AMAÇ: Bu çalýþmanýn amacý Ankaferd “Blood Stopper”in (ABS) tükrük bezi dokusu üzerinde kanama durdurucu etkisini incelemektir.
YÖNTEMLER: Çalýþmada 15 eriþkin Wistar Albino cinsi sýçan kullanýldý. Uygun diseksiyon iþlemi sonrasýnda sað submandibuler glandlarý tam kat kesilip 0.2 cc ABS damlatýldý. Sol glanda da ayný kesi iþlemi sonrasýnda salin emdirilmiþ tampon ile baský yapýldý. Ýki tarafýn kanama süreleri ölçüldü.
BULGULAR: Kanama zamaný ABS uygulanan tarafta 21.9±8.9 saniye, salin emdirilmiþ tampon ile baský yapýlan tarafta 89.8±33.9 saniye olarak bulundu. ABS uygulanan tarafta kanama zamaný anlamlý olarak kýsa bulundu.
SONUÇ: Yeni bir hemostatik ajan olarak ABS’nin tükrük bezlerinde kanamayý kontrol etmek için potansiyel bir yararý olabilir. Doku üzerinde histopatolojik etkilerini incelemek, olasý
toksik etkilerini belirlemek için daha çok ileriye dönük kontrollü çalýþmalara ihtiyaç vardýr.

OBJECTIVE: The aim of this study was to investigate the hemostatic effect of Ankaferd Blood Stopper (ABS) on salivary gland tissue.
METHODS: Fifteen adult Wistar Albino rats were used in this study. After an appropriate dissection, the right submandibular glands were incised through all layers and 0.2 cc of ABS was
administered. After performing the same procedure on the left glands, compression was applied with a saline-moistened pack. The duration of bleeding on both sides was measured.
RESULTS: The duration of bleeding was 21.9±8.9 seconds in the ABS administered side, whereas the duration of bleeding was found to be 89.8±33.9 seconds in the side in which only a salinemoistened pack was applied. The duration of bleeding was significantly shorter in the ABS administered side.
CONCLUSION: ABS as a novel hemostatic agent could have a potential benefit in controlling bleeding from salivary glands. Further prospective controlled studies are required to investigate
its pathological effects on the tissue and to determine possible toxic effects.

AMAÇ: Bu çalýþmada, Ýstanbul Bakýrköy Dr. Sadi Konuk Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde son altý yýlda alt gastrointestinal sistemde stoma uygulamasý yapýlan
hastalar deðerlendirildi.
YÖNTEMLER: Mayýs 2005 - Mayýs 2011 tarihleri arasýnda alt gastrointestinal sistem hastalýklarý nedeniyle acil ve elektif olarak stoma uygulanan 201 hasta retrospektif olarak deðerlendirildi. Hastalarýn endikasyonu, tercih edilen stoma tipi, cerrahi komplikasyonlar, kapatýlma süreleri ve kapatma ameliyatlarýndan sonra görülen komplikasyonlar geriye dönük olarak deðerlendirildi.
BULGULAR: Stoma yapýlan 201 hastanýn %60’ý erkek ve yaþ ortalamasý 70.5 (daðýlým, 18-87 yaþ) idi. Stoma uygulamasýnýn %82.5’i acil ameliyatlarda yapýldý. En sýk endikasyon rektosigmoid
malignite cerrahisi idi (%52). En sýk tercih edilen stoma çeþidi uç kolostomi idi (%27). Tüm stomalarýn %10’unda stenoz, iskemi, prolapsus, parastomal herni ve retraksiyon
gibi komplikasyonlar görüldü. Stomaya ait komplikasyonlar en sýk uç kolostomide görüldü. Stomalarýn %43’ü çeþitli nedenlerle kapatýlamadý. En sýk görülen neden hastalarýn kapatýlma öncesi hayatlarýný kaybetmeleri idi (%53). Stomasý kapatýlan hastalarýn %30’unda komplikasyon geliþti. En sýk görülen komplikasyon yara yeri enfeksiyonu idi ve en sýk uç kolostomi kapatýlmasý sonrasýnda görüldü. En az komplikasyon saptýrýcý tipte enterostomilerde izlendi.
SONUÇ: Stoma komplikasyon oraný yüksek bir iþlemdir. Bu sebeple alt gastrointestinal sistem cerrahisinde primer anastamoz öncelikle düþünülmeli, stoma ihtiyacý olan hastalarda
saptýrýcý enterostomi tercih edilmelidir.

OBJECTIVE: In this study, we aimed to make analysis of patients in whom lower gastrointestinal system stomas were performed at General Surgery Clinic of Istanbul Bakirkoy Dr. Sadi
Konuk Training and Research Hospital during last six years.
METHODS: Totally 201 patients in whom stoma was performed following emergency or elective lower gastrointestinal system surgery during May 2005 and May 2011 were retrospectively analyzed. Indication, stoma type, surgical complications of stoma,
time to stoma closure and complications related to closure were evaluated.
RESULTS: Of the 201 patients, 60% were male. Mean age of the patients were 70.5 (range 18 to 87 years). Stomas were performed via emergency surgery in 82,5% of cases. Surgery for recto-sigmoid cancer was the leading indication (52%). End colostomy was preferred in 27% of the patients. Overall complication rate of 10% was observed related to stoma (stenosis, ischemia, prolapsus, parastromal hernia and retraction). The highest complication rate was in patients with end colostomy. Totally 43% of the stomas could not be closed due to several reasons where death before closure was the major cause (53%). A complication rate of 30% was observed in cases when stoma closure was performed. The most common complication which is wound infection was observed in end colostomy closure. The lowest overall complication rate was in group of loop enterostomy patients.
CONCLUSION: Stoma is a surgical procedure which has a relatively high complication rate. For this reason in lower gastrointestinal tract surgery, primary anastomosis should be the first
choice in general. In cases where stoma is needed, loop enterostomy should be preferred, when possible.

AMAÇ: Bu çalýþmada, radyasyon onkolojisi bölümü çalýþanlarýnýn tükenmiþlik ve depresyon düzeyleri ile bunlarla baðlantýlý olabilecek sosyodemografik etkenler incelendi.
YÖNTEMLER: Çalýþmaya kliniðimizde calýþmakta olan 36 kiþi dahil edildi. Katýlanlarýn sosyodemografik özelliklerini belirlemek için bir kiþisel bilgi formu hazýrlandý. Veri toplama amacý ile Beck Depresyon Ölçeði (BDÖ) ve Maslach Tükenmiþlik Ölçeði kullanýldý.
BULGULAR: BDÖ puan sonuçlarýna göre 1 kiþide (%2.8) orta derecede depresyon saptandý. Maslach toplam puaný ile BDÖ puaný arasýnda anlamlý doðrusal korelasyon bulundu. Çalýþmamýzda süreðen hastalýðý olanlarda olmayanlara göre kiþisel baþarý (KB) puanlarý arasýnda anlamlý fark (p=0.04), duyarsýzlaþma (D) deðerinde ise iki grup arasýnda anlamlýya yakýn
(p=0.06) sonuç elde edildi. Kiþisel baþarý iþyeri koþullarýný yetersiz bulanlarda ortamý klasik bulanlara göre anlamlý fark gösterdi (p=0.003). Kiþilik yapýsý ile de KB deðerleri arasýnda anlamlý fark saptandý.
SONUÇ: Onkoloji bölümünde çalýþan saðlýk personeli ruhsal olarak zorlanmaktadýr, bu alanda daha fazla sayýda çalýþaný kapsayacak yeni çalýþmalar yapýlmalýdýr. Saðlýk personelinin
yaþam kalitesinin artýrýlmasýnýn saðlanmasý ile verimlilik daha da artacaktýr.

OBJECTIVE: The aim of our study was to evaluate depression and burnout levels and their relation with sociodemographic factors of health workers in our Radiation Oncology Clinic.
METHODS: Thirty-six persons working at our clinic were included in the study. For determining the sociodemographic characteristics of the participants, a personal information form was designed. For data collection, Beck Depression Inventory (BDI) and Maslach Burnout Inventory were used.
RESULTS: According to BDI score results, moderate depression was detected in 1 person (2.8%). A significant correlation was detected between total Maslach score and BDI score. In our
study, a comparison of workers with and without chronic diseases revealed that differences in personal accomplishment (PA) points were significant (p=0.04) and in depersonalization (D) values were close to significant between the two groups. There was a significant difference (p=0.003) in PA between people that found their working conditions insufficient when compared with those who did not. A significant difference was
detected between personality and PA values.
CONCLUSION: Health workers in the Radiation Oncology Clinic have psychological difficulties, and more studies should be conducted in this area including a greater number of workers. By increasing the quality of life of health workers, productivity can also be increased.

AMAÇ: Bu çalýþmada, semptomatik safra kesesi taþý nedeniyle üç porttan laparoskopik kolesistektomi (LK) yapýlan olgular geriye dönük olarak incelendi ve üç port LK’nýn güvenliði araþtýrýldý.
YÖNTEMLER: Semptomatik safra kesesi taþý nedeniyle LK yapýlan toplam 32 hasta geriye dönük olarak incelendi. Hastalarda dördüncü port gereksinimi, ameliyat süresi, ve komplikasyon oranlarý incelendi.
BULGULAR: Olgularýn 24’ü (%75) kadýn, 8’i (%25) erkekti. 32 hastanýn 29’una (%90.6) üç porttan güvenli bir þekilde LK uygulandý. Üç (%9.4) olguda dördüncü trokar gereksinimi oldu. Hiçbir olguda safra fistülü, safra sýzýntýsý veya safra yolu yaralanmasý gibi majör komplikasyonlar ya da mortalite izlenmedi.
SONUÇ: Semptomatik kolelithiyazisli hastalarda uygulanan 3 port LK’nin güvenli olduðu ve morbiditeyi artýrmadýðý görüldü.

OBJECTIVE: In this study, we aimed to examine patients with three port-laparoscopic cholecystectomy (LC) due to symptomatic cholelithiasis and to investigate the safety of the three-port LC, retrospectively.
METHODS: In total, 32 patients who received three port-LC due to symptomatic cholelithiasis were investigated in a retrospective fashion. Requirement of a fourth port, length of operation,
and complication rates were evaluated.
RESULTS: Twenty-four cases (75%) were female and 8 (25%) were male. Out of 32 patients, 29 (90.6%) received the threeport laparoscopic cholecystectomy successfully. Three (9.37%)
cases required a fourth port. None of the cases demonstrated mortality or major complications such as biliary fistula, leak, or injury.
CONCLUSION: Three-port LC in patients with symptomatic cholelithiasis was found to be safe and no increase in morbidity was observed.

AMAÇ: Saðlýklý term ve preterm yenidoðanlarýn tiroid fonksiyonlarýnýn incelenmesi ve preterm ve term bebeklerin tiroid hormon düzeylerinin karþýlaþtýrýlmasý planlandý.
YÖNTEMLER: Saðlýklý term (≥37 gebelik haftasý) ve saðlýklý preterm (<37 gebelik haftasý) yenidoðanlarýn postnatal üçüncü günlerinde alýnan tiroid stimulan hormon (TSH) ve serbest tiroksin düzeyleri geriye dönük deðerlendirildi. Çalýþmaya annelerinde tiroid hastalýðý olan bebekler, sepsis, solunum güçlüðü, asfiksi vb. hastalýk nedeniyle yenidoðan yoðun bakým ünitesinde izlenen bebekler ve <31 haftalýk preterm bebekler alýnmadý.
BULGULAR: Toplam 371 yenidoðan incelendi. Bebeklerin 190’ý (%51) erkek ve 181’i (%49) kýz idi. TSH deðerleri bakýmýndan gruplar arasýnda fark saptanmadý (p>0.05). Term olgularýn
ortalama serbest tiroksin deðeri preterm olgulardan anlamlý derece yüksekti (p<0.05). Gruplar arasýnda ortalama serbest tiroksin deðerleri bakýmýndan anlamlý farklýlýk gözlendi.
SONUÇ: Saðlýklý pretermlerde saðlýklý term bebeklere göre hipotiroksinemi saptanmýþtýr.

OBJECTIVE: We aimed to investigate thyroid functions and to compare the thyroid hormone levels in healthy preterm and term infants.
METHODS: Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels determined in healthy term (≥37 gestational weeks) and preterm (<37 gestational weeks) neonates on the
postnatal third day were retrospectively evaluated. Infants whose mothers with thyroid disease, treated in neonatal intensive care unit for diseases including sepsis, respiratory distress, etc and <31 weeks preterms were excluded.
RESULTS: We studied 371 neonates (190 males, 51.2%; 181 females, 48.8%). There was no significant relationship among infant groups regarding TSH values (p>0.05). FT4 values were significantly higher in term infants than in preterm infants (p<0.05). There was a significant difference in FT4 values between term and preterm infants.
CONCLUSION: Hypothyroxinemia was detected more commonly in healthy preterm infants than in healthy term infants.

AMAÇ: Glioblastoma multiforme (GBM) yetiþkinlerde en sýk görülen maling primer beyin tümörüdür. Taný ve tedavisi oldukça zordur. Sýk görülmesine raðmen GBM’de tedavi seçenekleri çok fazla deðiþmemiþtir. Bu çalýþma, GBM’li hastalarda tedavi seçeneklerinin yaþam sürelerine etkisini incelemek amacýyla planlandý.
YÖNTEMLER: Bu çalýþmada nöroþirürji kliniðinde taný, tedavi ve izlemleri yapýlan 32 GBM’li hasta (16 erkek, 16 kadýn) geriye dönük olarak deðerlendirildi. Olgulara hastalýk hakkýnda ve uygulanan tedavi yöntemleri hakkýnda bilgi verildi. Hastalarýn performans durumunu belirlemek için Karnofsky performans skalasý kullanýldý, saðkalým süreleri kaydedildi.
BULGULAR: Hastalarýn yaþ medyan deðeri 64 yýl, takip süresi medyan deðeri 7.5 ay ve performans ortalamasý 59.06±9.95 olarak bulundu.
SONUÇ: Bu çalýþmanýn sonucunda GBM’li hastalarda, hastalarýn performans durumlarýnýn prognostik faktörleri etkilediði görülmüþtür.

OBJECTIVE: Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. They are difficult to diagnose and challenging to treat. Treatment options for GBM have not changed over the years despite its high frequency in patients. This study was planned to examine the effects of treatment options on the duration of life in patients with GBM.
METHODS: In this study, we retrospectively evaluated 32 patients (16 male, 16 female) with a GBM diagnosis who were treated in the department of neurosurgery. All of the patients were informed about the disease and the treatment modalities. The Karnofsky performance scale was used to evaluate performance status and survival times were noted.
RESULTS: The median age was 64 years, the median follow–up duration was 7.5 months and the mean of performance status was 59.06±9.95.
CONCLUSION: The results of this study indicate that the performance status of patients diagnosed with GBM is in close relation to their initial prognosis.

Stevens-Johnson sendromu yüksek ateþ, pürülan konjunktivit, eroziv stomatit ve jeneralize ekzantemli cilt lezyonlarý ile kendini gösteren bir hastalýktýr. Etyolojide özellikle ilaçlar, enfeksiyon ajanlarý, karsinomlar, lösemiler ve kollajen doku hastalýklarý gibi pek çok faktörün rol oynadýðý bilinmektedir. Radyoterapi bu hastalýðýn etyolojisinde yer alan nadir nedenlerden biridir. Ancak radyoterapinin tek baþýna bir etken olup olmadýðý konusu henüz daha aydýnlatýlmamýþtýr. Nazofarenks epidermoid karsinomu nedeniyle dosetaksel ve sisplatin kemoterapisi ile eþ zamanlý radyoterapi alan ve radyoterapinin
34. gününde özellikle radyasyon uygulanan bölgede baþlayarak tüm vücuda yayýlan eritem, bül, yer yer erode alanlar ve hemorajik kurutlar, konjuktival hiperemi geliþen
hastayý sunuyoruz.

Stevens-Johnson syndrome is a disease characterized by fever, purulent conjunctivitis, erosive stomatitis, and skin lesions with generalized exanthem. Many factors including drugs, infectious agents, carcinomas, leukemias, and collagen tissue diseases are known to play a role in its etiology. Radiotherapy is one of the factors that rarely has a part in the etiology of this disease. However, it is not clear whether radiotherapy is an etiological factor in and of itself. We present a case who had been receiving radiotherapy concurrently with docetaxel and cisplatin chemotherapy for epidermoid carcinoma. The patient developed erythema, bullae and occasional eroded areas that started at the site of radiation on the 34th day of radiotherapy and spread to the whole body, as well as hemorrhagic crusts and conjunctival hyperemia.

Sinonazal yol mukozal malign melanomlarý olduça nadirdir, tüm mukozal malign melanomlarýn %0.3-2’sini, baþ boyun tümörlerinin ise %4’ünü oluþturur. Her iki cinste ileri yaþlarda görülür ve kötü prognozludur. Cerrahiyle beraber radyoterapi ve/veya kemoterapi tercih edilir. Lokal nüks oldukça sýktýr ve ayný zamanda nüksetme tedavi baþarýsýzlýðýnýn en önemli sebebidir. Kliniðimize tek taraflý burun týkanýklýðý ve burun kanamasý þikayetiyle baþvuran 76 yaþýnda kadýn hastanýn paranazal bilgisayarlý tomografisinde sinonazal yolda kitle görüldü. Kitlenin histolojik incelemeside malign melanom tanýsý aldý.

Sinonasal tract mucosal malignant melanomas are rare, accounting for between 0.3% and 2% of all malignant melanomas and about 4% of head and neck melanomas. They occur in older patients of both genders and frequently have poor prognoses. Surgery accompanied by radiation and/or chemotherapy is generally used as treatment. The frequency of local recurrence is high and recurrence is also the major determinant of treatment failure. Herein we report the case of a 76 year-old woman who was admitted with unilateral nasal obstruction and epistaxis. She also had a mass lesion in the sinonasal tract of her paranasal BT. A histological examination of the mass indicated malignant melanoma.

Pulmoner sekestrasyon, akciðerin nadir görülen konjenital bir malformasyonudur. Normal bronkopulmoner sistemden köken alan ve aberran sistemik arterden kanlanan, fonksiyone olmayan akciðer dokusu ile karakterizedir. Ýntralober ve ekstralober olmak üzere iki tipi vardýr. Ýntralober pulmoner sekestrasyonlar visseral plevra ile, ekstralober pulmoner sekestrasyonlar ise kendine ait bir plevra ile çevrilidir. Radyolojik olarak pnömonik infiltrasyon, kistik görünüm ve daha nadir olarak nodül ve kitle görüntüleri verebilir. Polikliniðimizde soliter pulmoner nodül nedeniyle tetkik edilen hastaya intralober pulmoner sekestrasyon tanýsý konuldu. Bu vaka soliter pulmoner nodül ayýrýcý tanýsýnda pulmoner sekestrasyonlarýn alýnmasý gerektiðini vurgulamak için yayýnlandý.

Pulmonary sequestration is a rare congenital malformation of lung. It is characterized by a nonfunctioning lung tissue originating from bronchopulmonary system that has anomalous systemic arterial blood supply. The two forms of pulmonary sequeastration are intrapulmonary, which is surrounded by normal lung tissue, and extrapulmonary, which has its own pleural investment. Radiologically, they may present as pneumonic infiltration, cystic nodules and rarely mass images. The patient was evaluated for solitary pulmonary nodule in our clinic and diagnosed as intralobar pulmonary sequestration. We decided to publish this case to remind that in the differential diagnosis of solitary pulmonary nodules pulmonary sequestration should be taken to highlight.

Desendan nekrotizan mediastinit (DNM) nadir, fakat yüksek oranda ölümcül seyreden bir durumdur. Sýklýkla orofarenjeal veya odontojenik þiddetli enfeksiyonlara baðlý geliþen bir
komplikasyondur. Kliniðe, DNM tablosu ile baþvuran 50 yaþýnda kadýn hastada trakeaotomi açýlarak, transservikal giriþimle boyundaki apse drene edildi. Apse lojundaki nekrotik dokulara debridman uygulandý. Çekilen toraks bilgisayarlý tomografisinde ampiyem poþlarý oluþmasý ve retrofarinjeal bölgeden cerahat içeriðinin mediastene yayýlýmý olmasý üzerine dekortikasyon ve ampiyemektomi yapýldý. Mediastinal plevra açýlarak mediasten temizlendi. Hasta sorunsuz olarak taburcu edildi. Derin boyun enfeksiyonuna ikincil geliþen DNM’li olgu nadir görülmesi ve baþarýlý tedavisi nedeniyle
literatür eþiðinde sunuldu.

Descending necrotizing mediastinitis (DNM) is a rare fatal complication. It mostly develops due to severe oropharyngeal or odontogenic infections. A 50-year-old female patient who admitted to our department with the diagnosis of DNM underwent tracheotomy, and the abscess in her neck was drained with transcervical resection. Necrotic tissue in the area was debrided. Since thorax computerized tomography revealed formation of empyema pouches and emission of pus content from the retropharyngeal area into the mediastinum, decortication and empyemectomy were performed. The mediastinal pleura was resected and the mediastinum was cleaned. The patient was discharged with full recovery. Descending mediastinitis secondary to a deep neck infection is a rare occurrence. This study aims to share this successfully treated case in the light of the literature.

Heterotopik ossifikasyon normalde ossifiye olmamasý gereken bir dokuda yeni kemik oluþumu ile karakterize olan bir antitedir. Ýlk defa 1918 yýlýnda Dejerine ve Ceillier tarafýndan, “paraosteoartropati” terimi ile tanýmlanmýþtýr. Heterotopik ossifikasyon travmatik beyin yaralanmalarý ve omurilik yaralanmalarý sonrasý da oldukça sýk görülen bir komplikasyondur. Genel olarak travma heterotopik ossifikasyon insidansýný arttýrýr. Heterotopik ossifikasyon nörojenik heterotopik ossifikasyon, travmatik heterotopik ossifikasyon, miyozitis ossifikans progresiva olarak genelde üç grupta incelenir. Heterotopik ossifikasyon genellikle büyük eklemlerde görülür. Heterotopik ossifikasyonun tedavi seçenekleri arasýnda eklem hareket açýklýðýnýn korunmasý, ilaç tedavisi (antienflamatuvar ilaçlar), radyoterapi ve cerrahi eksizyonu yer almaktadýr. Heterotopik ossifikasyonda tedaviden çok profilaksi daha önemlidir. Steroid olmayan antienflamatuvar
ilaçlardan özellikle indometazin profilakside kullanýlýr. Heterotopik ossifikasyonda cerrahi rezeksiyon maturasyon tamamlandýktan sonra uygulanabilir. Heterotopik ossifikasyon
geliþme riski yüksek olan hastalarda profilaktik radyoterapi uygulanmasý antiinflamatuvar ilaçlardan daha etkilidir.

Heterotopic ossification is an entity characterized by a new bone formation in a tissue that is not normally ossified. In 1918, Dejerine and Ceillier defined ”paraosteoarthropathy” for the first time. Heterotopic ossification is a frequent complication after traumatic brain injury and also of spinal cord injuries. In general, trauma increases the heterotypic ossification incidence. Heterotopic ossification is usually observed in three groups as neurogenic heterotopic ossification, traumatic heterotopic
ossification and progressive myositis ossificance. Heterotopic ossification is usually seen in the large joints. Treatment options for heterotopic ossification are protection of joint range of motion, medication (anti-inflammatory drugs), radiotherapy, and surgical excision. Prophylaxis of heterotopic ossification is more important than treatment. Non-steroidal anti-inflammatory drugs, especially indomethacin, are used for prophylaxis. Surgical resection of heterotopic ossification can be applied after the completion of maturation. In patients at high risk for developing heterotopic ossification, prophylactic
radiotherapy is more effective than anti-inflammatory drugs.