Manual analysis of urine sediment, although clinically useful, is fraught with methodological problems. To this end, there have been attempts to automate the process to improve accuracy and precision. In this study, we aimed to compare the performance of our conventional visual microscopic methods with that of the automated microscopic method in the detection of erythrocytes, leukocytes and squamos cells. Urine specimens from 203 patients were examined with IRIS Model 500 urine analyzer, which based on flow microscopic method and manual microscopy. Results matched with Mann-Whitney U test and we made linear regression analysis for searching relation each other. We use to study relation results, which obtained each method. We use McNemar's test to investigate each patient/healthy ratios importance and relations, which obtained each methods. When we compared results of automated and manual microscopy with linear regression analysis; the results of both methods erythrocytes (r=0.7678), leukocytes (r=0.8302) and squamos cells (r=0.8570) counts were correlated. We grouped each method's results according to reference range study and obtained 2x2 table. When we investigating this table; for erythrocytes 84%, for leukocytes 81%, for squamos cells 90% of all specimens were within the same range by both methods. When we made statistical analysis to find detection's difference, the automated method detected greater number of abnormal erythrocyte (p=0.0367) and leukocyte (p<0.0001) counts than did the manual method. In contrast, manual method detected greater number of squamos cell (p=0.0037) than did the automated method. Depending on this study; we conclude that microscopic urine analysis with automated method for erythrocytes, leukocytes and squamos cells counts were correlated, even better in determining pathological urine than did manual microscopic sediment analysis and automated method useful for providing standardization.

We evaluated the mortality rate in emergency department thoracotomies performed in our emergency unit. We have retrospectively evaluated emergent department thoracotomies performed on 19 cases between January 2002 and January 2004. Demographic aspects, mechanisms of injuries, vital findings at admission, indications of emergency department thoracotomies, need for internal cardiac massage, injuries and surgical techniques and associated organ injuries were noted. Mortality rate was calculated. Mean age was 23.7 and female/male ratio was 9: 10. Eight (42,1%) cases were admitted for blunt trauma, II (57.8%) cases had penetrating injuries. Nine (47,3%) cases had vital findings at admission. Mortality was observed in 13 (68,4%) cases. Eight (72,7%) patients with penetrating injuries survived, mortality was seen in 3 (27,3%) cases. All of blunt traumas were died. As presented in the literature, our study concluded that emergency department thoracotomies might not be successful with blunt traumas as it is in penetrating injuries. We believe that resuscitation must be aggressively performed since an adequate triage system is not obtained to (he trauma patients in our country.

Forty unpremedicated patients of ASA class I-II, without cardiovascular and ocular disease, were included in this study. The patients were divided into two equal groups. Group S received sufentanil 0.5 µg/kg, group Preceived serum physiologic at the same volume. Additionally all of the groups received propofol 2 mg/kg, vecuronium 0.1 mg/kg. Sixty seconds after the injection of the muscle relaxant. intubation was started. Anesthesia was maintained with isoflurane 1.5% in N 2O 50%, + O2 50%. Intubation conditions, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), peripheric oxygen saturation (SpO₂) and intraocular pressure (IOP) were recorded before intubation and at 30, 60, 120, 240 seconds after intubation. In group S, there were 18 excellent and 2 good intubation conditions while in group P, there were 17 excellent and 3 good conditions. In group S, IOP was decreased at 30, 60, 120, 240 seconds while in group P. IOP was increased at 30, 60, 120, 240 seconds. HR was increased at 30, 60 seconds in group P (p>0,05). In conclusion, it should be needed a lot of studies in great of population and different doses while sufentanil 0,5µg/kg was decreased insignificant hemodynamic parameters and IOP.

Nasal airways in children create technical difficulties in operations. This study was presented to evaluate the efficacy of endonasal dacryocystorhinostomy (OCR) and external OCR in children with congenital nasolachrimal duct obstruction. Twelve eyes of 10 patients (2 male, 8 female) with congenital nasolachrimal duct obstruction with an age range from 4 to 14 years were applied DCR and silicon tube intubation in our clinic between 2000-2003. Five unsuccessful eyes, ages between 4-7, which applied silicon tube intubation and 1 unsuccessful eye (11 years old) which have two times recurrences after external DCR, were applied endonasal endoscopic DCR and silicon tube intubation. Six eyes of 6 patients whose ages were between 12-14 underwent external DCR operation and silicon tube intubation. The cases were followed about 1 year and success rate was 100%. So we found that after unsuccessful silicon tube implantation in 4 -7 years old children it may be better to perform endonasal endoscopic DCR, in children greater than 7 years old external DCR should be preferred.

Although conservative follow-up of the stab wounds, which penetrate the abdominal cavity, reduces negative laparotomies, gunshots wounds penetrate to the abdominal cavity have no accepted follow-up criteria yet. In this study, we evaluated the patients with negative laparotomies after gunshot wounds to anterior abdominal wall. Forty-one cases, admitted to our clinic between 1.1.1999-1.1.2004, were retrospectively evaluated. Mean age was 30, 5 (14-75) and male/female ratio was 35/6. Thirty-seven (90,2%) cases were treated with laparotomy, 4 (9,8%) cases were treated with diagnostic peritoneal lavage without laparotomy. Hollow organs were injured in 28 (68,2%) cases and solid organs were injured in 16 (38,9%) cases. In 3 (8,1%) cases no visceral injuries were found at the time of laparotomy. In 7 (17,1%) out of 41 cases had no intraabdominal visceral injuries. Laparotomy is inevitable in cases who have abdominal tenderness or hemodynamic instability after gunshot wounds to the abdominal cavity. In our study, no injury was observed in 17,1% of cases and no mortality was observed in this group. We think that, hemodynamically stable patients who have no radiological findings indicate surgery and who have no abdominal tenderness may be treated conservatively. Diagnostic peritoneal lavage, diagnostic laparoscopy and clinical follow may be chosen in these cases.

Carpal Tunnel Syndrome (CTS) is one of the frequently seen trap neuropathy. CTS are more common in diabetics than the normal population. The prevalence of CTS in diabetics was changed according to the different studies. In this study, we aimed to investigate symptomatic CTS prevalence in diabetics and related conditions with this. 67 patients, who were consecutively admitted to the diabetes outpatient clinic of our hospital, were enrolled in the study. Patients who had other disease that can be a cause of CTS were dropped out. Patients were asked for CTS symptoms, diagnosed with provocative tests and diagnosis of CTS was confirmed with EMG. The mean age, the age of beginning diabetes, diabetes duration and HbA1C levels of the 67 patients [35 (52.2%) male, 32 (47.8%) female] were 27.1±9.4 years, 19.9±8.2 years, 7.2±6.8 years and 9.4±2.6 respectively. CTS symptoms were found in 8 (11.9%) patients. All patients who were performed EMG, were diagnosed as CTS with or with neuropathy. Polyneuropathy was found with EMG in 7 (87.5%) patients. In our study, the prevalence of symptomatic CTS among type 1 diabetics was in concordance with literature. Furthermore, we found that CTS is more frequent in females and related with diabetes duration.

This study was performed to investigate the importance of selection of vitrectomy technique in diabetic proliferation with hard and firmly attached membranes. This study was performed between April 2001-January 2003. Thirty-seven eyes of 35 patients (15 males, 20 females) with a mean age of 56.2 (range, 36 to 77 years) were included in this study. Twelve of the patients had type 1 diabetes while 23 of them had type 2 diabetes. Membranes with a stalk-shaped firm attachment site to the retina were delaminated with the help of a retinal spatula, cut with horizontal scissors and excised thereafter. Membranes that were attached to the retina through more than one stalk and those that were firmly attached throughout their surface were shaved as much as possible with a high speed cutter probe (cutting speed, 1500 per min.) and the remaining parts were left in their places. Endolaser photocoagulation was applied densely around these remaining membranes. The mean patient follow-up period was 12.6 months (range, 6 to 20 months). In proliferative diabetic retinopathy cases with thick, stiff and firmly attached membranes, attempts to remove the membranes totally and with intravitreal pincers frequently cause serious complications. Retinal spatulas, retinal scissors and a high-speed cutter vitrectomy probe are more safely employed in such cases. The usage of silicone oil also positively affects the prognosis.

Patients with hydatid disease, who were operated with radical techniques between January 2000-May 2004, were retrospectively evaluated. Forty-four cases with hydatid disease in liver were operated. Partial cystectomy was performed in 30 (68,1%) cases and 14 (31,8%) of them underwent radical operations. The mean age was 41,3±23,7 for radical operations and male/female ratio was 6/8. Seventeen cysts were excised in 14 cases. Fourteen (82,3%) pericytectomy, 2(11,7%) left lateral segmentectomy and 1 (5,8%) segment 6 resection were performed. Mean operation time was 132,1±47,9 minutes. Mean hospitalization time was 5,5±1,5 days after the operation. The morbidity ratio was 14,2% and no mortality was observed. Neither bile leakage nor recurrence occurred in our patients. Radical hydatid cyst operations are safe methods in selected cases. In our clinic, radical hydatid cyst operations have been performed more often in recent years and these operations may have advantages of lower bile leakage or lower morbidity rates. Furthermore, albendazole treatment and the use of scolisidal agents are not needed in these patients, since there is no risk of abdominal cavity contamination.

Spontaneous intracranial hypotension is characterized by low cerebrospinal fluid pressure and the prominent feature of the syndrome is orthostatic headache. Meningeal cerebrospinal fluid leakage is blamed at the etiology. It is a rare syndrome where the diffuse pachimeningeal gadolinium enhancement can be observed in the cranial magnetic resonance imaging studies.

The Horner's syndrome, which may be seen during epidural anesthesia, is a reversible complication and may be accepted as the first symptom of the extensively spreading blockade. In this report a Horner's syndrome case, developed during the management of an epidural anesthesia for orthopedic operation, is presented and the mechanisms responsible for development of the syndrome are revised.

The division of a single fertilized ovum is forming monozygotic twins, carrying identical genes. There are plenty of literatures on simultaneous onset of diseases in monozygotic twins. Simultaneous renal colic symptoms were seen in monozygotic twins in this case. We would like to discuss about this amazing case.

Cystosarkoma phyllodes is an uncommon neoplasm of the breast. The tumor is similar to fibroadenoma in structure. The local recurrence rate is high after limited surgery for malignant phyllodes. In phyllodes tumor’s natural progress, tumor size and positive surgical margin shows a higher risk for recurrence. Radiotherapy is indicated in selected cases.

Fire-eater's pneumonia, a rare form of acute pneumonitis, develops after aspiration of hydrocarbon products. It is characterized by symptoms such as dyspnea, cough, hemoptysis, chest pain, fever and lung consolidations which typically cavitate forming pneumatoceles. Despite the fact that it is a pseudoinfectious entity, superinfections may sometimes coexist. Corticosteroids and antibiotics are used in treatment. In this study, a 23-year-old male patient with fire-eater's pneumonia due to gas aspiration is presented.

Hemolyüc uremic syndrome, characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute nephropathy is the most frequent cause of acute renal failure during infancy. Hemolytic uremic syndrome should be suspected in a child with azotemia, fever and hematological abnormalities after a recent diarrhea or upper respiratory tract infection episode. Aggressive treatment of hypertension, fluid and electrolyte restoration, early dialysis and nutritional support decreases the mortality. In this case report, we presented 4 hemolytic uremic syndrome patients with different prognosis to emphasize the importance of the disease as the most frequent cause of acute renal failure in infancy.

The word ichthyosis is derived from Greek word 'ichthys' which means fish. It is used to name a group of diseases with excessive scales. Epidermolytic hyperkeratosis of Brocq, which is seen very rarely (1 in 200000-300000), can be considered in this group and it could be autosomal dominant transmitting, but most of the cases are sporadic. Mutation has been detected in keratin 1 and keratin 10. After birth, large blisters can be seen but later they take the appearance of fish scale. In spite of similar histopathological features, because of different clinical characteristics, 6 sub-types have been determined. In this paper, as it is rarely seen, epidermolytic hyperkeratosis of Brocq (subtype NPS-1) in a 5 years old girl is presented. The etiopathogenesis, clinical findings and treatment of disease are given with an emphasis on differential diagnosis. We, doctors, would like to underline that we have to deal with this disease with a multi-disciplinary approach as it not only affects the external look of the patients but also affects their psychological and social life. Undoubtedly, genetic consulting which is widely ignored in our country must be given to these families.

Myasthenia gravis (MG) is a disorder of neuromuscular transmission, manifesting variable weakness of skeletal muscle. Myasthenic crisis, defined as respiratory failure requiring mechanical ventilation is a common life-threatening complication that occur approximately 15% to 20% of patients with MG. Management relies on combination of medications that influenced the function of the neuromuscular junction and the immune response. The advent of effective mechanical ventilation and widespread use of immunotherapies have substantially altered the prognosis of myasthenic crisis. We discussed the myasthenic crisis and its treatment by means of good prognosis related to mechanical ventilation and immunotherapies in patients followed up by neurology department and improved respiratory distress.

Heterotopic ossification is a rare complication of laparotomy occurs secondary to the seeding of bone particles to the incision. Total excision is the procedure of the treatment if it is symptomatic. In this paper, a patient who was operated for acute pancreatitis via a midline incision 12 months before the admission is presented. Ultrasound examination was performed for the evaluation of severe incisional pain, revealed an incisional hernia. The patient underwent an operation aiming hernia repair, however a 10x4x2 cm in-diameter mass, which was totally excised, was observed at the time of surgery. The pathological examination of the specimen revealed a piece of mature bone (heterotopic ossification). The aim of this paper is to present the details of the diagnosis and treatment of this interesting entity.