AMAÇ: Çalýþmamýzda acil serviste düzenlenen adli raporlarý mevzuat eþliðinde incelemeyi amaçladýk.
YÖNTEMLER: Çalýþmamýzda bir üniversite araþtýrma ve uygulama hastanesi acil týp kliniðine 01.08.2012-01.02.2013 tarihleri arasýnda baþvuran 220 olguya ait genel adli muayene raporu ve hasta dosyasý incelendi.
BULGULAR: Çalýþmaya dahil edilen olgularýn 157’si (%71.4) erkek, 63’ü (%28.6) kadýn, yaþ ortalamasý ise 27.3±15.9 SD (min: 1, maks: 87) idi. Olgularýn 56’sýnda (%25.5) herhangi bir konsültasyon yapýlmamýþ olup, en sýk beyin cerrahi kliniðinden konsültasyon istendiði tespit edildi. Adli olgularýn en sýk trafik kazasý 67 (%31.5) nedeniyle olduðu görüldü. Olgularýn hiçbirisinde alkol alým durumlarýnýn tespitine iliþkin analizlerin yapýlmadýðý belirlendi. Adli raporlarýn 114’ünde (%51.8) yaralanmanýn basit týbbi müdahale ile giderilebilecek nitelikte olduðu saptandý. Raporlarýn 61’inde (%27.7) hayati tehlikenin varlýðýnýn belirtildiði bulgusuna ulaþýldý. Düzenlenen raporlarýn türüne bakýldýðýnda 215’inin (%97.7) geçici, beþinin (%2.3) ise kati rapor olarak düzenlendiði tespit edildi.
SONUÇ: Çalýþmamýzda hekimlerin adli rapor düzenlenmesinde eksik yaklaþým sergilediði görülmektedir. Hekimlerin adli olgulara iliþkin yapacaðý iþ ve iþlemler ile adli olgulara nasýl bir yaklaþým sergileyeceði hem týp eðitiminde hem de mezuniyet sonrasý eðitimlerde iþlenmelidir.

OBJECTIVE: In this study we aimed to investigate the forensic reports prepared in the emergency department in respect of current legislation.
METHODS: Forensic examination reports and medical records of 220 medico-legal cases that applied to the emergency department of a university medical faculty hospital between 01.08.2012 and 01.02.2013 were retrospectively investigated.
RESULTS: Of the cases included in the study 157 (71.4%) were male and 63 (28.6%) were female, with a mean age of 27.3±15.9 years (min: 1 year, max: 87 years). Consultations were most commonly requested from the department of brain surgery; however, no consultation was requested for 56 (25.5%) cases. No alcohol analysis was performed for any of the cases. Described injuries were found to be treatable with simple medical intervention in 114 (51.8%) forensic reports. Reports indicated the presence of life-threatening clinical status in 61 (27.7%) cases. Regarding the type of reports, 215 (97.7%) reports were concluded as temporary, while only 5 (2.3%) were final reports.
CONCLUSION: Obtained findings revealed improper preparation to forensic reports of physicians. Physicians need to be educated regarding approach to medico-legal cases, forensic reporting and related procedures during undergraduate and postgraduate life-long education programs.

AMAÇ: Otuz beþ yaþ ve üstü eðitim seviyesi düþük kadýnlarýn meme kanseri hakkýnda bilgilerini ölçmek, risk faktörlerini ortaya koymak ve risk hesaplamasý yaparak kadýnlarý bilgilendirmek.
YÖNTEMLER: Saðlýk Bakanlýðý meme kanseri risk deðerlendirme formu ve Gail modeli ile olgularýn risk oranlarý tespit edildi. Ayrýca kadýnlarýn meme muayenesi ve tarama hakkýndaki bilgileri de kaydedildi.
BULGULAR: Olgularýn Gail modeliyle yapýlan hesaplamasýnda yüksek risk saptanmadý. Saðlýk Bakanlýðý’nýn risk deðerlendirme formuna göre sadece iki olguda orta risk bulundu. Düzenli olarak doktora giden ve muayene olan kadýnlarýn sayýsý %60’ýn altýndaydý. Kadýnlarýn kendi kendine muayene yapanlarýn oraný %67 idi. Meme kanserinin en sýk görüldüðünü bilenler %81 oranýnda olup bilgilerin çoðunluðu televizyondaki saðlýk programlarýndandýr.
SONUÇ: Meme rahatsýzlýðý ile baþvuran hastalarýn riskleri ortaya konularak hesaplama yapmanýn ve ayný zamanda bilgilendirmenin yararlý olacaðý sonucuna varýlmýþtýr.

OBJECTIVE: The aim of this study is to assess breast cancer risk and level of knowledge in women over the age of 35 and with a low level education.
METHODS: Risk ratios of patients were determined by the breast cancer risk assessment form of The Turkish Ministry of Health and the Gail model. We also recorded information about women’s knowledge of breast examination and screening.
RESULTS: There were no high-risk patients with Gail model. Only two cases were found at moderate risk according to the Ministry of Health’s risk assessment form. The number of women who were seeing their doctor on a regular basis was 60 (60%). The number of women who perform self-examination was 67 (67%). The number of women who know “breast cancer is the most common” was 81% and the source of this knowledge was television health programs.
CONCLUSION: Breast cancer risk determination has to be performed for patients who admit with breast complaints, and at the same time, having the information available is useful.

AMAÇ: Aspartat aminotransferaz (AST) ve alanin aminotransferaz (ALT) en fazla karaciðerde bulunan ancak karaciðere özgül olmayan testlerdir. Bazý çocuklarda uzun süreli ve ciddi karaciðer fonksiyon testi (KCFT) yüksekliði karaciðer dýþý nedenlerden de kaynaklanabilmektedir. Bu çalýþmada, çocuklarda uzun süren KCFT yüksekliðinde kas kaynaklý nedenler araþtýrýldý.
YÖNTEMLER: Çocuk polikliniðine baþvuran ve karaciðer enzim yüksekliðine baðlý olarak musküler distrofi tanýsý alan çocuklar geriye dönük olarak deðerlendirildi.
BULGULAR: Yaþlarý 5-10 yaþ arasý olan 11 çocuk deðerlendirildi. Hastalarýn 9’u erkek (%81.8) ve 2’si (%18.2) kýz idi. Fizik muayenede tüm çocuklarýn boy ve kilosu 3. persentilin üzerinde ve hepsinin nörolojik geliþimi normal bulundu. Beþ erkek çocukta (%45.5) gastroknemius kasýnda hipertrofi saptandý. ALT seviyesi 70-2400 IU/L arasýnda, AST seviyesi 70-1300 IU/L arasýnda ve kreatinin kinaz (CK) 900-20389 IU/L deðiþmekteydi. Karaciðer biyopsisi 2 hastaya (%18.2) yapýldý ve normal morfoloji saptandý. Kas biyopsisi 8 çocuða (%72.7) yapýldý, 1 hastada distrofinopati ve 7 hastada musküler distrofi saptandý. Genetik test ile 2 erkek hastaya (%18.2) Becker müsküler distrofisi tanýsý kondu.
SONUÇ: Çocuklarda uzun süreli, nedeni açýklanamayan KCFT yüksekliði araþtýrýlýrken, musküler distrofi ayýrýcý tanýda yer almalýdýr. Serum CK düzeyinin temel taný testlerine eklenmesi erken tanýya yardýmcý olacaðý gibi gereksiz incelemeleri de önleyecektir.

OBJECTIVE: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are mostly found in the liver but are not the only tests for liver function. Prolonged elevated transaminases can be due to extrahepatic reasons. We aimed to evaluate muscle diseases associated with elevations of transaminases among children.
METHODS: Data of children who were admitted to a pediatric polyclinic due to elevated transaminases and who were diagnosed with muscular dystrophy were evaluated retrospectively.
RESULTS: There were 11 children aged between 5-10 years, 9 of them were boys (81.1%) and 2 were girls (18.2%). Physical examination revealed normal developed children with normal neurologic examination in all children. Five boys (45.5%) had hypertrophied gastrocnemius muscles. Levels of AST, ALT and CK ranges were 70-1300 IU/L, 70-2400 IU/L, and 900-20389 IU/L, respectively. A liver biopsy was performed on 2 patients (18.2%) and revealed normal histology. A muscle biopsy was performed to 8 children (72.7%) and revealed dystrophinopathy in 1 and muscular distrophy in 7 children. Genetic testing revealed Becker muscular dystrophy in 2 boys.
CONCLUSION: Muscular dystrophy should be suspected in children who have long term elevated transaminases. Creatinine kinase testing would help diagnose the disease and prevent unnecessary tests.

AMAÇ: Bu çalýþmada pankreas kitlelerinin, difüzyon aðýrlýklý MR görüntüleme ile görünür difüzyon katsayýsý (ADC) deðerlerinin ölçülmesinin tanýya ve kitlelerin benign malign ayrýmýna katkýsýnýn deðerlendirilmesi amaçlandý.
YÖNTEMLER: Pankreas kitlesi olan 31 olgunun 31 adet kitlesine difüzyon aðýrlýklý MR sekansý uygulandý. Aksiyal planda, single shot eko-planar spin eko sekansý ile her üç yönde (x, y, z), üç farklý b deðerinde (b=0, b=500 ve b=1000 s/mm²) difüzyon duyarlý gradiyentler uygulanarak difüzyon aðýrlýklý görüntüler ve b=500 deðeri için ADC haritalarý elde edildi. Verilerin istatistiksel olarak deðerlendirmesi yapýlýrken gruplar arasýndaki deðiþkenler için Mann-Whitney U testi kullanýldý.
BULGULAR: Otuz bir pankreas kitlesinin 17 tanesi benign, 14 tanesi malign özellikteydi. Benign kitlelerin sekizi psödokist, sekizi indetermine, biri kitleyi taklit eden pankreatit oluþturuyordu. Malign kitleler ise sekizi adenokarsinom, üçü intraduktal papiller musinöz neoplazi, üçü orijini bilinmeyen malign hücrelerden oluþmaktaydý. ADC ölçümleri sonucunda en yüksek deðerler psödokistler aitti. B=500 s/mm² deðerinde benign kitlelerin ortalama ADC deðeri, 2.12±0.56x10-3 mm2/s, malign kitlelerin ortalama 1.25±0.14x10-3 mm2/s olarak ölçüldü.
SONUÇ: Benign lezyonlarýn ortalama ADC deðeri malign lezyonlarýn ortalama ADC deðeri ile karþýlaþtýrýldýðýnda; ADC ölçümlerinin pankreas kitlelerinin malign benign ayrýmýnda anlamlý olduðu bulundu (p<0.05).

OBJECTIVE: In this study, we aimed to evaluate the value of diffusion weighted MR imaging with the use of apparent diffusion coefficient (ADC) measurements on diagnosis and differentiation of benign and malignant pancreatic masses.
METHODS: Diffusion weighted MR sequence was performed to 31 masses of 31 cases. In axial plan single shoot echo-planar spin echo sequence for 3 plans (x, y, z) at 3 different b values (b=0, b=500, b=1000 s/mm2) diffusion sensitive gradients were applied and diffusion weighted images and maps of ADC for the value of b=500 were obtained. During the evaluation of statistical data, between the groups for variables, Mann-Whitney U test statistical analysis was used.
RESULTS: The number of benign and malignant masses was 17 and 14, respectively. Benign masses were consisted of 8 pseudocysts, 8 undetermined, 3 mass-forming pancreatitis. Malignant masses were 8 adenocarsinoma, 3 intraductal papillary mucinous neoplasms, 3 malignant cells of unknown origins. The ADC values of pseudocysts were the highest among all pancreatic masses. Mean value of benign lesions was 2.12±0.56x10-3 mm2/s at b=500 s/mm² and mean value of malign lesions was 1.25±0.14x10-3 mm2/s at b=500 s/mm².
CONCLUSION: When compared mean values of ADC between benign and malign pancreatic masses, there were statistically significance (p<0.05).

AMAÇ: Hiponatremi acil servise baþvurularda giderek artan sýklýk gösteren, yüksek morbidite ve mortalite ile seyreden ciddi bir klinik durumdur. Çalýþmamýzda hastanemiz acil iç hastalýklarý servisi’ne yatýrýlan hiponatremik hastalarýn etiyoloji ve prognozlarýný deðerlendirmeyi amaçladýk.
YÖNTEMLER: Þubat 2012-Temmuz 2013 tarihleri arasýnda hastanemiz acil iç hastalýklarý servisi’ne yatýrýlan hiponatremili ardýþýk 118 hasta geriye dönük olarak deðerlendirildi. Tüm hastalarýn demografik verileri, serum Na+ seviyeleri, volüm durumlarý, hiponatermiye yol açtýðý belirlenen faktörler ve prognozlarý kayýt altýna alýndý.
BULGULAR: Çalýþmaya 57 erkek (%48.3), 61 kadýn (%51.7) hasta alýndý. Median yaþ 68 olarak saptandý. Hastalarýn ortalama Na+ düzeyi 114.6±8.4 mEq/l olarak hesaplandý. Elli bir (%43.2) hastada normovolemik, 37 (%31.4) hasta hipervolemik, 30 (%25.4) hastada hipovolemik hiponatremi tespit edildi. Uygunsuz ADH sendromu hiponatremi nedenleri arasýnda ilk sýrada saptandý. En yüksek mortalite oraný normovolemik hasta grubunda saptandý.
SONUÇ: Çalýþmamýzýn sonuçlarý üçüncü basamak saðlýk hizmeti veren kurumlarda en sýk hiponatremi sebebinin hipotonik solüsyonlar deðil uygunsuz ADH sendromu olabileceðini düþündürmektedir.

OBJECTIVE: Hyponatremia is a serious clinical condition characterized by a high morbidity and mortality that shows an increasing incidence in presentation to the emergency department. We aimed to evaluate the etiology and prognosis of patients with hyponatremia hospitalized to the emergency internal medicine service.
METHODS: 118 consecutive patients with hyponatremia hospitalized to emergency internal medicine service from February 2012 to July 2013 were included in our study. We recorded demographic data, serum Na+ levels, volume status, factors that led to hyponatremia and prognosis of all patients.
RESULTS: 57 (48.3%) men and 61 (51.7%) women were included in our study. Median age was 68 years. The mean level of Na+ was 114.6±8.4 mEq/l. We detected normovolemic hyponatremia in 51 patients (43.2%), hypervolemic hyponatremia in 37 patients (31.4%) and hypovolemic hyponatremia in 30 patients (25.4%). Syndrome of inappropriate ADH was the leading cause of hyponatremia. Normovolemic patients had the highest mortality rate.
CONCLUSION: The results of our study suggest that the most common cause of hyponatremia in tertiary health care units is not hypotonic solutions, but rather syndrome of inappropriate ADH.

AMAÇ: Kanserli hastalarda depresyon en sýk görülen psikiyatrik sorundur. Depresyonun erken taný ve tedavisi, hastalarýn tedaviye uyumunu ve yaþam kalitesini artýracaktýr. Biz kemoterapi alan hastalarýmýzda depresyon varlýðý ve psikiyatrik destek gereksinimini deðerlendirdik.
YÖNTEMLER: Çalýþmamýzda, kemoterapi ünitemizde tedavi almak için gelen 155 hastayý deðerlendirdik. Hastalarýn depresyon varlýðýný ve düzeyini belirlemek için Beck Depresyon Ölçeði (BDÖ) kullandýk. Hastalarýn kiþisel ve klinik özellikleriyle psikiyatrik destek gereksinimi arasýndaki iliþkilerini ki-kare testi ile deðerlendirdik.
BULGULAR: Hastalarýmýzýn yaþ ortalamasý 58 (21-78) idi. Hastalarýmýzýn 61.9%’u erkek olup, çoðunluðu emekli idi. BDÖ’ye göre ortanca depresyon puaný 9 (0-41) olarak bulundu. Depresyon sýnýflamasý; %10.3 (n=16) ciddi, %10.3 (n=16) orta, %27.1 (n=42) hafif depresyondu. Geriye kalan 81 hastada (%52.3) depresyon saptanmadý. Metastaz varlýðý ve aldýðý kemoterapi þekli ve progresyon varlýðý psikiyatrik tedavi gereksinimi ile iliþkili olarak bulundu (p<0.05).
SONUÇ: Kanserli hastalarda depresyonun tanýsý ve derecelendirmesi ile hastaya uygun psikiyatrik desteðin saðlanmasý kanser tedavisinin bir parçasýdýr. Bu süreçte hastalara psikososyal destek saðlamak kemoterapi ünitesi ve onkoloji çalýþanlarý için bir görev olmalýdýr.

OBJECTIVE: Depression is frequently seen in patients with cancer. The early diagnosis and management of depression may improve quality of life and treatment compliance. We evaluated the depression and requirement of psychiatric support in cancer patients who received chemotherapy.
METHODS: We evaluated 155 cancer patients who attended our chemotherapy unit to receive chemotherapy treatment. We used the Beck Depression Scale (BDS) to classify depressýon. The X² test was performed to evaluate the relationship between the need for psychiatric support and patient’s characteristics.
RESULTS: The median age of the patients was 58 years (range: 21-78 years). The majority of patients (61.9%) were male, and most patients were retired. The median depression score was 9 (0-41). Depression was classified as 10.3% (n=16) serious, 10.3% (n=16) moderate, and 27.1% (n=42) weak. Depression was not detected for the other 81 (52.3%) patients. The presence of metastasis, chemotherapy type and progression were related with need for psychiatric support (p<0.05).
CONCLUSION: The early diagnosis and psychiatric support for depression in cancer patients were an important part of treatment. During therapy for cancer, psychiatric support for cancer patients should be the responsibility of the health care personnel in the oncology department.

AMAÇ: Tibia diafiz kýrýklarýnýn tedavisinde kullanýlan intramedüller çivileme (ÝMÇ) sonrasý patellar tendinit dizönü aðrýlarýnýn önde gelen nedenlerindendir. Çalýþmamýzda amaç opere ÝMÇ hastalarýnda kaynama sonrasý hastalarda saðlam ve opere taraf arasýndaki patellar tendon deðiþikliklerini MR görüntüleme ile karþýlaþtýrmaktýr.
YÖNTEMLER: Çalýþmamýz Temmuz 2010 ile Eylül 2011 tarihleri arasýnda kliniðimizde tibia kýrýðý nedeniyle transpatellar yolla ÝMÇ uygulanmýþ dizönü aðrýsý olan 12 hasta üzerinde yapýldý. Kýrýk kaynamasýný takiben yapýlan saðlam ve kýrýk taraf karþýlaþtýrmalý MR görüntülemesi ortalama 19.9 ayda (14-28) yapýldý. Ölçümler belirlenen sabit anatomik bölgelerde yapýldý. Sagital plan ölçümleri patellar tendon 3 parça bölünüp, üst-orta-alt bölümler olarak deðerlendirildi.
BULGULAR: Kýrýk taraf sagital proksimal, orta, distal ölçümleri saðlam tarafa göre istatistiksel olarak anlamlý düzeyde yüksek bulundu (p<0.01). Kýrýk taraf aksiyel ölçümleri de saðlam tarafa göre istatistiksel olarak anlamlý düzeyde yüksekti (p<0.05). Opere taraftaki patellar tendon kalýnlaþmalarýnýn, tendon distaline doðru arttýðý gözlendi.
SONUÇ: Tibia diafiz kýrýðý nedeniyle ÝMÇ yapýlan hastalarda dizönü aðrýsý en sýk gözlenen komplikasyonlardan biridir. Dizönü aðrý nedenlerinden biriside patellar tendondaki kalýnlaþmadýr. Bunu önlemek için nazik doku açýlmasý ve oyma sýrasýnda doku koruyucularýnýn kullanýlmasýna özen gösterilmelidir.

OBJECTIVE: Patellar tendinitis is the major cause of anterior patellar pain after intramedullary nailing (IMN) procedures. In this study our aim is to compare patellar tendon changes with MRI between the healthy side with the operated side in IMN patients after union.
METHODS: Our study is carried out in 12 patients with anterior knee pain between July 2010 and September 2011. Following fracture union, MRI are evaluated comparing healthy and fractured sides at 19.9th months (14-28). Measurements are obtained at constant anatomical regions which were previously determined. Sagittal plane measurements were evaluated as 3 pieces dividing patellar tendon in superior-middle-inferior segments.
RESULTS: Saggital measurements of the fractured side when compared with the healthy side were statitically significantly higher (p<0.01). Axial measurements also of the fractured side when compared with the healthy side were statitically significantly higher (p<0.05). The thickening of patellar tendon at the operated sides were increasing towards the distal part of the tendon.
CONCLUSION: In patients that were operated due to fracture of tibia, anterior knee pain is the most frequent complication. Patellar tendinitis is one of the cause of anterior knee pain. To prevent this complication, during the reaming procedure gentle dissection must be used.

AMAÇ: Bu çalýþmanýn amacý, fototerapi alarak tedavi edilmiþ olan indirekt hiperbilirübinemili hastalarda yenidoðan sarýlýðý etiyolojisini geriye dönük olarak deðerlendirmektir.
YÖNTEMLER: Fototerapi amacýyla hastaneye yatýrýlmýþ gestasyon haftasý 37 ve üzeri olan 140 yenidoðan bebek çalýþmaya dahil edildi. Ýstatistik programý olarak SPSS 16 kullanýldý. Gruplar arasý fark deðerlendirilmeler için Student-t testi kullanýldý. P<0.05 istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Bütün hastalarda ortalama yatýþ bilirübin deðeri 17.5±2.4 mg/dl, fototerapi için yatýþ günü ortalama 5.5±3.2 gün idi. Hastalarýn %28’inde (38 hasta) ABO grup uyuþmazlýðý, %4.9’unda (7 hasta) Rh grup uyuþmazlýðý, %3.5’inde (5 hasta) RH artý ABO grup uyuþmazlýðý vardý. Hastalarýn %63’ünde (90 hasta) ABO ya da Rh grup uyuþmazlýðý yoktu. Olgularýn %1.4‘ünde (2 hasta) G6PD aktivitesi eksikliði, %5’inde (7 hasta) idrar kültürü ile kanýtlanmýþ üriner sistem enfeksiyonu, %0.7’sinde (1 hasta) geçici TSH yüksekliði tesbit edildi. Olgularýn %12’sinde (17 hasta) beslenme yetersizliðine baðlý %10 ve üzeri kilo kaybý, hastalarýn %2.1‘inde (3 hasta) gastroenterit bulgularý vardý. Tüm gruplarda ortalama yatýþ günü ve ortalama yatýþ bilirübin seviyeleri açýsýndan anlamlý farklýlýk tespit edilmedi (p>0.05).
SONUÇ: ABO ve Rh grup uyuþmazlýðý sarýlýk sebebi olarak bilinmekle birlikte, üriner sistem enfeksiyonu, G6PD eksikliði ve özellikle beslenme yetersizliði sarýlýk sebebleri arasýnda önemini koruyarak devam etmektedir.

OBJECTIVE: The aim of this study is to evaluate the etiological factors of neonatal jaundice retrospectively in infants with indirect hyperbilirubinemia who were treated with phototherapy.
METHODS: This study included one hundred and forty newborn infants who were born at an age of more than the 37th gestational week and hospitalized for phototherapy. Statistical evaluations were calculated with SPSS 16 program for Windows. Students-t test was used to evaluate differences between groups, and p<0.05 was accepted as statistically significant.
RESULTS: Mean serum bilirubin level was 17.5±2.4 mg/dl, and mean hospitalization day was 5.5±3.2 day in the study group. Thirty eight patients (28%) had ABO blood group incompatibility, 7 patients (4.9%) had Rh group incompatibility, and 5 patients (3.5 %) had both RH and ABO blood group incompatibility. Ninety patients (63%) had no blood group incompatibility. Two patients (1.4%) had G6PDH deficiency, 7 patients (5%) had urinary tract infection that was proven by urinary culture, and 1 patient (0.7%) had a transiently elevated TSH level. Seventeen patients (11.9%) had weight loss equal to or more than 10% due to insufficient feeding. Three patients (2.1%) had gastroenteritis. Both mean hospitalization day and mean bilirubin levels in all groups were not statistically significantly different (p>0.05).
CONCLUSION: Even though ABO blood group and Rh group incompatibility are known as reason for neonatal jaundice; urinary tract infections, G6PD deficiency and especially insufficient feeding keep going as a matter of concern in neonatal jaundice.

AMAÇ: Son yýllarda yaþam kalitesinin her alanda giderek artan bir ilgi görmesi benign prostat hiperplazisinde (BPH) özellikle tedaviyi yönlendirmedeki rolü açýsýndan önem kazanmaya baþlamýþtýr. Bu nedenle çalýþmamýzda BPH’ye baðlý alt üriner sistem semptomlarý olan hastalarda prostatýn transüretral yolla rezeksiyonu sonrasýnda yaþam kalitesindeki deðiþikliklerin incelenmesini amaçladýk.
YÖNTEMLER: Çalýþmamýza Þubat 2010-Mayýs 2012 tarihleri arasýnda BPH nedeniyle transüretral prostat rezeksiyonu (TUR-P) uygulanan ve yaþ ortalamasý 66.70±8.92 yýl (49-82 yaþ) olan 25 hasta alýndý. Çalýþma süreci içinde hastalarýmýzdan ikisi öldü ve çalýþma 23 hastayla tamamlandý. Çalýþmaya katýlan hastalara TUR-P öncesi ve TUR-P sonrasý üçüncü ayda Uluslararasý Prostat Semptom Skoru (IPSS), Hastane Anksiyete Depresyon Ölçeði (HAD), Genel Yaþam Kalitesi Ölçeði Kýsa Form-36 (KF-36), Üriner Semptomlara Göre Yaþam Kalitesi Ölçeði uygulanarak herhangi bir fark olup olmadýðý deðerlendirildi.
BULGULAR: TUR-P öncesi ve sonrasý üçüncü aydaki deðerlendirme sonuçlarý karþýlaþtýrýldýðýnda IPSS skoru (p=000), HAD-A (p=001), HAD-D (p=000), KF-36 alt ölçeklerinde istatistiksel olarak anlamlý düzeyde deðiþikliklerin olduðu gözlenmiþtir. Üriner Semptomlara Göre Yaþam Kalitesi Ölçeði kötü, mutsuz kategorisinden orta ve iyiye doðru deðiþiklik göstermiþtir.
SONUÇ: TUR-P sadece klinik olarak etkili olmakla kalmayýp hastalarýn genel yaþam kalitelerini de olumlu yönde etkilemektedir. Geniþ hasta çalýþmalarýnda uzun dönem sonuçlarý deðerlendirecek çalýþmalarýn yapýlmasý gerekmektedir.

OBJECTIVE: Quality of life, which has gained more and more importance in every field, has also become important in benign prostate hypertrophy (BPH), especially for its guidance in treatment. In this study we aimed to investigate the changes in the quality of life after operation in patients with lower urinary tract symptoms due to BPH who had transurethral resection of the prostate.
METHODS: Twenty-five patients with a mean age of 66.70±8.92 (49-82) years who had transurethral resection of prostate due to BPH between February 2010 and May 2012 were included in our study. Two patients died during the study period and the study was completed with 23 patients in total. Before TUR-P and 3 months after TUR-P, International Prostate Symptom Score (IPSS), Hospital Anxiety Depression Scale (HAD), general Quality of Life Scale Short Form (SF-36) and quality of life scale according to urinary symptoms were applied to the study group.
RESULTS: The comparison of the scores before and after the operation revealed that IPSS score (p=000), HADA (p=0.001), HADD (p=000) and SF-36 sub scales were significantly better in postoperative evaluation. Quality of life scale according to urinary symptoms changed from bad and unhappy to moderate and well categories.

CONCLUSION: TUR-P is not only clinically effective but also affects the quality of life of the patients in a positive manner. Further studies with larger series evaluating the long term results are needed.

AMAÇ: Yardýmcý üreme teknikleri (YÜT) ile tedaviye alýnan çiftlerde tedavinin yarýda býrakýlmasý nadir görülen bir durum deðildir. Stimülasyonun yarýda býrakýlmasý veya embriyo transferine gidilememesi birçok farklý nedene baðlý olabilir. Bu yazýda Tüp Bebek Ünitemizde iptale giden olgularýmýzýn özelliklerini irdeledik.
YÖNTEMLER: Hastanemiz Tüp Bebek Ünitesi’ nde Mayýs 2010- Ekim 2012 tarihleri arasýnda tedaviye alýnan 554 çiftin kontrollü overyan hiperstimülasyon-intrasitoplazmik sperm injeksiyonu (KOH-ICSI) tedavilerinin retrospektif analizi yapýldý.
BULGULAR: KOH-ICSI siklusuna alýnan 554 çiftin 71’ inde embriyo transferi yapýlamadý. Bu 71 vakanýn ortalama kadýn yaþý, infertilite süresi ve daha önceki deneme sayýlarý sýrasýyla 34.2± 6.1 yýl, 9.4±6.7 yýl ve 1.4±0.7 idi. 31 vaka ile iptalin en sýk sebebi testiküler sperm ekstraksiyonunda (TESE) sperm bulunamamasý idi. Ardýndan 17 total fertilizasyon baþarýsýzlýðý ve 8 boþ folikül sendromu vakalarý 2. ve 3. en sýk iptal nedenleri idi. Geriye kalan 15 vakanýn iptal nedenlerini ise matür oosit yokluðu (6 vaka), folikül geliþiminin olmamasý (2 vaka), fragmanlý embriyo (3 vaka), overyan hiperstimülasyon sendromu (1 vaka), prematür luteinizasyon (1 vaka), prenatal genetik tanýda saðlýklý embriyo olmamasý (1 vaka) ve kemoterapi öncesi total embriyo dondurulmasý (1 vaka) olarak tespit ettik.
SONUÇ: ICSI sikluslarýnda en sýk iptal nedeni TESE’de sperm çýkmayan azoospermi vakalarý olarak görünmektedir.

OBJECTIVE: Cycle cancellation is not a rare condition during assisted reproductive treatments. Cancellation of ovarian stimulation or embryo transfer may happen due to different reasons. In this study we researched the characteristics of cancelled cycles that were performed in our in vitro fertilization (IVF) center.
METHODS: The 554 controlled ovarian hyperstimulation- intacytoplasmic sperm injection (COH-ICSI) cycles performed during May 2010- October 2012 in our IVF Center were retrospectively analyzed.
RESULTS: Among 554 COH-ICSI cycles, embryo transfer could not be performed in 71 cycles. Mean female age, infertility duration and previous cycle number of couples were 34.2± 6.1 years, 9.4±6.7 years and 1.4±0.7 respectively. The majority of cycle cancellation cases were consisted of sperm absence after testicular sperm extraction (TESE) procedure. The second and third cancellation factors were total fertilization failure (n=17) and empty follicle (n=8) respectively. The remaining 15 cycle cancellation causes were as follows: absence of mature oocyte (n=6), absence of follicular development (n=2), fragment embryo (n=3), ovarian hyperstimulation syndrome (n=1), premature luteinization (n=1), absence of normal embryo after prenatal genetic diagnosis (n=1) and total embryo freezing before chemotherapy (n=1).
CONCLUSION: It was seen that our major factor of cycle cancellation in ICSI-ET cycles was sperm absence after TESE procedure.

Sinoviyal kistler genellikle tendon kýlýfý ve periartiküler yapýlarda yerleþim gösterirler. Spinal kanalda sinoviyal kistler nadiren gözlenir ve bunlar sinoviyal kýlýfýn kistik geniþlemeleridir. Servikal ve torakal bölgelerde de görülmekle birlikte en sýk görüldükleri yer lomber bölgedir. Bu yazýda lomber zigapofizyal eklem sinoviyal kisti nedeni ile radikülopati yakýnmalarý bulunan, fizik tedavi ve faset eklem enjeksiyonu ile yakýnmalarý tamamen düzelen bir olgu sunuldu.

Synovial cysts usually exist within tendon sheath placement and periarticular structures. Synovial cysts are rarely observed in the spinal canal and they are the cystic expansions of the synovial sheath. Although they can be seen in cervical and thoracic regions, the most frequently reported region is the lumbar region. In this article, a case of zygoapophyseal joint synovial cyst due to symptoms of lumbar radiculopathy and her symptoms completely resolved with physical therapy and facet joint injection is presented.

Hipokalemik periyodik paralizi kas güçsüzlüðü ataklarý ile seyreden ve tedavi edilmediði zaman ölümcül olabilen nadir bir hastalýktýr. Otuz altý yaþýndaki erkek hasta hastanemiz acil servisine bacaklarda kas güçsüzlüðü ile baþvurdu. Dört ay önce benzer þikayeti olan hasta 16 saat içerisinde kendiliðinden iyileþmiþti. Acil rutin kan testlerinde serum potasyum seviyesi belirgin düþük saptandý. Kliniði potasyum yerine koyma tedavisi ile kýsa sürede tamamen düzeldi. Nadir görülen olgu; acil servise ani geliþen kas güçsüzlüðü ile gelen hastalarda akýlda bulundurulmasý amacýyla sunulmuþtur.

Hypokalemic periodic paralysis is a rare disease characterized by episodes of muscle weakness and can be fatal when left untreated. A 36-year-old male was admitted to our emergency service of the hospital with common muscle weakness in his legs. He had the same complaint four months prior and normalized in 16 hours without any intervention. The serum potassium level of the patient was significantly low. In the clinic, it is important for patients to receive potassium replacement therapy as soon as possible for resolution of symptoms. This rarely seen case is presented to make physicians aware of incoming patients to the emergency department with sudden muscle weakness.

Ekinokokkozis, diðer adý ile kist hidatik hastalýðýnýn etkeni Ekinokokus granülosus’dur. Taný ve tedavisindeki ilerlemelere raðmen hastalýk halen Türkiye’nin de içinde bulunduðu Orta ve Doðu Avrupa, Güney Amerika, Avustralya, Yeni Zelanda ve Güney Afrika gibi endemik ülkelerde ciddi saðlýk sorunlarýna neden olmaktadýr. Hastalýk en sýk karaciðeri ve akciðeri etkilemekle birlikte dalak üçüncü sýklýkta etkilenen organdýr. Dalak tutulumu genellikle karaciðer ve akciðer tutulumu ile birliktelik göstermektedir. Dalaðýn primer izole tutulumu oldukça nadir görülür. Hastalar genellikle semptomsuzdur. Farklý nedenlerle yapýlan incelemeler esnasýnda rastlantýsal olarak taný koyulur. Bu makalede oldukça nadir rastlanan izole dalak kist hidatikli iki olguyu ve normalden farklý klinik presentasyonlarýný sunmayý amaçladýk.

Echinococcosis, also known as hydatid disease, is caused by Echinoccus granulosus. Despite advances in diagnosis and treatment, hydatid disease leads to serious health problems in the endemic countries such as Central and Eastern Europe, South America, Australia, New Zealand and South Africa, including Turkey. The most common affected organs with hydatid disease are the liver, then lung, with the spleen being the third most frequently affected organ. Splenic involvement is usually seen with liver and lung diseases. Primary isolated involvement of the spleen is a rare occurrence. These patients are typically asymptomatic. Generally, diagnosis is made incidentally during investigations for various reasons. In this article, we aimed to present two cases that have isolated splenic hydatid cysts and their unusual clinical presentations.

Turner sendromlu 45XO/46XY mozaikliði, nadir görülen kromozomal bir anomalidir. Yaklaþýk 1/10.000‘de bir görülen bu mozaismin fenotip yansýmalarý normal bir erkekten, klasik Ullrich-Turner Sendromuna (UTS) kadar deðiþen çeþitliliktedir. Primer amenore þikayeti ile kliniðimize baþvuran hastanýn yapýlan kromozom analiz sonucu 45XO/46XY olarak geldi.

Turner syndrome is a rare chromosomal abnormality of 45XO/46 XY mosaicism. Approximately 1/10000 are seen with a phenotypic reflection of mosaicism that shows variability from a normal man to Ullrich-Turner syndrome. We present this case report as a result of chromosomal analysis (45XO/46XY) who admitted to our clinic with primary amenorrhea.

Ekstartestiküler lipom nadir görülen selim bir mezenkimal tümördür. Otuz beþ yaþýnda hasta skrotumda aðrýsýz þiþlik þikayeti ile baþvurdu. Taný amaçlý ultrason ve manyetik rezonans görüntüleme yapýldý. Rezeksiyon sonrasý histopatolojik tanýsý ekstratestiküler lipom geldi. Nadir görülen bu olgumuzu sunmayý amaçladýk.

Extratesticular lipoma is a rare benign mesenchymal tumor. A 35 year old patient was invoked with complaint of painless swelling in the scrotum. Ultrasound and magnetic resonance imaging was performed for diagnosis. After resection, the extratesticular lipoma was diagnosed histopathologically. We aim to present this rare case.

Spontan glob subluksasyonu orbitanýn nadir görülen bir komplikasyonu olup dramatik tarzda oluþur. Globun öne doðru yer deðiþtirmesiyle karakterize olan bu durumda globun ekvatoru, retrakte göz kapaklarýndan dýþarý çýkar. Bu olgumuzda göz dibi muayenesi için tropicamid %0.1’lik damla göze damlatýlýrken sað göz alt ve üst kapaklarýn aralanmasý esnasýnda þiddetli basýnç hissi ve görme kaybý ile birlikte globun aniden öne subluksasyonu geliþti. Daha sonra globun yavaþça geriye doðru çekildiðini gördü. Bir-iki dakikalýk bu zaman süreci sonunda hasta rahatlamýþ, görme fonksiyonlarý normale dönmüþ ve aðrý hissi ortadan kalkmýþtý. Konjonktivada minimal hiperemi dýþýnda gözde bir patoloji geliþmedi.

Spontaneous globe subluxation is a rare orbital complication and presents in a dramatic fashion. It is characterized by the anterior displacement of the eye, usually when the equator of the globe protrudes beyond the retracted lids. In this case, while opening the upper and lower eye lids to drop 0.1% tropicamide to examine fundus, a strong pressure feeling and a loss of vision occurred along with the spontaneous globe subluxation. Later, the globe was observed to be retracted to the back. After 1-2 minutes the patient was relaxed, vision functions returned and the pain disappeared. There was no pathology in the globe except minimal conjunctival hyperemia.

Kýrým-Kongo kanamalý ateþi (KKKA), viral hemorajik ateþ sendromlarý arasýnda yer alan zoonoz karakterli bir enfeksiyondur. Hayvanlarda insanlara nazaran daha yaygýn olmakla birlikte sporadik olgular veya salgýnlar halinde insanlarda da görülebilmektedir. Taný virüsün üretilmesi, virüse karþý oluþan antikorlarýn saptanmasý ya da moleküler yöntemlerle konulur. Bu makalede prepisyumda kene saptanan, Kýrým-Kongo kanamalý ateþi þüphesi ile sünnet uygulanan olgu sunulmuþtur.

Crimean-Congo hemorrhagic fever (CCHF) is an infection with zoonosis character that comes from viral hemorrhagic fever syndromes. In spite of being observed more frequently among animals, it could be detected among human beings in sporadic cases or as epidemics as well. The diagnosis is determined by generating the virus, detecting antibodies against the virus, or molecular methods. In this paper, a case is presented where a tick was detected on the prepuce and circumcision was performed on suspicion of CCHF.

Kemoterapötik ilaçlar sýklýkla venöz, daha nadiren de arteriyel tromboembolik olaylara sebep olmaktadýr. Ýskemik inme, bildirilen nadir komplikasyonlardan olup post-kemoterapi iskemik inme insidansý %0.137, iskemik inme ile komplike olan kemoterapi siklusu sýklýðý %0.035’dir. Birçok kanser tipinde ilk tercih olarak kullanýlan sisplatin ise iskemik inmeye en sýk neden olan ilaçtýr. Bu yazýda, sisplatin tedavisi esnasýnda iskemik inme geliþen küçük hücreli akciðer kanserli bir olgu sunuldu.

Chemotherapeutic agents frequently cause venous, rarely arterial thromboembolic events. Ischemic stroke as a complication is rare while the reported incidence of post-chemotherapy ischemic stroke is 0.137%. Frequency of chemotherapy cycles complicated with ischemic stroke is 0.035%. Cisplatin, used as the first choice of many types of cancer, is the most common drug that causes ischemic stroke. In this case, we discuss a patient with small cell lung cancer that had ischemic stroke during to the course of cisplatin treatment.

Akut mekanik kolon obstrüksiyonlarý kolorektal acil hastalýklarýn yaklaþýk %30’unu oluþturmaktadýr. Akut sol kolon obstrüksiyonlarý sýklýkla malignite nedeniyle ortaya çýkmaktadýr. Cerrahi tedavide birçok seçenek mevcut olup yüksek morbidite ve mortalite ile iliþkilidir. Geçici veya kalýcý stoma ile sonuçlanarak hastalarýn hayat kalitesinde anlamlý ölçüde düþüþe neden olmaktadýr. Bu yazýda, akut kolonik obstrüksiyon tespit edilen ve stent uygulamasýndan sonra elektif laparoskopik sigmoid rezeksiyon uygulanan bir olgu sunulmaktadýr. Kolon kaynaklý tümör nedeniyle oluþan obstrüksiyonlarda stent uygulanmasý ilk dekompresyonu saðlayýp stomadan kaçýnmayý saðlamakta ve acil operasyonu mekanik baðýrsak hazýrlýðý sonrasýnda planlý ve güvenli cerrahiye çevirmektedir.

Acute mechanic colon obstructions account for approximately 30% of emergent colorectal diseases. Acute left colon obstructions are frequently occurring due to malignity. There are many options in surgical treatment that are associated with high morbidity and mortality. It causes a considerable decrease in the quality of life of patients by resulting in temporary or permanent stoma. In this article, we present a case where acute colonic obstruction was determined and elective laparoscopic sigmoid resection was applied after stent application. Stent application in obstructions that occur due to the colonic tumor provides initial decompression and reversal of emergency operation to planned and safe surgery after mechanic bowel preparation.

Kanser tanýsý konulan hastalarda geriatrik yaþ grubunun oraný her geçen gün artmaktadýr. Yeni taný alan küçük hücreli dýþý akciðer kanserli hastalarýn yaklaþýk %30-40’ý 70 yaþ üzerindedir. Yaþlý hastalarýn genel durum bozukluklarý ve tedaviyi tolere edememeleri nedeni ile bu grup hastalara genellikle destek tedavi uygulanmaktadýr. Yaþlý hastalarda özellikle komorbidite ve performans esas belirleyicidir ve kapsamlý bir geriatrik deðerlendirme yapýlarak tedavi kararý bireysel olarak verilmelidir. Çalýþmalarda 70 yaþ üstüne yer verilmemiþtir ve sýnýrlý sayýda geriye dönük verilere dayanan sonuçlar vardýr. Yaþlý hastalarda tedavi ile ilgili doðru çýkarýmlar yapabilmek için yalnýzca ileri yaþ grubuna yönelik düzenlenmiþ faz III randomize çalýþmalara ihtiyaç vardýr.

The rate of the geriatric age group patients diagnosed with cancer is increasing every day. Approximately 30-40% of non-small cell lung cancer patients are over 70 years of age at diagnosis. In order for geriatric patients who have general disorders and inability to tolerate the treatment, supportive treatment is generally applied to this group of patients. In elderly patients, co-morbidities and performance are decisive and by making comprehensive geriatric assessment, treatment decisions can be made individually. Studies did not include patients over 70 years of age and there are a limited number of results based on retrospective data. Inferences about the correct treatment of elderly patients require advanced phase III randomized trials that are only tailored to the elderly age group.