AMAÇ: Bu çalýþmada parotis kaynaklý tümörlerin anatomik ve histopatolojik daðýlýmýnýn yaný sýra tedavi yaklaþýmýndan elde ettiðimiz sonuçlar sunulmuþtur.
YÖNTEMLER: Dr.Lütfi Kýrdar Kartal Eðitim ve Araþtýrma Hastanesi 2. KBB kliniðinde 2001 ile 2008 tarihleri arasýnda parotis cerrahisi uygulanan 52 hastanýn kayýtlarý retrospektif olarak gözden geçirildi. Yaþ, cins, klinik belirti ve bulgular, histopatolojik taný, komplikasyonlar, tümör evresi ve prognoz gibi bilgiler analiz edilmiþtir.
BULGULAR: Yirmiüçü kadýn, 29 u erkek yaþ aralýðý 15-77 arasýnda deðiþen 52 parotis cerrahisi uygulanan hastanýn 6 sýnda kronik inflamatuar hastalýk 41 inde benign tümör 5 inde malign tümör mevcuttu. Malign tümörlü hastalarýmýz ve derin lob yerleþimli benign patolojiye sahip hastalarýmýza total, diðer hastalarýmýza yüzeyel parotidektomi uygulandý. Malign tümörlü hastalara ayrýca boyun dissseksiyonu ve kemoradyoterapi gibi tedavi modaliteleride eklendi.
SONUÇ: Tükrük bezi tümörlerinin preoperatif deðerlendirilmesinde ÝÝAB (ince iðne aspirasyon biyopsisi) önemli yer tutmaktadýr. Yüzeyel parotidektomi halen seçkin tedavi olarak yerini korumaktadýr. N0, M0 boyunlarda elektif boyun disseksiyonu halen tartýþmalýdýr.
Anahtar kelimeler: tükrük bezi tümörleri, parotis, pleomorfik adenom.

OBJECTIVE: In this study we presented our results about distribution of anatomic and histopathological properties of parotid gland tumors and treatment modality of these tumors.
METHODS: Fiftytwo parotid tumor patients who underwent parotid gland surgery between november 2001 - september 2008 in Dr.Lutfi Kirdar Kartal training and research hospital 2 nd ENT clinic were included in this study. Age, sex, clinical signs and symptoms, histopatological diagnosis, complications, tumor stage and prognosis of these 52 patients evaluated retrospectively.
RESULTS: Histopathological results of 23 female and 29 male patients aged between 15-77 years underwent parotid gland surgery because of parotid gland mass were 6 chronic inflammatory disease, 41 benign tumor and 5 malign tumor. We performed total parotidectomy for patients who had malign tumor or benign tumor localized in deep lobe and superficial parotidectomy for the others. Also for some of the malign tumors, additional treatment modalities performed like neck dissection and chemoradiotheraphy.
CONCLUSION: Superficial parotidectomy is still a preferable treatment modality in most of the parotid gland tumors and neck dissection is controversial in N0 and M0 patients. Fine needle aspiration biopsy is helpful and important diagnostic technic in preoperative evaluation.

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AMAÇ: Medikal ve/veya klasik filtrasyon cerrahisine cevap vermeyen glokom olgularýnda uyguladýðýmýz Ahmed Glokom Valv implantasyonun göziçi basýncýný düþürmedeki etkinliðini deðerlendirmek.
YÖNTEMLER: Ahmed Glokom Valvi implante edilmiþ 21 olgu retrospektif olarak incelendi. Olgularýn 12’sinde (%57) neovasküler glokom, 8’inde (%38) sekonder glokom, 1’inde (%5) konjenital glokom mevcut idi. Tüm olgularýn göziçi basýnçlarý maksimum medikal tedaviye raðmen 22 mmHg’nin üzerinde idi. Cerrahi baþarý olarak ilaçlý veya ilaçsýz oküler tansiyon deðeri 22 mmHg altý olmasý ve 5 mmHg üstü kabul edildi.
BULGULAR: On kadýn, on bir erkek toplam 21 hastanýn yaþ ortalamasý 47.1 (7-88 yaþ) ve ortalama izlem süresi 17 (3-35 ay) idi. Preoperatif ortalama göziçi basýncý 36.3±9.62 mmHg iken postoperatif bu deðer 15.6±3.97 mmHg olarak bulundu. Postoperatif dönemde 4 (%19) olguda hifema, 3 (%14.2) olguda enkapsülasyon, 2 (%9.5) olguda ön kamara sýðlaþmasý, 2 (%9.5) olguda fasya erimesi, 2 (%9.5) olguda tüp týkanmasý, 1 (%4.7) olguda ön kamarada kýsa tüp, 1 (%4.7) olguda koroid dekolmaný görüldü. Toplam 19 olguda göziçi basýncý yeterli düzeye düþürülerek %90.5 baþarý elde edildi.
SONUÇ: Klasik filtrasyon cerrahisi baþarý þansý düþük olan glokomlu gözlerde Ahmed Glokom Valvi, yeterli göziçi basýncý düþüþü saðlayan etkin bir cerrahi yöntem olarak deðerlendirildi.

OBJECTIVE: To evaluate the efficacy of Ahmed Glaucoma Valve (AGV) implantation in reducing intraocular pressure in glaucoma, resistant to medical therapy and/or glaucoma filtration surgery.
METHODS: Twenty one eyes of 21 patients who underwent AGV implantation were retrospectively evaluated. AGV were implanted for neovascular glaucoma in 12 (57%) cases, secondary glaucomas in 8 (38%) cases and congenital glaucoma in 1 (5%) case. Success of surgery was defined as an intraocular pressure less than 22 mmHg and greater than 5 mmHg with or without medical treatment.
RESULTS: The mean follow up of 21 patients (11 male, 10 female) was 17 (3-35 months) and the mean age was 47.1 (7-88 years). Intraocular pressure was reduced from a mean of 36.3±9.62 mmHg before surgery to 15.6±3.97 mmHg at the last follow-up after surgery. Postoperative complications were hyphema in 4 (19%) cases, encapsulation in 3 (14.2) cases, shallow anterior chamber in 2 (9.5%) cases, fascia melting in 2 (9.5%) cases, tube occlusion in 2 (9.5%) cases, short tube in anterior chamber in 1 (4.7%) case and choroidal detachment in 1 (4.7%) case. Sufficient intraocular pressure were obtained in 19 patients with 90.5% ratio.
CONCLUSION: Ahmed Glaucoma Valve can be an effective and safe method in cases which conventional filtration surgery seem to be insufficent in the management of refractory glaucoma.

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AMAÇ: Radikülopatik semptomlara neden olan lomber disk hernilerinde minimal invaziv giriþimler ile hastalarýn aðrýlarý önemli ölçüde azaltýlabilir. Transforaminal epidural steroid uygulamasý bu yöntemlerden biridir. Biz bu çalýþmada, radikülopatik semptomlarý olan lomber disk hernisi olgularýnda transforaminal steroid etkinliðini geriye dönük olarak deðerlendirmeyi amaçladýk.
YÖNTEMLER: Ocak 2007 ve Mayýs 2008 tarihleri arasýnda transforaminal epidural steroid enjeksiyon uygulanan 125 hastanýn (40 erkek, 85 kadýn) dosyalarý geriye dönük olarak incelendi.
Vizüel analog skalasý (VAS), düz bacak kaldýrma testi, el-parmak düz zemin mesafesi ve hasta memnuniyet skorlarý deðerlendirildi.
BULGULAR: VAS, düz bacak kaldýrma testi, el-parmak düz zemin mesafesi giriþim öncesi deðerleri
ile kýyaslandýðýnda anlamlý derecede düzelmeler olduðu görüldü.
SONUÇ: Transforaminal epidural steroid uygulamasý kronik bel aðrýsýnda baþarý ile uygulanacak bir yöntemdir.

OBJECTIVE: The pain of the patients can be decreased with a big percentage with minimal invasive applications in lomber disc hernias which causes radiculopathic symptoms. Transforaminal epidural steroid application is one of these methods. We aim to evaluate transforaminal steroid efficiency as retrospective in lomber disk hernia cases which has radiculopathic semptoms.
METHODS: The files of the 125 patients (40 males, 85 females) which applied transforaminal epidural steorid injection between the dates of January 2007 and May 2008 were examined retrospectively. Visual Analogue Scale (VAS), straight leg lifting test, hand-finger straight ground distance and patient pleasure scores were appreciated.
RESULTS: It is observed that there is a meaningful improvement when VAS, straight leg lifting test, hand-finger straight ground distance compared with the the value of the enterprise before transforaminal epidural steroid application.

CONCLUSION: Transforaminal epidural steroid application is a good method which can be performed in cronic low back pain triumphantly.

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AMAÇ: Diabetes mellitus nedeniyle takip edilen hastalardaki kardiyak otonom nöropati (KON) varlýðý ile bu hastalardaki glisemik kontrol düzeyi ve otonom nöropati arasýndaki iliþki araþtýrýldý.
YÖNTEMLER: Tüm olgulardan en az 8 saatlik açlýk sonrasý açlýk ve tokluk 2. saat plazma glukozu, HbA1c düzeyi, açlýk insülin ve c-peptid düzeyi ile 20 parametreli hemogram ve lipid profilleri yaný sýra AST, ALT, GGT, ALP, LDH, Na, K, Ca, Cl ile tam idrar analizi ve spot idrarda mikroalbumin / kreatinin oranlarý çalýþýldý. Fundoskopik ve kan basýncý muayeneleri yapýldý.
Tüm hastalara, diyabetik KON tanýsýnda kullanýlan kardiyovasküler otonom nöropati testleri uygulandý.
BULGULAR: Olgularýn 51’inde (%66,2) KON pozitif ve 26’sýnda (%33,8) KON negatif olarak saptandý. Diyabet yaþý ile KON varlýðý arasýnda istatistiksel anlamlýlýk saptanmadý. Nöropati pozitif olgularýn yaþ ortalamalarý, nöropati saptanmayan olgulara kýyasla anlamlý düzeyde yüksek bulundu. Nöropatisi olan ve olmayan olgular arasýnda, ortalama HbA1c deðerleri açýsýndan ve diyabetik retinopati varlýðý açýsýndan anlamlý fark görülmedi. Sadece oral antidiyabetik ilaç kullanan hastalardaki diyabetik KON sýklýðý, sadece insülin kullanan hastalara kýyasla daha fazla saptanmasýna raðmen, istatistiksel fark bulunmadý.
SONUÇ: Diyabetik KON, artmýþ mortalite ve sessiz miyokard iskemisi ile beraber inmeye yol açabilen, ciddi bir komplikasyondur. Ýyi glisemik kontrolün, KON’yi önlediði, geciktirdiði ve hatta mevcut nöropatiyi gerilettiði bir gerçektir.

OBJECTIVE: We aimed to investigate the existence of cardiovascular autonomic neuropathy (CAN) in diabetic patients and to search for a relation between the level of glycemic control and autonomic neuropathy in these patients.
METHODS: All subjects provided samples to determine levels of fasting and postprandial 2nd hour glucose, HbA1c, fasting insulin, and c-peptide. Complete blood count, lipid profile with the other biochemical parameters (AST, ALT, GGT, ALP, LDH, Na, K, Ca, Cl) and urine analysis evaluating also the presence of microalbuminuria were performed. Blood pressure was measured with funduscopic examination. The battery of CAN tests was applied to all patients.
RESULTS: Fifty-one (66.2%) patients were CAN-positive and 26 (33.8%) were CAN-negative. There was no significant relation between CAN existence and diabetes duration. CAN-positive patients were significantly older in age, but there was no significant relation with mean HbA1c levels and the existence of diabetic retinopathy between CAN-positive and -negative patients. A comparison with patients on only insulin therapy showed that those using only oral antidiabetics had a higher rate of CAN positivity, but the difference was not statistically significant.
CONCLUSION: Diabetic CAN is a serious complication that may cause higher mortality, silent ischemia and even stroke. Good glycemic control can prevent, postpone and even improve existing neuropathy.

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AMAÇ: Bu çalýþmada, kronik dakriyosistit nedeniyle endoskopik endonazal dakriyosistorinostomi ve silikon tüp entübasyonu uygulanan 26 hastanýn sonuçlarý deðerlendirildi.
YÖNTEMLER: Çalýþmaya alýnan 26 hastanýn 19’u (%73) kadýn, 7’si (%17) erkek olup yaþlarý 23 ile 67 arasýnda (ortalama 44,2) deðiþmekteydi. Ameliyat edilen hastalar 6 ay ile 72 ay arasýnda takip edildi. Ameliyat sonrasý 6. ayda operasyonlarýn baþarý oraný ve komplikasyonlar deðerlendirildi.
BULGULAR: Cerrahi sonrasý hastalarýn 23’ünde tek taraflý, 3’ünde iki taraflý olmak üzere, toplam 29 endoskopik endonazal dakriyosistorinostomi giriþiminin 24’ünde (%82,8) endonazal ostium açýklýðýnýn yeterli, fonksiyonel olduðu ve hastalarýn þikayetlerinin olmadýðý saptandý; 5’inde (%17,2) ostium açýklýðý saptanmadý.
SONUÇ: Bu çalýþma sonucunda, endoskopik endonazal dakriyosistorinostominin hastalar tarafýndan iyi tolere edilebilen, dýþarýdan görülebilecek insizyon skarýna yol açmadýðý için kozmetik açýdan tercih edilen, travma oranýnýn düþük ve baþarý oranýnýn yüksek olduðu fonksiyonel bir operasyon olduðunu düþünüyoruz.

OBJECTIVE: In this study, endoscopic endonasal dacryocystorhinostomy and silicone tube intubation were applied to 26 chronic dacryocystitis patients and the clinical results were reviewed.
METHODS: Of 26 patients, 19 (73%) were female, 7 (27%) were male and their ages ranged between 23 and 67 (mean age: 44.2). Operated patients were followed for 6-72 months. At the sixth postoperative month, the clinical results and complications were reviewed.
RESULTS: Of 29 endoscopic endonasal dacryocystorhinostomy operations (23 unilateral, 3 bilateral), the endonasal ostium remained patent and functional in 24 patients (82.8%), and the patients had no complaints. Ostium patency could not be viewed in five (17.2%) patients.
CONCLUSION: Endoscopic endonasal dacryocystorhinostomy is well tolerated by patients and cosmetically preferred due to its advantages, such as no external scar. We think that endoscopic endonasal dacryocystorhinostomy is a functional operation with a low trauma rate and a high success rate.

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Double J üreteral stentler uzun yýllardýr üroloji pratiðinde kullanýlmaktadýr. Kullanýmdaki sýklýðýn artýþýna baðlý olarak stente ait komplikasyonlarda da artýþ gözlenmektedir. Bu yazýda, unutulmuþ bir double J stent ve buna baðlý geliþen ilginç bir taþlaþma olgusunu ve uyguladýðýmýz tedavi yöntemlerini literatür eþliðinde tartýþmayý amaçladýk. Unutulan stente baðlý komplikasyonlarý önlemede en önemli noktanýn hastaya gerekli bilgi ve eðitimin verilmesi olduðunu düþünmekteyiz.

Double J ureteral stents have been used in urological practice for a long time. The indications for stent insertion have increased in recent years, leading to a subsequent increase in stent complications as well. In this study, we discuss a forgotten double J stent and an interesting related stone formation development and the treatment methods used, in light of the related literature. The most important point in preventing complications of a forgotten stent is related to informing the patient and providing the necessary education before granting the procedure.

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Elin iþlevini bozan baþparmak hipoplazileri ve tenar kas anomalileri kompleks konjenital hastalýklar olup, genellikle baþka sendromlar veya konjenital anomalilerle birlikte görülürler. Abduktor pollisis brevis kasýnýn konjenital yokluðu oldukça nadirdir ve genellikle baþka kas, sinir ve tendonlarýn yokluðu veya fonksiyon bozukluklarý da bu kasýn yokluðuna eþlik eder. Yirmi yaþýndaki erkek hasta, ellerini tam kullanamama, özellikle baþparmaðýyla diðer parmaklarýný kavuþturamama ve ince beceri gerektiren iþleri yapamama yakýnmasýyla polikliniðimize baþvurdu. Fizik muayene, nörolojik inceleme ve elektromiyografi ile bilateral abduktor pollisis brevis kasý yokluðu saptandý. Olguda herhangi bir düzeltici giriþim yapýlmasýna gereksinim duyulmadý. Bu çalýþmada, benzeri ulaþabilen yayýnlarda bulunamayan sadece bilateral abduktor pollisis brevis kasý yokluðu olan bu olgu sunularak, elin iþlevini bozan konjenital hastalýklar ve tedavi yöntemleri gözden geçirildi.

Thumb hypoplasia and thenar muscle anomalies that distort hand function are complex congenital anomalies and are often seen in connection with other syndromes or congenital anomalies. Congenital absence of the abductor pollicis brevis muscle is very rare, and generally, absence or dysfunction of the other muscles, nerves or tendons will accompany this muscle’s absence. A 20-year-old male patient was admitted to our outpatient clinic with a complaint of deficiency in some hand functions; he especially could not touch the thumbs to the other fingers or do jobs that require such skills. Physical, neurological and electromyographic assessment revealed the bilateral absence of the abductor pollicis brevis muscle. For this case, no corrective initiative was needed. In this study, presenting a case with bilateral absence of the abductor pollicis brevis muscle, congenital muscle diseases determinant of hand function and their treatment methods are reviewed. To our knowledge, no such case report has been published in the literature previously.

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Hemanjiyoperistom damar duvarýndan kaynaklanan nadir bir vasküler tümördür. Tipik olarak retroperitoneal boþluk, ekstremiteler, baþ ve boyunda görülebilir. Nazolakrimal duktus hemanjiyoperistomu ise çok nadirdir. Sunulan olgu, 2003 yýlýndan beri kronik dakrosistit nedeniyle takip edilmekte iken, gözünde sulanma ve sað göz medial kenarýnda ele gelen kitle þikayetleriyle göz kliniðine baþvurdu. 2006 yýlýnda çekilen orbitanýn bilgisayarlý tomografisinde (BT), lakrimal kanal proksimal bölümünde 15x15 mm çapýnda kitle saptandý ve dakrosistosel olarak deðerlendirilip takip edildi. Kitlede büyüme saptanmasý üzerine hastaya orbita eksizyonel biyopsi yapýldý ve hemanjioperistom tanýsý kondu. Kontrol orbital BT’sinde saðda nazolakrimal duktus seviyesinde, 2x1 cm boyutlu kitle saptandý. Metastaz taramasý için yapýlan görüntüleme tetkiklerinde patoloji saptanmadý. Reeksizyonu kabul etmeyen hasta, 3 ay aralýklarla kontrole çaðýrýlarak takibe alýndý. Lakrimal kanalda büyüyen kitle saptandýðýnda hemanjiyoperistom akla gelmelidir. Bu hastalarda total eksizyona raðmen uzak metastaz yýllar sonra görülebilmektedir. Bu yazýda, nadir görülmesi sebebiyle, uzun süre dakrosistosel olarak takip edilen bir nazolakrimal kanal hemanjiyoperistom olgusu sunuldu.

Hemangiopericytoma is rare tumor which derived from vascular endothelium most commonly seen in retroperitoneum, extremities, head and neck. Hemangiopericytoma of the nasolacrimal duct is infrequent. Inhere we reported a patient who was followed-up for 3 years due to chronic dacrocystitis. Because of she presented with swelling in the medial side of right orbita, she referred to ophtalmology clinic. Computerized tomography of right orbita revealed 15 mm mass in proximal area of the nasolacrimal duct. The mass was interpreted as dacrocytocel however the mass was growth progressively during 2 years followed-up period. So excisional biopsy was performed and diagnosis of hemangiopericytoma was confirmed. Although there was about 2 cm residual mass in nasolacrimal duct after excision and no distant metastasis. Consequently reexcision was offered to patient but she did not want. She is followed-up in our clinic for 16 months. In this case we reported infrequent case of hemangiopecytoma derived from nasolacrimal duct.

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Progresif sistemik sklerozis (PSS) diðer adý ile skleroderma, deri, kan damarlarý ve visseral organlarda özellikle de gastrointestinal sistem, kalp ve böbreklerde fibrozis oluþumu ile kendini gösteren bir hastalýktýr. Hastalarýn çoðunluðu uzun süre hayatta kalabilmelerine karþýn, bazý olgular kýsa sürede ölmektedirler. Pulmoner hipertansiyon ve pulmoner sistem tutulumu en sýk ölüm nedenidir. PSS’li hastalarýn anestezi uygulamasýnda, ameliyat öncesi iyi bir deðerlendirme çok önemlidir. Çünkü, eklem ve cilt tutulumuna baðlý olarak zor entübasyon ve aspirasyon geliþebilme riski vardýr. Bu yazýda, PSS tanýsý olan 67 yaþýndaki erkek hastada yapýlan diz altý amputasyonunda uygulanan anestezi yönetimi literatür bilgileri eþliðinde sunuldu.

Progressive systemic sclerosis (PSS), also termed ‘scleroderma’, is a disease characterized by fibrosis in skin, blood vessels and visceral organs, especially in the gastrointestinal system, heart and kidneys. Although most patients have long survival, some of them progress rapidly to death. Pulmonary system involvement and pulmonary
hypertension are the most frequent causes of death. Preoperative assessment is very important in the management of anesthesia, as there is an increased risk of difficult intubation in association with involvement of joints and skin and aspiration risk. In this article, we aimed to present the anesthetic management in a case of a 67-year-old male with PSS disease who had an amputation surgery, together with a literature review.

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Bu yazýda, yaygýn retroperitoneal hemorajiye neden olan bir renal anjiyomiyolipom olgusu sunuldu ve güncel literatür gözden geçirildi. Anjiyografik embolizasyonu, kanamanýn kontrolü ve cerrahi iþlemi kolaylaþtýrmasý bakýmýndan retroperitoneal hemorajili anjiyomiyolipom olgularýnda ilk tercih olarak kullanýlabileceðini düþünmekteyiz.

In the present study, a patient with renal angiomyolipoma causing massive retroperitoneal hemorrhage is presented and reviewed in light of the current literature. We suggest that angiographic embolization may be the first choice in hemorrhagic renal angiomyolipoma to control bleeding and facilitate the surgical operation.

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