AMAÇ: Bu yazýda, düþük dozlu hormon tedavisi (HT) ve raloksifenin tiroid hormonlarý, glikoz metabolizmasý ve serum lipidleri üzerindeki etkinlikleri karþýlaþtýrýldý.
YÖNTEMLER: Postmenopozda 100 kadýn çalýþmaya dahil edildi, 90’ý çalýþmayý tamamladý. Kadýnlara 3 ay boyunca düþük dozlu HT (grup I), raloksifen (grup II) ve kalsiyum-D3 (grup III) verildi. Hastalar tiroid hormonlarý, glikoz ve kan lipid düzeyleri deðiþimleri açýsýndan deðerlendirildi. Verilerin deðerlendirilmesinde eþleþtirilmiþ t, ANOVA, ki-kare, Kruskal-Wallis, Dunn’s çoklu karþýlaþtýrma testi kullanýldý. Anlamlýlýk p≤0,05 düzeyinde kabul edildi.
BULGULAR: HDL kolesterol (p=0,006), trigliserid (p=0,047), açlýk kan þekeri (AKÞ) (p=0,001) ve HbA1C’de (p=0,039) grup II’de anlamlý düþme gözlendi. LDL ve total kolesterolde ise hem grup I, hem de grup II’de anlamlý düþme saptandý. Tüm gruplarda tiroid hormon düzeylerinde anlamlý bir deðiþiklik saptanmadý. Tedavi öncesi-sonrasý deðiþim farkýna göre grup II’de Kupperman indeksi, TSH, AKÞ, HbA1C ve total kolesteroldeki azalma; grup I’de ise Kupperman indeksi, endometrial kalýnlýk, HbA1C, total ve LDL kolesteroldeki azalma ile HDL kolesteroldeki artýþ grup III’e göre anlamlý bulundu (p<0,05).
SONUÇ: Postmenopozdaki hastalarda hem düþük dozlu HT hem de raloksifen yan etkisi düþük, glikoz metabolizmasýný ve tiroid hormonlarýný etkilemeyen, lipid profiline olumlu etkileri olan ilaçlardýr.

OBJECTIVE: We aimed to compare the effectiveness of low-dose hormone therapy (HT) and raloxifene on thyroid hormones, glucose metabolism and serum lipids.
METHODS: One hundred postmenopausal women were included into the study, and 90 of them completed the study. Low-dose HT (Group I), raloxifene (Group II) and calcium-D3 (Group III) were given to the patients for three months. Patients were evaluated with respect to thyroid hormones, glucose and plasma lipid levels. Paired t, ANOVA, chi-square, Kruskal-Wallis, and Dunn’s multiple comparisons tests were used to evaluate the data. Significance was accepted as a p value ≤0.05.
RESULTS: Significant decreases in high-density lipoprotein (HDL) (p=0.006), triglyceride (p=0.047), fasting blood sugar (p=0.001) and HbA1C (p=0.039) levels were observed in Group II. Significant decreases in low-density lipoprotein (LDL) and total cholesterol levels were determined in Groups I and II. Thyroid hormone levels were unchanged in all groups.
Regarding before-after treatment differences, we observed decreased Kupperman index, thyroid stimulating hormone (TSH), fasting blood sugar, HbA1C, and cholesterol in Group II and decreased Kupperman index, endometrial line, HbA1C, cholesterol, and LDL and increased HDL in Group I. The differences in comparison with Group III were significant (p<0.05).
CONCLUSION: Low-dose HT and raloxifene are drugs with low adverse effects, and they have no effect on glucose metabolism or thyroid hormones and beneficial effects on the lipid profile in
postmenopausal women.

AMAÇ: Glokom þüphesi olan ya da yeni taný almýþ glokom hastalarýnda kýsa dalga boyu otomatik perimetrenin olasý görme alaný kayýplarýnýn baþlangýcýný ve yerini öngörmedeki etkinliði araþtýrýldý.
YÖNTEMLER: Çalýþma grubuna Ankara Eðitim ve Araþtýrma Hastanesi Glokom Birimi’nde takip edilen 30-60 yaþ arasý 17 hastanýn (6 erkek, 11 kadýn) 34 gözü dahil edildi. Hastalar 6 ay ara ile standart otomatik perimetre ve kýsa dalga boyu otomatik perimetre ile 4 yýl boyunca takip edildi.
BULGULAR: Baþlangýçta 34 gözün 14’ünde standart otomatik görme alaný normal iken kýsa dalga boyu otomatik perimetre ile görme alaný kaybý saptandý. Bu 14 gözün 7’sinde (%50) takip süresince standart otomatik perimetre ile görme alaný kayýplarý oluþtu. Çalýþmanýn sonunda, 34 gözün 13’ü standart otomatik perimetre ile progresyon gösterdi. Bunlarýn hepsinde kýsa dalga boyu otomatik perimetre ile ayný alanlarda daha geniþ ve ilerleyen görme alaný kayýplarý saptandý.
SONUÇ: Kýsa dalga boyu otomatik perimetre erken glokomatöz hasarýn saptanmasýnda ve olasý görme alaný kayýplarýnýn öngörülmesinde standart otomatik perimetreye göre daha etkin bir yöntemdir.

OBJECTIVE: In this study, to determine whether blue-on-yellow perimetry (B/Y) is effective in predicting the onset and location of impending glaucomatous visual field loss in glaucoma suspect patients and patients recently diagnosed as glaucoma was investigated.
METHODS: The study population consisted of 34 eyes of 17 patients (6 male and 11 female) at the ages of 30-60 years who were followed up in the Glaucoma Department of Ankara Training and Research Hospital. Patients were examined in 6 months intervals by a Standard Automated Perimetry (SAP) and a Short Wavelength Automated Perimetry (SWAP) for a period of 4 years.
RESULTS: Initially, 14 of 34 eyes had normal SAP results while having defects in SWAP. Seven (50%) of these 14 eyes showed progressive visual field loss in SAP during the follow-up period. At the end of the study, 13 of 34 eyes included in the study, showed progression with SAP. All of these had larger and progressive defects at the corresponding areas in SWAP.
CONCLUSION: Short Wavelength Automated Perimetry is an effective method for early detection of glaucomatous damage and prediction impending visual field loss compared to Standard Automated Perimetry.

AMAÇ: Septum deviasyonu, septumun anormal olarak saða veya sola yönelip etkilenen hava pasajýnda týkanýklýða neden olmasýdýr. Bu çalýþmanýn amacý, nazal septum deviasyonunun (NSD), Kulak Burun Boðaz (KBB) polikliniðine baþvuran hastalar arasýnda görülme sýklýðýný ve yaklaþýmlarýný incelemektir.
YÖNTEMLER: Bu çalýþma, Ocak 2008 - Þubat 2009 tarihleri arasýnda KBB polikliniðimize baþvuran 20596 hastanýn kayýtlarý retrospektif olarak incelenerek gerçekleþtirildi.
BULGULAR: 20596 hastanýn 7958’inde (%39) NSD belirlendi. NSD saptanan 7958 hastanýn 3024’ü
(%38) kadýn, 4934’ü (%62) ise erkekti, cinsiyet farký istatistiksel olarak anlamlýydý (p<0,05). Ýkinci ve üçüncü dekadlarda NSD sýklýðý diðer yaþ gruplarýna göre daha fazla tespit edildi ve saptanan fark istatistiksel olarak anlamlýydý (p<0,05). NSD belirlenen 7958 hastanýn sadece 2113’ü burun týkanýklýðý þikayeti olduðunu ifade etmiþ ve 2113 hastanýn 1142’sine cerrahi tedavi uygulanmýþtýr.
SONUÇ: NSD toplumda oldukça sýk gözlenmekte olup KBB polikliniðine neredeyse en sýk baþvuru nedeni olarak yer almaktadýr. NSD özellikle çocukluk döneminde yüz geliþimini etkileyerek kiþilerin yaþam kalitesini etkileyen komplikasyonlara yol açabilmektedir. Bu nedenle, ülkemizde NSD sýklýðýný belirleyip neden olabileceði komplikasyonlarý ortaya koymak için daha geniþ hasta gruplarýnda çalýþmalar yapýlmalýdýr.

OBJECTIVE: A deviated septum is an abnormal condition in which the top of the cartilaginous ridge leans to the left or the right side, causing obstruction of the affected nasal passage. The aim of this study was to determine the prevalence of nasal septum deviation among the patients admitted to the Ear, Nose and Throat (ENT) outpatient clinic.
METHODS: The records of 20,596 patients who admitted to our clinic between January 2008 and February 2009 were reviewed retrospectively.
RESULTS: Nasal septum deviations were determined in 7,958 of 20,596 patients (39%). Of the 7,958 patients with septal deviation, 3,024 (38%) were female and 4,934 (62%) were male, and the difference was statistically significant (p<0.05). The incidence of septum deviation was higher in the second and third decades, and the difference when compared to other decades was statistically significant (p<0.05). 2,113 patients suffered from nasal congestion, and 1,142 of them were treated surgically.
CONCLUSION: Nasal septal deviation is observed quite frequently in the community, and it is nearly the most frequent reason for application to the ENT outpatient clinics. Nasal septal deviation, especially in childhood, may affect facial development. It may lead to complications and affect quality of life. Therefore, to identify the incidence of this disease and its complications in our country, data regarding broader patient groups should be obtained.

AMAÇ: Çalýþmamýzda perinatal asfiksi tanýlý olgularýmýzýn demografik özelliklerini belirlemek, asfiksi görülme yüzdesini ve mortalite oranýný ortaya koymak ve yýllar içerisindeki deðiþimi deðerlendirmeyi amaçladýk.
YÖNTEMLER: Çalýþmamýzda Ocak 1999 - Aralýk 2005 tarihleri arasýndaki yedi yýllýk süre içerisinde perinatal asfiksi tanýlý 295 yenidoðanýn dosya kayýtlarý retrospektif olarak deðerlendirildi.
BULGULAR: Olgularýn 116’sý (%39) kýz, 179’u (%61) erkekti. Sarnat&Sarnat sýnýflamasýna göre 105
(%36) olgu evre I, 119’u (%40) evre II ve 71’i (%24) evre III olarak deðerlendirildi. Olgularýn 112’si (%38) kaybedildi. Elli dokuz (%20) olgu konvulziyon geçirdi. Perinatal
asfiksi sýklýðýný ortalama 10/1000 canlý doðum olarak saptadýk. Tüm yýllar içerisinde en düþük oran 6,8/1000 canlý doðum ile 2005 yýlýnda saptandý. Çalýþmamýzda evre III olgularýn oraný 2005 yýlýnda en düþük düzeyde saptandý (%9,7).
SONUÇ: Asfiksi açýsýndan riskli gebeliklerin saptanmasý ve uygun resüsitasyon giriþimlerinin
uygulanmasýnýn yaygýnlaþtýrýlmasý asfiksiye baðlý mortalite ve morbiditeyi azaltmaya katkýda bulunacaktýr.

OBJECTIVE: The aim of our study was to determine the demographic features of neonates with perinatal asphyxia, the asphyxia frequency, mortality rates, and the changes observed over a 7-year period.
METHODS: In this study, conducted from January 1999 to December 2005, the medical records of newborns with perinatal asphyxia were evaluated retrospectively.
RESULTS: Of the 295 patients, 116 were female (39%) and 179 were male (61%). According to Sarnat and Sarnat classification, 105 (36%) neonates were in stage I, 119 (40%) in stage II and 71 (29%) in stage III. One hundred and twelve patients (38%) died. Fifty-eight (20%) neonates had convulsions. Perinatal asphyxia frequency was found to be 10 per 1000 live births. The lowest asphyxia frequency was observed in 2005 with 6.8 per 1000 live births. The lowest number of patients in stage III was determined in 2005 (9.7%).
CONCLUSION: Identification of high-risk pregnancies, establishment of optimum delivery conditions and optimal resuscitation efforts would help to decrease perinatal asphyxia mortality and morbidity.

AMAÇ: Bu çalýþmanýn amacý, acil servise baþvuran ve dermatoloji konsültasyonu istenen hastalarýn baþvuru nedenleri, klinik özellikleri, tanýlarý, tedavileri ve yatýþ oranlarý hakkýnda epidemiyolojik bilgiler edinmektir.
YÖNTEMLER: Ocak 2004 ile Aralýk 2006 tarihleri arasýnda, Elazýð ilinde, Fýrat Üniversitesi Týp Fakültesi acil servisine baþvuran ve dermatolojik yakýnmasý olan 404 hasta retrospektif olarak deðerlendirildi. Hastalarýn baþvuru nedenleri, tanýlarý, tedavileri ve yatýþ oranlarý hasta kayýt formlarý incelenerek elde edildi.
BULGULAR: Yirmi dört aylýk sürede acil servise baþvuran 29,616 hastanýn 404’ünü (%1,36) dermatoloji hastalýklarý oluþturmaktaydý. Hastalarýn 227’si (%56,2) kadýn ve 177’si
(%43,8) erkekti (daðýlým, 17-89 yaþ; ortalama 41,66±16,69 yýl). Altý grup halinde incelenen hastalýklar arasýnda en sýk olarak %57,40 oranýnda (n=232) ürtiker-anjiyoödem saptandý. Ýkinci sýklýkta ise 49 hasta ile (%12,10) enfeksiyon hastalýklarý bulunmaktaydý.
SONUÇ: Çalýþmamýzda dermatoloji hastalarýnýn acil servise baþvurma nedenlerinin baþýnda ürtiker-anjiyoödem ve enfeksiyon hastalýklarý olduðunu tespit ettik.

OBJECTIVE: The aim of this study was to obtain information regarding the reasons for application, clinical characteristics, diagnoses, treatments, and hospitalization rates of patients applying to the emergency service who underwent dermatology consultation.
METHODS: Four hundred and four patients with dermatological complaints who applied to Fýrat University Hospital emergency service in the city of Elazig between January 2004 and December 2006 were evaluated retrospectively. The reasons for application, diagnoses, treatments, and hospitalization rates of the patients were obtained by investigation of the patient register forms.
RESULTS: Four hundred and four patients of a total of 29,616 who applied to the emergency service over a 24-month period had dermatological disorders. Two hundred and twenty-seven (56.2%) of these patients were males and 177 (43.8%) were females. Age range of the patients was 17 to 89 years, and the mean age was 41.66±16.69 years. The diseases were examined in 6 groups. The most common disease group was found as urticaria-angioedema, with a rate of 57.4% (232 patients), followed by infectious diseases, which affected 49 patients (12.1%).
CONCLUSION: In our study, we determined that urticaria-angioedema and infectious diseases were the main reasons for the application of patients to the emergency service with dermatological complaints.

Birçok hastalýðýn tedavisinde yararlandýðýmýz gluteal enjeksiyonlar sadece týp personelinin deðil bu iþlemde deneyim kazanmýþ yan komþumuzun da sýklýkla uyguladýðý bir tedavi uygulama yöntemidir. Genelde ilk akla gelen komplikasyon olarak siyatik sinir hasarý düþünülse de, buzdaðýnýn görünen kýsmý budur. Enjeksiyon yerinin intramusküler yerine hipodermal alanda kalmasý, özellikle tekrarlayan enjeksiyonlar sonrasý, apseleþme ve ileri dönemde de aðrýlý nekrozlara yol açmaktadýr. Medikal tedavisi mümkün olmayan bu nekrotik alanlarýn sýklýkla cerrahi olarak debride edilmesi düþünüldüðünden, çok daha büyük kraterlere yol açarak hastalarý bir anda evre 3 basý yaralý hasta grubuna dönüþtürmektedir. Sadece bu enjeksiyonlarýn tekniði deðil, enjeksiyonlarýn yüzeyel uygulanýmýnýn yol açtýðý ülser ve apselerin tedavisi de hafife alýnmamalýdýr.

Gluteal injections are therapeutic procedures frequently performed in our own homes as well by medical staff. Though the most frequent complication is thought to be sciatic nerve damage, this is only a small portion of the possible complications. When the drug is applied to a hypodermal plane instead of intramuscularly, it can lead to abscess formation and later to painful necrosis. As medical therapy is ineffective in treating these
necrotic areas, they are surgically debrided, and as a result, evolve into deep craters, as seen with a grade 3 decubitus ulcer. Both of these injection techniques and the ulcer and abscesses caused by injections performed superficially should be seriously considered.

Radyoterapi cilt kanserlerinin tedavisinde önemli rol oynamaktadýr. Kaposi sarkomu (KS) ilk olarak 1872’de dermatolog Moritz Kaposi tarafýndan tanýmlanmýþtýr. KS lezyonlarý radyoduyarlý olup, radyoterapi aðrý, kanama ve ödemin palyasyonunda etkili ve tolere edilebilir bir tedavi yöntemidir. Literatüre baktýðýmýzda gövde ve ekstremite yerleþimli kutanöz lezyonlarda tek fraksiyon 800 cGy radyoterapi ile tam yanýt gözlenen seriler elde edilmiþtir. Radyoterapi uygularken düzensiz dokularda homojen doz daðýlýmý elde etmek amacýyla bolus materyali kullanýlmaktadýr. Su, doku eþdeðeri olmasý, kolay bulunabilirliði ve uygulama rahatlýðý nedeniyle tercih edilmektedir. Çalýþmamýzda bilateral alt ekstremitede diz altýndan ayaða kadar yaygýn semptomatik cilt lezyonlarý olan KS tanýlý olguda, su bolusu kullanarak uyguladýðýmýz radyoterapi deneyimini ve tedavi sonucunu deðerlendirdik.

Radiotherapy plays an important role in the treatment of skin cancers. In 1872, dermatologist Moritz Kaposi first described Kaposi’s sarcoma (KS). KS lesions are radiosensitive. Radiotherapy is an effective and tolerable treatment for pain, bleeding and edema palliation. A review of the literature revealed that a single fraction radiotherapy 800 cGy to cutaneous lesions located in the trunk and extremities resulted in a series of complete response. While using radiotherapy, in order to obtain a homogeneous dose in irregular distribution of tissues, a bolus material is used. Water is preferred because of its equivalence to tissue, availability and ease of application. In our study, we reviewed the experience with radiotherapy by using water bolus and the outcome of the treatment in a patient diagnosed with KS who had symptomatic skin lesions on the bilateral lower extremities starting under the knee and extending to the foot.

Renal onkositom, benign bir böbrek tümörü olup genellikle cerrahi sonrasý patolojik inceleme ile taný konur. Ayýrt edici klinik ve radyolojik özellikleri olmadýðýndan onkositomlar malign kitle gibi deðerlendirilirler. Bu olgu sunumunda, kliniðimizde böbrek kitleleri nedeniyle renal hücreli karsinom ön tanýsýyla ameliyat edilen, patoloji raporlarý onkositom olarak rapor edilen iki olguyu literatür eþliðinde tartýþmayý amaçladýk.

Renal oncocytoma is a benign renal tumor, generally diagnosed with postoperatively pathologic examination. According to clinical and radiological differential diagnostic problems oncocytomas usually treated like renal masses. In our case presentation; 2 cases who underwent surgery pre-diagnosis (preliminary diagnosis) of renal masses and whose pathological results were oncocytomas discussed according to current literatures.

Kavernöz hemanjiyomlar, santral sinir sisteminin tüm bölgelerinde görülebilmesine raðmen, en çok beyin parankiminde görülürler. Spinal sistemde, genellikle omurga cismini etkilemesine raðmen, intramedüller, intradural - ekstramedüller ve nadiren sadece ekstradural alanda ortaya çýkabilirler. Tüm spinal epidural tümörlerin yaklaþýk
%4’ünü, tüm spinal vasküler malformasyonlarýn ise %5-12’sini oluþtururlar. Pür epidural kavernöz hemanjiyomlar oldukça nadirdirler. Literatürde bildirilen toplam olgu sayýsý 90’dýr ve bunlarýn sadece 14’ü servikal lokalizasyondadýr. Oluþturduðu klinik tablo ve radyolojik görünümleri, kraniyal lokalizasyonda görüldüðünden oldukça farklýdýr. Bu çalýþmada, ilerleyici spinal kord sendromuna neden olan, pür servikotorasik epidural kavernöz hemanjiyomu olan bir olguyu bildiriyor ve bu nadir görülen lezyonlarýn manyetik rezonans görüntüleme bulgularýný, ayýrýcý tanýlarýný ve tedavi seçeneklerini tartýþýyoruz.

Althought cavernous hemangiomas can occur in any part of neuroaxis, they are primarly seen in the brain. Althought cavernous hemangiomas most commonly affect the vertebral bodies in the spine, they can also be seen intramedullary, intradural-extramedullary, and pure extradurally. They represent approximately 4% of all spinal epidural tumors and 5 -12% of all spinal vascular malformations. Pure epidural cavernous
hemangiomas are quite rare. Just about 90 cases have been reported in available literature, and only 14 of them was located in cervical level. Clinical features and radiologic findings are so different from its cranial localization. We report a case of pure cervicotoracic epidural cavernous hemangioma who has presented with symptoms of progressive spinal cord syndrome and we discuss the clinical behaviour, MRI findings, differential diagnosis and treatment options of these unusual lesions.

Ýskemik inmelerin yaklaþýk olarak %40’ýnda kesin tanýmlanabilen etyolojik sebep bulunamamakta ve bu olgular kriptojenik inme olarak adlandýrýlmaktadýr. Kriptojenik inmelerin bir kýsmýný tespit edilemeyen paradoksik emboliler (PDE) oluþturmaktadýr. PDE venöz trombozun saðdan-sola þant vasýtasý ile sistemik embolizasyonu olarak tanýmlanmaktadýr ve tanýsý genellikle atlanmaya devam etmektedir. Patent foramen ovale prevalansýnýn saðlýklý bireylerde %27-35 olduðu düþünülürse, nedeni açýklanamayan arteriyel týkanmalarda PDE’nin araþtýrýlmasýnýn gerekliliði ortaya çýkmaktadýr. PDE kontrast ekokardiyografi ve transkraniyal Doppler ultrason (TCD) ile tespit edilebilir. Taný konduktan sonra yapýlacak endovasküler kapama iþlemi, hastalarýn mortalite ve morbitide oranlarýný ciddi oranda etkileyecektir. Bu yazýda, kliniðimize iskemik inme tanýsý ile yatýrýlan ve TCD ile PDE saptadýðýmýz 59 yaþýndaki erkek hasta sunuldu. Raporumuzun amacý kriptojenik inmelerde PDE ihtimalinin de düþünülmesi, taný konmasý ve doðru tedavi edilmesidir.

Approximately 40% of ischemic strokes have no clearly definable etiology, and these cases are referred to as cryptogenic stroke. Undetermined paradoxical embolism (PDE) is a part of cryptogenic stroke. PDE is defined as a venous thrombosis causing systemic embolization through a right-to-left shunt, and this diagnosis continues to be missed frequently. Considering that the prevalence of patent foramen ovale (PFO) is 27-35% in the normal population, the need to search PDE in unexplained arterial occlusion has become evident. PDE can be diagnosed by contrast echocardiography and transcranial Doppler (TCD) ultrasound. After its diagnosis, surgery for endovascular closure will seriously affect the mortality and morbidity ratios in patients. In this study, we report a 59-year-old male who presented to our clinic with ischemic stroke and in whom PDE was
detected by TCD ultrasound. The aim of our report is to consider the probability of PDE in cryptogenic stroke in order to facilitate accurate diagnosis and treatment.