.5 k. Examination revealed congenital bilateral sixth nerve and left seventh nerve palsy. There was no papilledema, tumor, or intracranial pressure increase on MRI analysis. In oral examination, Mallampati III was recorded. Operation was planned under general anesthesia. No premedication was administered and anesthesia was achieved with sevorane 8% in three sequences under deep breathing. Vecuronium bromide (0.1 mg/kg) was used for neuromuscular block and fentanyl 1 mcg/kg was used for analgesic medication. After two failed attempts, intubation was successful on the third trial by the same doctor. Anesthesia was maintained with 40/60% oxygen-N2O using sevorane 2%. Cardiac and respiratory parameters stabilized during the operation. The patient was extubated in good condition, and transported to the recovery room. After cardiac and hemodynamic parameters had stabilized, the patient was transported to the relation clinic. In conclusion, it should be remembered that Mobius syndrome destroys multiple systems in the body and results in difficult intubation due to orofacial anomaly.

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