GÝRÝÞ ve AMAÇ: Aðýr influenza kliniðiyle 2015-2016 yýlýnda yatýrýlan hastalarýn etiyolojik profilini, klinik seyrini ve sonuçlarýný belirlemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Hastanemize 1 Aralýk 2015–15 Mart 2016 tarihleri arasýnda aðýr influenza kliniðiyle yatýrýlan hastalar çalýþmaya dahil edildi. Dispne, takipne, taþikardi, hipotansiyon, hipoksi, mental durum deðiþikliði, aðýr dehidratasyon, akciðer grafisinde bronkopnömoni/pnömoni varlýðý “aðýr influenza” olarak deðerlendirildi. Hastalarýn nazofarengeal aspirat örnekleri ters transkriptaz-polimeraz zincir reaksiyonu tekniði ile solunum virüsleri açýsýndan tarandý.
BULGULAR: Toplam 95 nazofarengeal aspirat örnekleri incelenen hastanýn 65’i (%68.4, 38’i eriþkin, 27’si çocuk) virüs-pozitifdi. Etken virüslerin daðýlýmý þöyleydi: 42’si (%64.6) influenza A (H1N1), 9’u (%13.8) influenza A (H3N2), 5’i (%7.7) coronavirus. Altý (%9.2) hasta gebeydi. Gebelerden sadece biri yoðun bakým ünitesinde (YBÜ) izlem gerektirdi ve H1N1 influenza nedeniyle kaybedildi. On beþ (%23, 14 yetiþkin, bir çocuk) hasta YBÜ’de izlendi. Bunlardan dokuzu kaybedildi [7’si influenza A (6 H1N1, 1 H3N2), 1’i HMPV, 1’i coronavirus], tüm çocuklar þifayla taburcu edildi. Hastanemize yatýrýlarak izlenen H1N1 enfeksiyonunda olgu fatalite hýzý %14.3’dü.
TARTIÞMA ve SONUÇ: Hastaneye yatýrýlan hastalarýn üçte ikisinde influenza A-H1N1 enfeksiyonu vardý. Yedisi (%16.7) YBÜ’de izlendi. Bunlarda H1N1 olgu-fatalite hýzý %14.3. Aðýr influenza için risk faktörü olan hastalar yatýrýlarak izlenmelidir.

INTRODUCTION: The aim of the present study was to determine the etiological profile, clinical course, and outcome of patients hospitalized with severe influenza during the 2015-2016 influenza season.
METHODS: Patients with severe influenza who were admitted to the emergency department of the hospital between December 1, 2015 and March 15, 2016 and who required admission were included. The presence of dyspnea, tachypnea, tachycardia, hypotension, hypoxia, mental status changes, severe dehydration, or chest X-ray compatible with bronchopneumonia/pneumonia were considered “severe influenza.” Nasopharyngeal aspirate specimens from all patients were tested for respiratory viruses using the reverse transcriptase-polymerase chain reaction technique.
RESULTS: Of a total of 95 hospitalized patients, 65 patients (68.4%; 38 adults and 27 children) were virus-positive. The etiological virus was 42 (64.6%) cases of influenza A (H1N1), 9 (13.8%) of influenza A (H3N2), and 5 (7.7%) of coronavirus. Six patients (9.2%) were pregnant. Only 1 pregnant patient died, due to H1N1 influenza. Fifteen (23%; 14 adults and 1 child) required follow-up in the intensive care unit (ICU). Nine adult patients died [7 due to influenza A (6 H1N1, 1 H3N2), 1 due to human metapneumovirus, 1 due to coronavirus], but all of the children survived. The case-fatality rate of H1N1 infection was 14.3%.
DISCUSSION AND CONCLUSION: Two-thirds of the admitted patients had an influenza A H1N1 infection. Seven (16.7%) of them required ICU follow-up. The H1N1 case-fatality rate was 14.3%. Patients with risk factors who have severe influenza should be hospitalized.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý 55 yaþ ve altýnda akciðer kanseri tanýsý alan olgularýn sosyodemografik, klinik, radyolojik, histopatolojik ve sað kalým özeliklerini araþtýrmak.

YÖNTEM ve GEREÇLER: Ocak 2014–Aralýk 2016 tarihleri arasýnda kliniðimizde akciðer kanseri tanýsý alan olgularýn dosyalarý geriye dönük olarak incelendi. Bu olgular 55 yaþ ve altý ile 55 yaþ üstü olmak üzere iki gruba ayrýldý. Olgularýn klinik, radyolojik, demografik bulgularý, kanserlerin histopatolojik tipleri, kanser evreleri, tedavi öyküleri, sað kalým verileri birbirleri ile karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 85’i (%26.3) 55 yaþ ve altýnda, 238’i (%73.7) 55 yaþýn üstünde toplam 323 olgu alýnmýþtýr. Her iki gruptaki akciðer kanserlerinin evreleri, kanserlerin histopatolojik tipleri, sigara öyküleri, cinsiyet özellikleri, onkolojik ve cerrahi tedavi özellikleri ve sað kalým özellikleri benzerdi (p>0.05).
TARTIÞMA ve SONUÇ: Akciðer kanserinde 55 yaþ sýnýr seçildiðinde pek çok açýdan gruplar benzer bulunduðundan, 55 yaþ altýnda ise beþ yýllýk alt gruplarda kanser olgu sayýsýnda katlanarak artýþlar olduðu için kanser için tarama yaþ sýnýrý özellikle risk faktörü taþýyan olgularda 55 yaþ altý gruplara da önerilebilir.

INTRODUCTION: The aim of this study was to investigate the sociodemographic, clinical, radiological, histopathological, and survival characteristics of lung cancer patients ≤55 years of age.
METHODS: The files of patients diagnosed in the clinic as lung cancer between January 2014 and December 2016 were retrospectively evaluated. These cases were divided into 2 groups: patients who were ≤55 years of age and patients >55 years of age. The clinical, radiological, and demographic findings; histopathological type and stage of cancer; treatment modalities used; and survival data were analyzed and compared.
RESULTS: A total of 323 cases, 85 (26.3%) of them aged ≤55 years and 238 (73.7%) aged >55 years, were included in the study. The stage and histopathological type of lung cancer, smoking history, gender, oncological and surgical treatment modalities used, and survival characteristics were similar in both groups (p>0.05).
DISCUSSION AND CONCLUSION: Since the 2 groups of lung cancer patients formed on the basis of the age limit of 55 years were similar in many respects, and because the number of cancer cases increases in 5-year subgroups under the age of 55 years, screening for lung cancer may be recommended for those under 55 years, especially in cases with risk factors.

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GÝRÝÞ ve AMAÇ: Hastanemizdeki sývý bazlý sitoloji yöntemiyle incelenen servikal sitoloji örnekleri ile eþ zamanlý olarak real-time polimeraz zincir reaksiyonu (RT-PCR) yöntemiyle incelenen human papilloma virus (HPV) enfeksiyonunun prevalansýný, en sýk görülen tiplerini, normal ve anormal sitolojili kadýnlardaki HPV tiplerini saptamak, HPV’nin sitoloji ile uyumunu incelemek ve ülkemiz istatistiklerine katkýda bulunmaktýr.
YÖNTEM ve GEREÇLER: Haziran 2016–Mart 2017 tarihleri arasýndaki 837 hasta geriye dönük olarak çalýþmaya alýndý. HPV tiplerini saptamada RT-PCR yöntemi, eþ zamanlý alýnan servikal sitoloji örneklerinde ise Thin Prep yöntemi kullanýlarak hastalara ait servikal sitoloji materyalleri deðerlendirildi.
BULGULAR: Sekiz yüz otuz yedi servikal sitolojinin 208’inde (%24.9) skuamoz hücre atipisi (SHA) mevcut iken 629’unda (%75.1) SHA görülmedi. SHA gösteren olgularýn 142’sinde (%17.0) önemi belirsiz atipik skuamoz hücre (ASCUS], 53’ünde (%6.3) düþük dereceli skuamoz intraepitelyal lezyon (LSIL), 13’ünde (%1.6) yüksek dereceli skuamoz intraepitelyal lezyon (HSIL) mevcuttu. Sekiz yüz otuz yedi hastanýn 344’ünde HPV pozitifti (%41.1). En sýk görülen HPV tipleri HPV tip 16, 18, 31, 51 idi. HPV prevalansý 30 yaþ altý ve 50 yaþ üstü kadýnlarda daha yüksekti. HPV 16’nýn ve multipl suþlarýnýn en sýk görüldüðü yaþ grubu 30 yaþ altý gruptu. Tek suþ olarak görülen en sýk HPV tipi HPV 16 idi. HPV 16’yý HPV 51, 31 ve 18 takip etmekteydi. Multipl en sýk görülen HPV tipleri arasýnda HPV 16 ilk sýrada iken bunu Tip 31, Tip 51 ve Tip 18 izlemekteydi. SHA gösteren olgularýn 132’sinde (%63.5) HPV pozitifliði mevcuttu. SHA içermeyen 417 (%66.3) hastada HPV negatif iken 212’sinde (%33.7) HPV pozitifti.
TARTIÞMA ve SONUÇ: Çalýþmamýzda en sýk görülen HPV tipi HPV 16 idi. HPV prevalansýnda bimodal yaþ daðýlýmý görülmekteydi. HPV prevalansý SHA derecesi ile korelasyon göstermekle birlikte SHA göstermeyen olgularda da RT-PCR ile yüksek oranda HPV pozitifliði saptandý. Bu durum HPV tipleri ve prevalansýnýn belirlenmesinde, HPV pozitif hastalarýn gerektiði þekilde takip ve tedavi edilmesinde RT-PCR yöntemi ve sitolojik incelemenin birlikteliðinin önemini göstermektedir.

INTRODUCTION: Cervical cytology samples were analyzed to determine the prevalence of human papilloma virus infection (HPV) and the most frequently observed types. Methods used to assess the presence of HPV were also evaluated.
METHODS: A total of 837 female patients who presented at the hospital between June 2016 and March 2017 were retrospectively included in the study. Real-time polymerase chain reaction (RT-PCR) analysis was used to detect the presence and identify the type of HPV, and a liquid-based cytology technique was also used to evaluate cervical cytology in concurrently obtained samples taken during a gynecological examination.
RESULTS: Of 837 cervical cytology samples, squamous cell atypia (SCA) was seen in 208 (24.9%) samples, and was not present in the remaining 629 (75.1%). Analysis of the samples with SCA revealed the presence of SCA of undetermined significance in 142 (17.0%), low-grade squamous intraepithelial lesion in 53 (6.3%), and high-grade squamous intraepithelial lesion in 13 (1.6%) samples. HPV-positivity was detected in 344 of the 837 patients (41.1%). The most frequently seen types were HPV 16, 18, 31, and 51. HPV prevalence was greatest in women younger than 30 years of age and those over 50. HPV 16 and multiple strains were most often seen in women under 30. HPV 16 was the most frequently seen single HPV strain, followed by HPV types 51, 31, and 18, respectively. HPV 16 was also most common among samples with multiple strains, followed by types 31, 51, and 18, respectively. HPV-positivity was detected in 132 (63.5%) patients with SCA. Of the 629 who had an SCA-negative result, HPV positivity was determined in 212 (33.7%) cases.
DISCUSSION AND CONCLUSION: The most frequently detected strain of HPV in this study was type 16. HPV prevalence demonstrated a bimodal age distribution. HPV was correlated with SCA; however, HPV-positivity was also observed using RT-PCR in cases without SCA. This indicates the importance of the combination of RT-PCR and cytological examination in the determination of HPV types and prevalence, and in the treatment and follow-up of HPV-positive patients.

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GÝRÝÞ ve AMAÇ: Pektoralis minör sendromu (PMS), üst ekstremiteyi etkileyebilen nörovasküler bir hastalýktýr. Bu çalýþmada, PMS tanýsý alan hastalar demografik ve klinik özellikleri ve eþlik eden subakromiyal sýkýþma sendromu açýsýndan deðerlendirildi.
YÖNTEM ve GEREÇLER: Pektoralis minör kas bloðu ile PMS tanýsý konulan 12 ve 70 yaþ arasýndaki 12 hasta geriye dönük olarak deðerlendirildi. Pektoralis minör kas bloðu ultrasonografi rehberliðinde uygulandý.
BULGULAR: Toplam 12 hasta deðerlendirildi. Hastalarýn %83’ünde aðrý, %58.3’ünde parestezi ve %16.6’sýnda þiþlik yakýnmasý mevcuttu. Fizik muayenede, hastalarýn %58.3’ünde biseps tendonunda hassasiyeti, %16.6’sýnda subakromiyal hassasiyet ve %16.6’sýnda akromioklaviküler eklem hassasiyeti saptandý. Hastalarýn %66.6’sýnda subakromiyal sýkýþma testleri pozitif saptandý, %33.3’ünde ise subakromiyal enjeksiyon testi pozitif olarak deðerlendirildi.
TARTIÞMA ve SONUÇ: Pektoralis minör sendromu, gözden kaçabilen bir tanýdýr ve subakromiyal sýkýþma sendromu gibi baþka diðer hastalýklarla karýþabilir. Bunun yanýnda, subakromiyal sýkýþma sendromu PMS’ye eþlik edebilir. Bu nedenle, bu tür aðrýlý patolojilerde taný için, referans test olarak subakromiyal enjeksiyon testi ve pektoralis minör kas bloðu gibi enjeksiyon testleri kullanýlmalý ve bununla birlikte bu iki klinik tablonun birlikte görülebileceði de akýlda tutulmalýdýr.

INTRODUCTION: Pectoralis minor syndrome (PMS) is a neurovascular disorder affecting the upper extremity. In the present study, the demographic and clinical features of patients diagnosed as PMS were examined, as well as cases of concomitant subacromial impingement syndrome (SIS).
METHODS: A retrospective trial was conducted with 12 patients with the diagnosis of PMS according to a pectoralis minor muscle (PMM) block test. The PMM block was performed under the guidance of ultrasonography.
RESULTS: Of the 12 PMS patients evaluated, 83% had a complaint of pain, 58.3% had paresthesia, and 16.6% had swelling of the hand. A physical examination revealed that 58.3% of the patients had tenderness at the biceps tendon, 16.6% had subacromial tenderness, and 16.6% had tenderness at the acromioclavicular joint. In 66.6% patients, subacromial impingement tests were positive, and 33.3% of them had a positive subacromial injection test (SIT).
DISCUSSION AND CONCLUSION: PMS can be overlooked and may also be confused with other disorders, such as SIS. Furthermore, SIS may also accompany PMS. Therefore, in such painful pathologies, injection tests such as SIT and PMM block should be used as the reference test for the diagnosis and it should be kept in mind that these 2 clinical disorders can be observed together.

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GÝRÝÞ ve AMAÇ: Retina ven dal týkanýklýðý ve santral ven týkanýklýðýna baðlý maküla ödemi tedavisinde tek doz intravitreal bevacizumab enjeksiyonu sonrasý kýsa dönem görme keskinliði ve fovea kalýnlýðý deðiþikliklerini incelemek.
YÖNTEM ve GEREÇLER: Hastalar iki ayrý gruba ayrýlýp ven dal týkanýklýðýna grubuna 18 hastanýn 18 gözü, santral ven týkanýklýðý grubuna 10 hastanýn 10 gözü dahil edildi. Çalýþmada araþtýrýlan göstergeler Early Treatment Diabetic Retinopathy Study (ETDRS) görme keskinliði ve OCT ile ölçülen fovea kalýnlýðý deðiþiklikleri ve komplikasyonlar idi.
BULGULAR: Retinal ven dal týkanýklýðý grubunda tüm aylarda baþlangýca göre fovea kalýnlýðýnda görülen azalma istatistiksel olarak anlamlý bulundu (p<0.05) ve ortalama ETDRS harf deðerinde (Snellen eþdeðeri) enjeksiyon sonrasý tüm aylarda görme keskinliðinde görülen artýþ istatistiksel olarak anlamlý bulundu (p<0.05). Santral ven týkanýklýðý grubunda enjeksiyon öncesi birinci ayda baþlangýca göre fovea kalýnlýðýnda görülen azalma istatistiksel olarak anlamlý (p<0.05) iken ikinci ve üçüncü aylardaki azalma miktarý istatistiki olarak anlamlý düzeyde deðildi (p>0.05) ve ortalama ETDRS harf deðerinde Enjeksiyon öncesi ETDRS harf deðerine göre enjeksiyon sonrasý tüm aylarda görme keskinliðinde görülen artýþ istatistiksel olarak anlamlý deðildi (p>0.05).
TARTIÞMA ve SONUÇ: Retina ven dal týkanýklýðýna baðlý maküla ödemi tedavisinde intravitreal bevacizumab enjeksiyonunun erken dönemde etkili ve güvenilir olduðu düþünüldü.

INTRODUCTION: The aim of the present study was to investigate changes in short-term visual acuity and foveal thickness after single-dose intravitreal bevacizumab treatments for macular edema secondary to central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO).
METHODS: The patients were separated into 2 groups: 18 eyes of 18 patients with BRVO, and 10 eyes of 10 patients with CRVO. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity scores, changes in foveal thickness measured with optical coherence tomography, and complications of treatment were evaluated.
RESULTS: In each monthly measurement, in the BRVO group, foveal thickness decreased from baseline statistically significantly from baseline (p<0.05) and ETDRS score of visual acuity increase also was statistically significant (p<0.05) at each interval. In the CVRO group, although 1 month after injection, foveal thickness decreased significantly (p<0.05), and second and third months, the reduction in foveal thickness was not statistically significant (p>0.05) and compared with preinjection values, increase ETDRS score at all months was not statistically significant (p>0.05).
DISCUSSION AND CONCLUSION: Treatment of macular edema secondary to BRVO with intravitreal injection of bevacizumab in the early stages was effective and reliable.

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GÝRÝÞ ve AMAÇ: Ýnsanoðlunun yaþama koruma içgüdüsü, ilkel kavimlerden bu yana saðlýkla ilgili konularda çeþitli inanç ve uygulamalarýn doðmasýna yol açmýþtýr. Bu çalýþma kadýnlarýn gebelik, doðum ve doðum sonrasý dönemde anne-bebek bakýmýna yönelik geleneksel inanç ve uygulamalarýný belirlemek amacýyla yapýlmýþtýr.
YÖNTEM ve GEREÇLER: Araþtýrma, Ýstanbul ilinde, bir kamu hastanesinde tanýmlayýcý kesitsel tipte yapýlmýþtýr. Veri toplama formu sosyo-demografik, obstetrik özellikler ile kadýnlarýn gebelik, doðum ve doðum sonu döneme iliþkin geleneksel uygulamalarýna iliþkin sorulardan oluþmuþtur. Veriler toplanmaya baþlanmadan önce, etik kurul onayý ve kurum izni alýnmýþtýr.
BULGULAR: Araþtýrmamýzda kadýnlarýn, bebek akýllý ve güzel olsun diye meyve yenmesi gerektiðine inanmasý, saðlýklý ve huzurlu bir gebelik geçirmek için çirkin þeylere bakmamasý, canýnýn çektiði her þeyin yedirilmesi, kolay doðum yapsýn diye yürüyüþ yaptýrýlmasý ve dua ederek odaklanmasý, sýrtýnýn sývazlanmasý zararlý olmayan kültürel uygulamalar olarak deðerlendirilmiþtir. Buna karþýlýk, bebeðin aðzýna emzirmeden önce hurma sürmek, kýrk basmasýndan korumak için bebek yataðýnýn altýna býçak koymak, kýyafetine çengelli iðne takmak ve 40 gün lohusa ve bebeðin evden çýkarýlmamasý, bebeðin tuzlanmasý zararlý uygulamalar olarak belirlenmiþtir.
TARTIÞMA ve SONUÇ: Gebelik, doðum ve doðum sonu kabul görmüþ, anne ve bebek saðlýðý üzerine zararý bulunmayan hatta faydasý olabilecek uygulamalarýn, kültürel zenginliðimizin bir parçasý olarak kabul edilip desteklenmesi, zararlý etkileri bulunan uygulamalarýn ise gerek gebelik okullarý gerekse taburculuk sýrasýnda yapýlan eðitimlerle önlenmesi önerilmektedir.

INTRODUCTION: This study was conducted to investigate traditional beliefs and practices of women regarding care of the mother and the infant during pregnancy, in childbirth, and in the postpartum period.
METHODS: This was a descriptive, cross-sectional study conducted at a public hospital in Istanbul. The data collected consisted of socio-demographic and obstetric characteristics, and responses to questions about some traditional customs regarding pregnancy, delivery, and the postpartum period.
RESULTS: In our research, some non-harmful cultural practices were found, such as the belief that to have a clever and beautiful baby the mother should eat fruit; that to have a healthy and peaceful pregnancy, the mother should not look upon ugly things; the mother should indulge her food cravings; and to have an easy birth, the mother should walk and focus on prayers. On the other hand, we also found beliefs that could be harmful, such as wiping the mouth of a baby with a date before breastfeeding, and practices believed to be protective that could cause harm, such as putting a knife under the baby’s bed, fastening a safety pin to the baby’s clothes, and for the mother and child to remain at home for 40 days.
DISCUSSION AND CONCLUSION: While non-harmful and beneficial practices related to maternal and infant health should be accepted and supported as a part of our cultural richness, practices that could be harmful should be prevented in pregnancy classes or with training upon hospital discharge.

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GÝRÝÞ ve AMAÇ: Deri kanserlerinin sýklýðý gün geçtikçe artmaktadýr. Bu çalýþmada amacýmýz Türkiye’de üç farklý ilde bulunan ikinci basamak özel saðlýk kuruluþu dermatoloji polikliniklerine 2016 yýlýnda baþvuran ve taný alarak tedavi edilen kutanöz prekanseröz ve kanseröz lezyon sýklýðýnýn tespit edilmesidir.
YÖNTEM ve GEREÇLER: Çalýþmada 2016 yýlý boyunca dermatoloji polikliniklerine baþvurmuþ tüm hastalar geriye dönük olarak deðerlendirildi. Ýlgili ICD kodu taramasý ile premalign ve malign kutanöz leyzonlarý olan hastalara ulaþýlarak týbbi kayýtlarýndan sosyodemografik ve klinik özellikleri tespit edildi.
BULGULAR: Üç farklý dermatoloji polikliniðine baþvuran toplam hastalarýn (n=21085) arasýnda toplam 81 olguda prekanseröz ve kanseröz lezyon tespit edildi ve bir yýllýk insidansý %0.38 olarak saptandý. Tüm baþvurular arasýnda prekanseröz lezyonlarýn (n=58) bir yýl içindeki insidansý %0.27 ve kanseröz lezyonlarýn (n=23) bir yýl içindeki insidansý %0.11 idi.
TARTIÞMA ve SONUÇ: Tüm dünyada deri prekanseröz ve kanseröz lezyonlarýnýn sýklýðý artmaktadýr. Çalýþmamýzda elde ettiðimiz sonuçlarýmýz ülkemizde ve dünya çapýnda daha önce bildirilen bulgular ile uyumluydu. Çalýþmamýz ülkemizin iki farklý bölgesini (Marmara ve Ýç Anadolu Bölgesi) içermektedir ve ikinci basamak dermatoloji polikliniði baþvurularý göz önüne alýndýðýnda referans bir çalýþma olabileceðini düþünmekteyiz.

INTRODUCTION: As the frequency of skin cancers continues to increase, the aim of this study was to determine the incidence of precancerous and cancerous skin lesions diagnosed and treated during 2016 at the dermatology outpatient clinics of 3 private hospitals in 3 cities in Turkey.
METHODS: All of the patients who presented at 3 outpatient clinics located in the Marmara and Anatolian regions of Turkey in 2016 were retrospectively evaluated. Patients with precancerous and cancerous skin lesions were identified via the relevant International Classification of Diseases code, and sociodemographic and clinical features were obtained from their medical records.
RESULTS: Among the 21,085 patients who presented at the 3 study centers, there were 81 cases of precancerous or cancerous skin lesions. The annual combined incidence of precancerous and cancerous skin lesions was 0.38%. The incidence of precancerous lesions (n=58) was 0.27%, while it was 0.11% (n=23) for cancerous lesions.
DISCUSSION AND CONCLUSION: The prevalence of precancerous and cancerous skin lesions is increasing worldwide. The results of this study were consistent with the findings previously detected in this country and worldwide. This study included patients from only 2 regions of Turkey, but the findings could be used as a reference for dermatology outpatient clinics located in second level healthcare facilities.

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GÝRÝÞ ve AMAÇ: Bu çalýþmadaki amacýmýz hastanemizde Merkezi Hekim Randevu Sistemi (MHRS) kullaným sýklýðýný ve etki eden faktörleri araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya 20 Ocak–28 Þubat 2017 tarihleri arasýnda hastanemiz polikliniklerine ayaktan baþvurmuþ ve muayenesi tamamlanmýþ 7187 kiþi dahil edildi. Hastalarla tek tek yüz yüze görüþüldü ve anket uygulandý.
BULGULAR: Tüm hastalarýn %49.9’u MHRS’den, %47.4’ü kiosklardan sýra aldýðýný söylemiþtir. Mesleklerden MHRS kullaným oraný memurlarda; esnaf, iþçi, ev hanýmý ve emeklilere göre daha yüksek bulundu (p<0.001). Eðitim seviyesi ve aylýk gelir düzeyi arttýkça MHRS kullaným oraný da artmaktadýr (p<0.001). Konya merkezde oturanlarda kýrsalda oturanlara göre MHRS kullanma oraný daha yüksekti (p<0.001). Hastalarýn memnuniyet oranlarý %89.4 olarak bulundu.
TARTIÞMA ve SONUÇ: Merkezi Hekim Randevu Sistemi kullanýmýný artýrmak için kýrsaldan gelen, sosyokültürel seviyesi düþük olan hastalar için yeni stratejiler geliþtirilmelidir. Mevcut olan kamu spotlarý ve tanýtýcý broþürler yaygýnlaþtýrýlmalýdýr.

INTRODUCTION: The aim of this study was to investigate the frequency of use of the Central Physician Appointment System (CPAS) in a Konya hospital and the factors affecting use.
METHODS: A total of 7187 people who were admitted to the outpatient clinics of the hospital and had completed an examination between January 20 and February 28, 2017 were included in the study. Face-to-face interviews were performed with the patients.
RESULTS: Of all the patients, 49.9% made their appointment via CPAS, and 47.4% made an appointment from a kiosk. CPAS usage was higher among white-collar workers than tradesmen, laborers, housewives, or retirees (p<0.001). As education level and monthly income level increased, the use of CPAS also increased (p<0.001). CPAS was also used more by those who lived in the center of Konya than by those who lived in surrounding rural areas (p<0.001). The patient satisfaction rate was 89.4%.
DISCUSSION AND CONCLUSION: In order to increase the use of CPAS, new strategies should be developed targeting residents of rural areas and those of lower socioeconomic status. Existing public service announcements and promotional leaflets should also be disseminated.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, toplumumuzdaki infertil kadýnlarda depresyon, anksiyete, yalnýzlýk ve sosyal desteðin deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Haziran 2012–Aralýk 2012 tarihleri arasýnda hastanemiz infertilite kliniðine baþvuran 140 hasta çalýþmaya dâhil edildi. Tüm katýlýmcýlar, Hamilton anksiyete, Beck depresyon, Kaliforniya Üniversitesi Los Angeles Yalnýzlýk (UCLA) ve Algýlanan Sosyal Destek Destekli Çok Boyutlu Ölçek (MSPSS) formlarýný doldurdu.
BULGULAR: Depresyon skorlarýnýn genel popülasyondan düþük olduðu tespit edildi. Anksiyete skorlarý popülasyona benzer oranlarda bulunmuþtur. Yalnýzlýk ölçeði, evlilik yýlýnýn ve aylýk gelirin artmasýyla azaldý (p<0.05, p<0.05). Sosyal destek, evli olanlarýn sayýsýnýn artmasýyla artmýþtýr (p<0.05). Depresyon skalasýna göre iki katýlýmcý ve kaygý ölçeðine göre dört katýlýmcý psikiyatri kliniðine sevk edildi.
TARTIÞMA ve SONUÇ: Finansal durumlarýn, evlilik süresinin ve sosyal desteðin infertil hastalarda depresyon, anksiyete ve yalnýzlýk puanlarý üzerinde etkili olduðunu düþünüyoruz. Bu hasta grubunda depresyon ve anksiyete arasýnda toplum geneline oranla bir fark olmadýðý için, psikolojik destek ve tedavide yalnýzca gerektiðinde yardým almanýn uygun olduðuna inanýyoruz.

INTRODUCTION: The aim of this study was to evaluate depression, anxiety, loneliness, and the effects of social support in infertile women in Turkey.
METHODS: A total of 140 patients who presented at the infertility clinic between June 2012 and December 2012 were included in the study. All of the participants completed the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the University of California Los Angeles Loneliness Scale, and the Multidimensional Scale of Perceived Social Support.
RESULTS: The depression score of the infertile women was lower than that of the general population, and the anxiety score was found to be similar to that of the general population. The loneliness scale score decreased with additional years of marriage and greater monthly income (p<0.05; p<0.05). The social support score also increased with the length of marriage (p<0.05). Two patients were referred to the psychiatry clinic based on the results of the depression scale, and 4 participants were referred based on their anxiety scale scores.
DISCUSSION AND CONCLUSION: Financial circumstances, duration of marriage, and social support influence depression, anxiety, and loneliness in infertile patients. Since there was no significant difference in the level of depression or anxiety in this group of patients, it was concluded that professional support and treatment are only necessary when appropriate.

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GÝRÝÞ ve AMAÇ: Ýnmeli hastalarýn rehabilitasyonu baþta hasta, hekim, hemþire, psikolog ve bakým veren olmak üzere çok yönlü bir ekip iþidir. Bu çalýþmada ekibin bir parçasý olarak kabul edilen bakým veren bireyler ele alýndý. Ýnme rehabilitasyonu amaçlý yatarak tedavi gören hastalara bakým veren bireylerde anksiyete, depresyon ve tükenmiþlik durumlarýnýn belirlenmesi amaçlandý.
YÖNTEM ve GEREÇLER: Çalýþmaya 72 inmeli hastaya bakým veren 72 gönüllü katýlýmcý dahil edildi. Çalýþmada anksiyete düzeyinin belirlenmesinde Beck Anksiyete Ölçeði, depresyon düzeyinin belirlenmesinde Beck Depresyon Ölçeði ve tükenmiþlik düzeyinin belirlenmesinde Maslach Tükenmiþlik Ölçeði kullanýldý.
BULGULAR: Ýnme hastalarýna bakým veren bireylerde hafif düzeyde depresyon ve hafif düzeyde anksiyete görüldü. Tükenmiþlik düzeyi yönünden deðerlendirmede gerek duygusal tükenme puaný, gerek duyarsýzlaþtýrma boyutu ve gerekse kiþisel baþarý boyutu normal düzeyde bulundu.
TARTIÞMA ve SONUÇ: Ýnme tedavisi ve rehabilitasyonunun psikiyatrik komponenti yalnýz hasta odaklý olmamalýdýr. Hastaya bakým veren bireyler baþta olmak üzere hasta yakýnlarýnýn öncelikli eðitimi ve gerektiðinde psikiyatrik desteðe ihtiyaç duyacaðý görülmüþtür. Uygulanacak rehabilitasyon programýnýn eðitsel gruplar ve etkileþim grup terapileri þeklinde düzenlenmesinde yarar olduðu düþünülmektedir.

INTRODUCTION: The rehabilitation of stroke patients is work that requires a multi-faceted team, which includes the patients, physicians, nurses, psychologists, and caregivers. In this study, the purpose was to determine the level of anxiety, depression, and burnout in caregivers of stroke inpatients.
METHODS: In all, 72 caregivers who each care for 1 stroke patient were included in the study. The Beck Anxiety Inventory, the Beck Depression Inventory, and the Maslach Burnout Inventory were used to assess the level of anxiety, depression, and burnout in the study group.
RESULTS: The caregivers of stroke patients were found to have scores reflecting mild depression and mild anxiety. The burnout level evaluated in subdimensions of emotional exhaustion, desensitization, and personal accomplishment was at a normal level.
DISCUSSION AND CONCLUSION: The psychiatric component of stroke therapy and rehabilitation should not only be patient-oriented. Patient relatives, and particularly their caregivers, may need training and psychiatric support. A rehabilitation program that includes education and interactive group therapies could be very useful.

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GÝRÝÞ ve AMAÇ: Retrorektal tümörler (presakral, prekoksigeal) nadir karþýlaþýlmasýndan dolayý taný ve tedavisi zordur. Bu çalýþmanýn amacý hastanemizdeki retrorektal tümörlere cerrahi deneyimimizi irdelemek.
YÖNTEM ve GEREÇLER: Çalýþmamýzda Ocak 2012 ve Aralýk 2016 tarihleri arasýnda S.B. Üniversitesi Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi/Ýstanbul Genel Cerrahi Kliniði’ne baþvuran 12 hasta deðerlendirildi. Radyolojik bulgular, patoloji raporlarý ve cerrahi teknik geriye dönük olarak týbbi kayýtlardan analiz edildi.
BULGULAR: Toplam olarak 12 hasta deðerlendirildi; 10 hasta kadýn, iki hasta erkekti, ortalama yaþ 45.2 (daðýlým, 31-65 yaþ) idi. Sekiz hastanýn kitlesi doðuþtan orijinli iken üç hastanýn kitlesi nörojenik orijinli ve bir hastanýnki anjiyomiksomatöz kaynaklý tümördü. Anteriyor ve posteriyor olmak üzere iki cerrahi teknik uygulandý.
TARTIÞMA ve SONUÇ: Tümörün total cerrahi rezeksiyonu ve nörolojik fonksiyonlarýn korunmasý baþarýlý tedavinin asýl amacýdýr. En iyi sonuca ulaþmak için multidisipliner yaklaþým ve doðru planlama önemlidir.

INTRODUCTION: Retrorectal tumors (presacral, precoccyxgeal) are rare, and remain a significant diagnostic and therapeutic challenge. The aim of this study was to describe the surgical experience of 1 hospital with retrorectal tumors.
METHODS: Twelve patients admitted to the Dr. Lutfi Kirdar Training and Research Hospital/Istanbul Department of General Surgery between January 2012 and December 2016 were included in our study. Medical records, radiology results, pathology reports, and surgical techniques were analyzed retrospectively.
RESULTS: Of the 12 patients evaluated, 10 were female and 2 were male. The mean age was 45 years (range: 31-65 years). Eight patients had masses of a congenital origin, 3 patients had masses of neurogenic origin, and 1 had an angiomyxomatous tumor. Both an anterior and posterior surgical approach were used.
DISCUSSION AND CONCLUSION: Complete removal of the tumor and preservation of neurological function remain major aspects of successful treatment. To achieve the best results, a multidisciplinary approach and correct planning are important.

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Amaç: Nazal, perinazal ve infraorbital defektleri genellikle travma ve tümör eksizyonu sonrasý ortaya çýkar. Bu bölgelerin rekonstrüksiyonunda iyi renk ve doku uyumunun yanýnda fonksiyonel kaybýn olmamasý veya en aza indirgenmesi ve çevre yapýlarda bozulma yaratmamasý da önemli noktalardýr. Bu yazýda fasiyal arter perforatör flep ile rekonstrüksiyonu yapýlmýþ orta yüz bölge defektleri sunulmaktadýr.
Gereç ve Yöntem: 2008 ile 2017 yýllarý arasýnda 19 hasta orta yüz bölgesindeki tümöral kitleler nedeniyle ameliyat edildi. Lezyonlar uygun cerrahi sýnýrlar ile eksize edildikten sonra ortaya çýkan defektler fasiyal arter perforatör flepler ile onarýldý. Her bölgenin rekonstrüksiyonunda o bölgenin anatomik yapýlarýnýn ve fonksiyonlarýnýn bozulmamasý veya yeniden saðlanmasýna özen gösterildi. Alt göz kapaðýnda ektropiyonu engellemek için flep periosta sabitlendi. Tüm flep donör alanlarý primer onarýldý.
Bulgular: Bir hastada venöz yetmezlik, bir hastada hematom ve ekimoz geliþti ancak bunlara raðmen bir flep kaybý yaþanmadý. Ayrýca iki hastada fleplerde trap door deformitesi geliþti. Bu hastalar dýþýnda hastalarýn tamamý estetik ve fonksiyonel açýdan sonuçlardan memnun kaldý.
Sonuç: Orta yüz bölge defektlerinin rekonstrüksiyonunda fasiyal arter perforatör flebi, tek seanslý olmasý cerraha flep dizayný ve taþýnmasýnda serbestlik ve rahatlýk saðlamasý ve donör alanýn primer kapatýlarak kabul edilebilir görünüme kavuþmasý ile çok kullanýþlý bir seçenektir.

Objective: Defects of the nasal, perinasal, and infraorbital areas usually develop after trauma or tumoral excision. The key points of reconstruction of these areas are achieving a good color match and tissue compatibility, avoiding or minimizing functional deficits, and preventing disfigurement in the surrounding tissue. This study is a review of midfacial defects reconstructed with a facial artery perforator flap.
Methods: Nineteen patients were operated on for midfacial tumoral masses between 2008-2017. After excision of the lesion with the appropriate surgical margins, the resulting defects were reconstructed with facial artery perforator flaps. Recovering the anatomical and functional structure of the area or avoiding deterioration was the goal. In order to avoid ectropion, flaps were anchored to the periosteum when the lower eyelid was involved. All flap donor sites were primarily repaired.
Results: In 1 patient, venous insufficiency was observed, and in another, hematoma and ecchymosis developed, but flap failure did not occur. A trap door deformity was observed in 2 flaps. The patients were satisfied with the aesthetic and functional outcomes.
Conclusion: The facial artery perforator flap is a good option for reconstruction of midface defects because it is elevated in a single stage, it provides freedom to design and transfer, and the donor site can be primarily closed.

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Farklý birden fazla akciðer kanserin ayný hastada bulunmasý nadir görülen bir durumdur. Ýlk kez 1924 yýlýnda yapýlan bir otopsi sýrasýnda karþýlaþýlan bu durum ‘multipl akciðer kanseri’ (MAK) adýný almýþtýr. Multipl akciðer kanseri senkron ve metakron tümör olarak adlandýrýlýr. Ayný anda farklý akciðer kanserinin saptanmasý senkron, ilk lezyonun saptanmasýndan belli bir zaman sonrasýnda ikinci tümör saptanýyorsa metakron tümör olarak adlandýrýlýr. Senkron tümörler, metakron tümörlere göre daha nadir görülüp, tedavi ve prognozu diðer metastatik akciðer kanserlerine göre farklýlýk gösterir. Son yýllarda çok kesitli bilgisayarlý tomografi (BT), PET-BT gibi radyolojik yöntemler ile EBUS, TTÝAB, TBÝAB gibi invaziv taný yöntemlerinin geliþmesi ile birlikte senkron tümörlerin saptanma oranlarý artmýþdýr. Bu yazýda, kliniðimizde taný konulup, ameliyat edilen iki MAK olgusunun özellikleri, taný ve tedavi süreçleri literatür bilgileri eþliðinde tartýþýlarak sunuldu.

The presence of more than 1 distinct lung cancer in the same patient, or multiple primary lung cancer (MPLC) is a rarely seen condition. Multiple lung cancers are classified as synchronous when more than 1 type of lung cancer is detected at the same time, and as metachronous tumors if the second tumor is detected some months after the first lesion. Synchronous tumors are more rare and the treatment and prognosis differs from that observed in metastatic lung cancers. In recent years, thanks to the development of radiological modalities, such as multislice computed tomography and positron emission tomography-computed tomography, as well as invasive diagnostic methods, such as endobronchial ultrasound, transthoracic needle aspiration biopsy, and transbronchial needle aspiration biopsy, the detection rate of synchronous tumors has increased.

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Multipl skleroz veya klinik izole sendrom santral sinir sisteminin otoimmün bir hastalýk spekturumunda olup enflamasyon, demiyelinizasyon ve aksonal hasarla seyretmektedir. Nörolojik bulgular bazen bir enfeksiyon sýrasýnda veya ateþ ile agreve olabilmektedir. Ayrýca malarya da nörolojik bulgularla birlikte serebral malarya sendromunu oluþturabilmekte ve nörolojik özüre neden olabilmektedir. Sunulan olguda da Plazmodium vivax enfeksiyonu sýrasýnda ateþle ortaya çýkan nörolojik bulgularýn deðerlendirilmesi sonucu serebral malaryoz ve diðer etkenler dýþlanarak hastaya santral sinir sistemi enflamatuvar demiyelinizan hastalýðý tanýsý konmuþ ve tedavisi düzenlenmiþ olup nadir görülen bir birliktelik nedeni ile sunulmuþtur.

Clinically isolated syndrome (CIS) and multiple sclerosis are autoimmune diseases of the central nervous system that are characterized by inflammation, demyelination, and axonal damage. Clinical symptoms can be aggravated by fever or concomitant infection. Malaria can also demonstrate neurological symptoms and develop into cerebral malaria, which can lead to severe neurological disability. The present patient had a diagnosis of Plasmodium vivax infection and displayed neurological symptoms and fever. After exclusion of cerebral malaria and other infectious diseases, the patient had a final diagnosis of CIS and the appropriate treatment was initiated. This report is a description of this rare presentation.

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Travmatik diyafragma hernisi (TDH) torakoabdominal travmalardan sonra görülen ve kolaylýkla atlanýlabilen komplike bir durumdur. TDH’nin tedavisi cerrahidir ve operasyonda torakotomi yaklaþýmý ile diyafragma onarýmý yapýlýr. Torakotomide tek akciðer ventilasyonu ile ameliyat edilen taraftaki akciðer kollabe edilir. Bu durum cerrahýn iþini kolaylaþtýrýrken anestezi uygulamasýný zorlaþtýrmaktadýr. Obstrüktif uyku apne sendromu (OUAS); uyku sýrasýnda üst hava yolunda kýsmi ya da tam obstrüksiyon sonucu apne ve hipoapne ataklarýnýn görüldüðü bir hastalýktýr. Obstrüktif uyku apne sendromlu olgularda anestezi uygulamasý; ventilasyon ve entübasyonun güç olmasý ayrýca ameliyat sonrasý dönemde solunum problemleri görülebilmesi gibi özellikleri içermektedir. Biz bu olgu sunumunda geçirdiði travmadan bir yýl sonra TDH tanýsý konulan OUAS’li 46 yaþýnda erkek hastanýn anestezi uygulamasýnda karþýlaþtýðýmýz önemli konularý literatür eþliðinde tartýþmayý amaçladýk.

Traumatic diaphragmatic hernia (TDH) is a serious, frequently overlooked complication observed secondary to a thoracoabdominal trauma. The treatment of TDH is surgical and diaphragmatic repair, usually performed with a thoracotomy approach. During a thoracotomy, the lung on the operation side is collapsed and single-lung ventilation is employed. This procedure facilitates the work of the surgeon; however, it makes the administration of anesthesia more difficult. Obstructive sleep apnea (OSA) is a disorder characterized by attacks of apnea and hypopnea due to partial or complete obstruction of the upper respiratory tract during sleep. Administration of anesthesia to patients with OSA involves several difficulties with respect to ventilation and intubation, as well as potential respiratory complications during the postoperative period. In this case report, critical issues faced during the administration of anesthesia to a 46-year-old male patient with OSA who was diagnosed with TDH 1 year after a trauma were discussed in the context of the literature.

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Baþ ve boyun enflamatuvar süreçlerine sekonder olarak geliþen atlanto-aksiyal eklemin spontan subluksasyonu Grisel sendromu olarak bilinir ve çoðunlukla çocuklarda görülür. Primer tedavisi konservatiftir. Gecikmiþ taný ve tedavi, aðrýlý ve kalýcý servikal deformiteye neden olabilir hatta cerrahi tedavi gerektirebilir. Bu yazýda, 14 yaþýnda adenotonsillektomi operasyonu sonrasý spontan atlanto-aksiyal rotatuvar subluksasyon saptanan ve konservatif tedaviler ile redüksiyon saðlanamayýp cerrahi uygulanan hasta literatür eþliðinde tartýþýldý.

Spontaneous subluxation of the atlantoaxial joint secondary to inflammatory head and neck conditions is defined as Grisel syndrome, and is usually seen in children. The primary treatment is conservative. Delayed diagnosis and treatment can result in a painful and persistent cervical deformity, and may require surgical treatment. In this report, the case of a 14-year-old patient who presented with spontaneous atlantoaxial rotatory subluxation after adenotonsillectomy is described. When no reduction was obtained with conservative treatment, surgical intervention was performed.

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