AMAÇ: Günümüzde serviks neoplazilerinde human papillomavirus’un (HPV) rolü kesin olarak kanýtlanmýþ olmakla birlikte, ülkemizde serviks lezyonlarýndaki HPV prevalansý hakkýnda bilgilerimiz sýnýrlýdýr. Bu çalýþmada, serviks kanseri ve prekanseröz lezyonu olan kadýnlarda HPV prevalansý ve HPV tipleri araþtýrýldý.
YÖNTEMLER: Ýnvaziv serviks kanseri ve servikal intraepitelyal neoplazi (CIN) tanýsý almýþ 50 adet servikal doku örneði “nested MY/GP polymerase chain reaction’’ (PCR) ile HPV DNA varlýðýný araþtýrmak için tarandý.
BULGULAR: Servikal doku örneklerinin 22’si invaziv serviks karsinomu, 12’si CIN 3, 7’si CIN 2 ve 9’u ise CIN 1 idi. Elli olgunun 35 tanesinde (%70) HPV DNA tespit edildi. Tipleme yapýldýðýnda, en sýk rastlanan 3 HPV tipi sýrasýyla, HPV 6/11 (%42,9), HPV 16 (%22,9) ve HPV 18 (%14,3) olarak bulundu. Ýki tip birden içeren HPV enfeksiyonu ise 7 olguda (%20) saptandý.
SONUÇ: Çalýþma grubumuzdaki HPV prevalansý ve HPV tiplerinin daðýlýmý literatürde bildirilenlere göre farklýydý. Bu durum HPV görülme sýklýðýnýn ve HPV tiplerinin daðýlýmýnýn coðrafi farklýlýklar göstermesi ile iliþkili olabilir. Ayrýca olgu sayýmýz sýnýrlý olduðundan, ülkemizdeki HPV prevalansý ve HPV tiplerinin daðýlýmýný daha doðru olarak belirlemede geniþ serilerle yapýlan çalýþmalara ihtiyaç vardýr.

OBJECTIVE: The role of human papillomavirus (HPV) in the etiology of cervical neoplasia is now well established, however in our country, the knowledge of HPV prevalence in cervical lesions is still limited. The aim of this study was to investigate the prevalence of HPV DNA and to determine HPV types distrubution among women with cervical cancerous and precancerous lesions.
METHODS: Fifty cervical tissues with invasive cervical carcinoma and cervical intraepithelial neoplasia (CIN) were screened by nested MY/GP polymerase chain reaction (PCR) for HPV DNA.
RESULTS: Twenty-two samples were invasive cervical carcinoma, 12 were CIN 3, 7 were CIN 2 and 9 were CIN 1 lesions. Thirty-five out of 50 (70%) cervical tissues were positive for the HPV DNA. When typing was performed, the three most common HPV types were HPV 6/11 (42.9%), HPV 16 (22.9%) and HPV18 (14.3%), respectively. Dual HPV infections were found in 7 (20%) cases.
CONCLUSION: HPV prevalence and type distrubition in our study population were different to that reported worldwide. This might be related to the geographic differences of prevalence and distrubition of HPV types around the world. However, as the number of study population was limited, the further and larger studies are needed to determine more reliable HPV prevalence and distrubition of HPV types in Turkish women.

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AMAÇ: Gastrointestinal stromal tümörler (GÝST) sindirim sisteminin en sýk görülen mezenkimal tümörleri olup tüm gastrointestinal tümörlerin yaklaþýk %3’ünü oluþtururlar. Çalýþmamýzýn amacý, GÝST’lerin sindirim sisteminin malign epitelyal tümörleri ile birlikte görülme sýklýðýný araþtýrmak, birliktelik izlenen olgularda tümörlerin lokalizasyonlarý, histopatolojik ve immünohistokimyasal özelliklerini saptamak ve sadece GÝST saptanan olgularla karþýlaþtýrmaktýr.
YÖNTEMLER: Hastanemizin patoloji kliniðinde taný alan 22 GÝST olgusu çalýþmaya dahil edildi. Bunlar arasýndan malign epitelyal tümör ile birliktelik gösterenler seçilerek ayrý bir grup oluþturuldu. Bu gruptaki malign epitelyal tümörlerde immünohistokimyasal olarak CD117 ve CD34 ekspresyonu araþtýrýldý.
BULGULAR: Yirmi iki olgunun 5’inde (%22,7) GÝST ile birlikte adenokarsinom saptandý. Bu olgularda GÝST’lerin 3’ü mide, 2’si ise ince baðýrsak yerleþimli idi. Bu gruptaki GÝST’ler agresif davranýþ açýsýndan düþük ya da çok düþük risk grubundaydý. GÝST’lerle birlikte görülen adenokarsinomlar ise genellikle mide yerleþimli olup üç tanesi taþlý yüzük hücreli karsinomdu. Adenokarsinomlarda CD34 ve CD117 ile immünohistokimyasal olarak boyanma saptanmadý.
SONUÇ: GÝST’lerin sindirim sisteminin malign epitelyal tümörleri ile birlikteliði rastlantýsal mý, yoksa farklý histopatolojik yapýya sahip bu tümörler geliþimleri sýrasýnda ortak bir mekanizmayý kullanýyor olabilirler mi sorusunu cevaplamak için geniþ serilerle yapýlan çalýþmalara ihtiyaç vardýr.

OBJECTIVE: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive system and they represent approximately 3% of all the gastrointestinal tumors. The aim of our study was to investigate the frequency of GIST concomitant with other malign epithelial tumors of the digestive system, to determine the localization, histopathologic and immunohistochemical features of the tumors in concomitant cases and compare with the cases that include only GIST.
METHODS: Twenty-two cases of GIST diagnosed in the pathology department of our hospital are included in the study. From these cases, the GISTs concomitant with malign epithelial tumors were separated to form a different group. Immunohistochemically CD117 and CD34 expression were investigated in malign epithelial tumors in this group.
RESULTS: Adenocarcinoma was found in 5 of the 22 cases (22.7%) concomitant with GIST. In these cases 3 of the GISTs were localised in the stomach, while 2 in the small bowel. GIST of this group belonged to low or very low risk group regarding aggressive behaviour. Adenocarcinoma seen with GIST were generally localized in the stomach and 3 of them were signet ring cell carcinoma. Immunohistochemical staining with CD34 and CD117 were not found in adenocarcinomas.
CONCLUSION: There is a need of studies with large series in order to find an answer to the question of whether the synchronous occurence of GIST and malign epithelial tumors of the digestive system is coincidental or whether they have a common origin and carcinogenetic mechanisms.

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AMAÇ: Bu çalýþmada, obstrüktif sarýlýk oluþturulan hayvan modellerinde ursodeoksikolik asit ve glutaminin bakteriyel translokasyon, karaciðer histopatolojisi ve karaciðer fonksiyon testlerine olan etkilerinin araþtýrýlmasý amaçlandý.
YÖNTEMLER: Deney hayvaný olarak aðýrlýklarý 200-280 gr arasýnda deðiþen, Wistar Albino cinsi 60 adet diþi sýçan üzerinde çalýþýldý. Her grupta 20 adet hayvan içeren üç grup oluþturuldu. Deney grubundaki hayvanlarda cerrahi iþlem sonrasý 3 gün içinde ikter geliþti. Dördüncü gün sýçanlarýn diyetine 10 mg/kg/gün ursodeoksikolik asit (Ursofalk®) ve 4 ml/kg/gün L-alanil L-glutamin içeren solüsyon (Dipeptiven®) eklendi. Tüm sýçanlardan bakteriyel translokasyonu belirlemek üzere mezenter, çekum ve kan örnekleri alýndý. Biyokimyasal parametreler için kan örneði alýndý. Histopatolojik inceleme için karaciðerden örnekler alýndý.
BULGULAR: Mekanik ikter oluþturduðumuz sýçanlarda AST, ALT, GGT, ALP, total bilirubin ve direkt bilirubin seviyelerinde artýþ olduðu belirlendi. Sýçanlarda hafif derecede yaðlanma saptanýrken ursodeoksikolik asit ve glutamin kullanýlan gruptakilerde bu oranýn azaldýðý saptandý ve total bilirubin düzeyleri arasýnda fark saptanmadý.
SONUÇ: Sonuç olarak, mekanik ikterli hastalarda bakteriyel translokasyon ve karaciðerdeki hasarlanmada ursodeoksikolik asit ve glutaminin operasyon öncesi ve sonrasý verilmesinin mekanik ikterli hastalardaki morbidite ve mortalite üzerinde önemli ölçüde olumlu etkileri olduðunu savunmaktayýz.

OBJECTIVE: In this study, our aim was to investigate the effects of ursodeoxycholic acid and glutamine on bacterial translocation, hepatic histopathology and liver function tests in animal models with obstructive jaundice.
METHODS: Sixty female Wistar Albino rats weighing 200-280 g were used. Twenty rats were assigned to each of three groups. The experiment group developed icterus on the 3rd postoperative day, and 10 mg/kg/day ursodeoxycholic acid (Ursofalk®) and 4 ml/kg/day L-alanyl L-glutamine solution (Dipeptiven®) were added to their diet with orogastric intubation on the 4th postoperative day. Investigated parameters were AST, ALT, ALP, GGT, total (T) bilirubin, and direct (D) bilirubin. Mesenteric, cecum and blood samples were collected in order to determine bacterial translocation. For measurement of biochemical parameters, blood sample was obtained. For histological investigation, samples of liver tissue were obtained.
RESULTS: Our study demonstrated elevated levels of AST, ALT, GGT, ALP, and T and D bilirubin in rats with mechanical icterus. While the ursodeoxycholic acid and glutamine-administered group exhibited a significant decline in AST, ALT, GGT, ALP, and D bilirubin levels, there was no difference regarding T bilirubin levels.
CONCLUSION: We concluded that in the case of bacterial translocation and liver damage, preoperative and postoperative ursodeoxycholic acid and glutamine administration in patients with mechanical icterus may have positive effects on morbidity and mortality.

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AMAÇ: Bu çalýþmada, intramedüller (ÝM) çivileme ve Ýlizarov eksternal fiksasyon (EF) yöntemi ile tedavi edilen kapalý tibia kýrýklý hastalarýn, fonksiyonel ve radyolojik sonuçlarýnýn karþýlaþtýrýlmasý amaçlandý.
YÖNTEMLER: Çalýþmada kapalý tibia þaft kýrýðý nedeni ile cerrahi tedavi uygulanan 26 hasta (19 erkek, 7 kadýn; ortalama yaþ 39,5; daðýlým 17-70) geriye dönük olarak deðerlendirildi. ÝM çivileme uygulanan 14 (%53,8) hasta ile Ýlizarov EF uygulanan 12 (%46,2) hastanýn takip sonuçlarý radyolojik ve fonksiyonel açýdan karþýlaþtýrýldý.
BULGULAR: Ortalama takip süresi 27,3 ay idi. Ortalama kaynama süresi 14 hafta (ÝM çivi 12,8 hafta, EF 15,3 hafta) idi. Diz hareket kýsýtlýlýðý iki grupta da görülmedi. Ayak bileði hareketleri, iki grupta da saðlam tarafa göre azalmýþ olarak bulundu. Johner Wruhs kriterlerine göre 5 çok iyi (4 ÝM, 1 EF), 7 iyi (5 ÝM, 2 EF), 9 orta (2 ÝM, 7 EF) ve 5 (3 ÝM, 2 EF) kötü sonuç elde edildi.
SONUÇ: Kapalý tibia þaft kýrýklý hastalarýn tedavi sonrasý radyolojik ve fonksiyonel açýdan karþýlaþtýrýlmalarýnda, ÝM çivileme Ýlizarov EF’ye göre daha iyi sonuçlar vermektedir.

OBJECTIVE: In this study, we aimed to compare functional and radiological results of tibial diaphysis-fractured patients who were treated with intramedullary (IM) nailing or Ilizarov external fixation (EF) technique.
METHODS: Twenty-six (19 male, 7 female; mean age 39.5 years; range 17 to 70 years) tibial diaphysis-fractured patients who had been treated surgically were evaluated. Follow-up results of 14 (53.8%) patients with IM nailing and 12 (46.2%) patients with Ilizarov EF were compared radiologically and functionally.
RESULTS: The mean follow-up was 27.3 months (range 4 to 48 months). The average union time was 14 weeks (IM nailing 12.8 weeks, EF 15.3 weeks). No limitation in knee motion was observed. In both groups, when compared with the unoperated side, ankle motion was decreased. According to Johner and Wruhs’ criteria, 5 excellent (4 IM, 1 EF), 7 good (5 IM, 2 EF), 9 poor (2 IM, 7 EF) and 5 bad (3 IM, 2 EF) outcomes were determined.
CONCLUSION: When we compared the treatment of closed tibia diaphysis fractures radiologically and functionally, IM nailing gives better results than Ilizarov EF.

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AMAÇ: Tiroid hastalýklarýnda baþlýca taný yöntemleri tiroid ultrasonografisi (USG), tiroid sintigrafisi ve ince iðne aspirasyon biyopsisidir (ÝÝAB). Biz bu çalýþmada, kliniðimizde tiroid hastalýklarý nedeniyle ameliyat ettiðimiz hastalarýn preoperatif taný yöntemleri sonuçlarýný, postoperatif histopatolojik inceleme sonuçlarý ile karþýlaþtýrarak, preoperatif taný yöntemlerinin etkinliðini kendi klinik deneyimlerimiz olarak sunmayý amaçladýk.
YÖNTEMLER: Kliniðimizde 2006 - 2007 yýllarý arasýnda ameliyat edilen 125 hasta retrospektif olarak incelendi. Hastalarýn yaþ, cinsiyet, preoperatif USG, sintigrafi, ÝÝAB bulgularý ile postoperatif histopatolojik inceleme sonuçlarý karþýlaþtýrýldý.
BULGULAR: ÝÝAB hastalarýn büyük kýsmýnda (%88,8) benign iken, malign sitoloji oranýmýz %11,2 bulunmuþtur. Ameliyat edilen hastalarda postoperatif histopatoloji sonuçlarý büyük oranda benign gelmiþtir (%88, n=110). Malign patoloji oranýmýz %12 bulunmuþtur.
SONUÇ: Preoperatif ÝÝAB sonucu ile postoperatif histopatoloji sonucu arasýnda istatistiki olarak çok kuvvetli bir iliþki olduðu görülmüþ olup, preoperatif dönemde hastalarýn büyük kýsmýnda ÝÝAB’nin yeterli bir taný yöntemi olacaðý kanaatindeyiz.

OBJECTIVE: The main diagnostic methods in thyroid diseases are thyroid ultrasound (US), thyroid scintigraphy and fine needle aspiration biopsy (FNAB). We aimed in this study to compare results of preoperative diagnostic methods and postoperative histopathologic examinations regarding the effectiveness of preoperative methods in patients operated for thyroid disease, based on our clinical experience.
METHODS: One hundred twenty-five patients who were operated in our clinic between 2006 and 2007 were retrospectively reviewed. Data collected for each patient included: age, gender and preoperative US, scintigraphy, and FNAB findings. Preoperative findings were compared with postoperative histopathologic examination results.
RESULTS: FNAB was benign in the majority of patients (88.8%), while our rate of malignant cytology was 11.2%. Postoperative histopathology results were largely benign (88% n=110), while the malignant pathology rate was 12% in patients who were operated.
CONCLUSION: A statistically significant relationship was determined between preoperative FNAB and postoperative histopathology results. Thus, we believe that FNAB would be a sufficient diagnostic method in the majority of patients in the preoperative period.

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Büyük ve küçük arter tutulumunun birlikteliði ve kardiyoembolizmin bulunmadýðý iskemik inme olgularýnda, etyolojik nedenler vaskülit, hematolojik bozukluk, koagülopati, nadir görülen hastalýklar ya da idiyopatik olabilmektedir. Romatoid artrit, konnektif doku hastalýklarý içerisinde en sýk vaskülit nedenidir. Kýrk yedi yaþýndaki kadýn hasta, akut geliþen, iskemik çoklu büyük ve küçük serebral arter tutulumuyla deðerlendirildi. Etyolojiye yönelik yaklaþým, olgumuzda olduðu gibi, kollajen doku hastalýðýnýn varlýðýnda, taný karýþýklýðý yaratmaktadýr. Bazen, multipl skleroz, miyasteni, parkisonizm tanýsý almaktadýr. Bu olgu, kollajen doku hastalýðýnda, tedavi ve prognoz açýsýndan, etyolojik deðerlendirmenin önemini vurgulamak için sunuldu.

The etiology of ischemic stroke without large and small artery damage or cardioembolism is vasculitis, hematologic dysfunction, coagulopathy, rarely seen diseases, or idiopathic. Rheumatoid arthritis within connective tissue diseases is the most common cause of vasculitis. A 47-year-old female had acutely presented with ischemic multiple small and large cerebral artery involvement. Investigation of etiology might confuse the diagnosis in the presence of collagenous tissue disease. Patients are sometimes diagnosed as multiple sclerosis, myasthenia gravis or parkinsonism. This case is important to emphasize etiologic research for the treatment and prognosis variabilities in collagenous tissue disease.

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Elli beþ yaþýnda erkek hasta tip 2 diyabetes mellitus nedeniyle oral antidiyabetik kullanmakta iken, intihar amacýyla 60 adet metformin HCL içtiði öðrenildi. Genel durum orta, bilinç açýk olan hastanýn tetkiklerinde pH: 7,29, PaCO2: 39, PaO2: 44 ve laktat: 23,4 olarak saptandý. Hastaya 5 ampul NaHCO3 puþe yapýldý ve NaHCO3 infüzyonu baþlandý. Tansiyonu düþük seyretmesi nedeniyle tedaviye dopamin infüzyonu eklendi. Yapýlan tedaviye raðmen laktik asidozu artan, genel durumu kötüleþen hasta entübe edildi. Derinleþen laktik asidoz nedeniyle hemofiltrasyon uygulanmasý planlandý. Hastanýn tansiyonunun tedaviye raðmen düþük seyretmesi nedeniyle hemofiltrasyona baþlanamadý. Laktik asidozu derinleþen hasta kardiyak arrest sonrasý hayatýný kaybetti.

A 55-year-old male patient taking oral antidiabetics due to type 2 diabetes mellitus took 60 metformin HCL in a suicide attempt. The patient was conscious and the tests revealed pH: 7.29, PaCO2: 39, PaO2: 44, and lactate: 23.4. The patient was given 5 ampoules of NaHCO3 and NaHCO3 infusion was started. Dopamine infusion was added to the therapy due to hypotension. Lactic acidosis increased nevertheless, and the patient’s condition worsened, so intubation was performed. Hemodiafiltration due to increasing lactic acidosis was planned, but was not possible because of continuing hypotension. The patient died after cardiac arrest.

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Özelikle tek taraflý burun kanamasý yaþlý hastalarda sýk karþýlaþýlan bir problemdir. Hipertansiyon gibi sistemik sebeplerden olabileceði gibi burun içi kitlelerden de kaynaklanabilir. Leiomiyomlar damar düz kaslarýndan orijin aldýðý düþünülen iyi huylu tümörlerdir. Baþ ve boyunda çok ender bulunurlar. Tedavisinde basit cerrahi eksizyonun kür oranlarý yüksektir. Sol taraftan burun kanamasý þikâyeti olan 58 yaþýndaki erkek hastamýzda endoskopiyle ameliyat edildikten bir yýl sonra nüks gözükmedi. Bu çalýþmada, nazal kavitede oluþan leiomiyomu klinik ve histolojik özellikleriyle beraber literatür bilgilerini de gözden geçirerek tartýþtýk.

Nose bleeding, particularly one-sided, is a common problem in elderly patients. It may be due to hypertension as well as the masses inside the nose. Leiomyomas are benign neoplasms that are thought to originate from the vascular smooth muscle. They are very rarely found in the head and neck area. Simple surgical excision yields high cure rates. A 58-year-old male presented with left-sided epistaxis. There has been no recurrence one year after the endoscopic excision of the nasal leiomyoma. In this paper, we present the clinical and histological features of a patient with leiomyomas of the nasal cavity together with a review of the literature.

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Prostatýn sarkomatoid karsinomu (karsinosarkom) malign epitelyal ve sarkomatoid komponentler içeren nadir bir prostatik neoplazidir. Bu tümörlerde epitelyal komponent genellikle yüksek gradlý adenokarsinomdur. Sarkomatoid komponent iðsi þekilli hücrelerden oluþur, buna raðmen osteosarkom, kondrosarkom ve anjiyosarkom benzeri heterolog elemanlar içerebilir. Bu yazýda, 65 ve 71 yaþlarýnda prostat spesifik antijen (PSA) deðerleri sýrasý ile 1,5 ve 5,6 olan iki olgu sunuldu. Her iki olgu da epitelyal ve sarkomatoid komponentler içeren malign prostat tümörüne sahipti. Ýmmünohistokimyasal olarak karsinomatöz komponentte pansitokeratin, sarkomatoid komponentte vimentin pozitivitesi izlendi. Bugüne kadar literatürde bildirilmiþ az sayýda prostatik karsinosarkom olgusu mevcuttur. Bu tümörleri daha detaylý tanýmlayabilmek amacý ile prostatik karsinosarkomlu iki olguyu klinik bilgi ve patolojik bulgularý ile beraber deðerlendirdik.

Sarcomatoid carcinoma (carcinosarcoma) of the prostate is a rare type of prostatic neoplasm that demonstrates a combination of malignant epithelial and sarcomatoid components. The epithelial component of these tumors is often a high-grade adenocarcinoma. The sarcomatoid component often demonstrates a spindled appearance, although heterologous elements resembling osteosarcoma, chondrosarcoma and angiosarcoma may be present in a subset of cases. We present two cases (65- and 70-year-old males) whose prostate-specific antigen (PSA) levels were 1.5 and 5.6, respectively. Both cases had malignant tumors of the prostate, which contained both epithelial and sarcomatoid components. Immunohistochemically, pancytokeratin was positive in the carcinomatous component and vimentin was positive in the sarcomatoid component. To date, only a small number of prostatic carcinosarcomas have been reported in the literature. To further characterize these tumors, we examined clinical information and pathologic findings in two patients with sarcomatoid carcinomas of the prostate.

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Sol kolunun üzerinde yattýktan sonra kolunda aðrý ile uyanan ve sadece fleksör pollisis longus kasýnda kuvvet kaybý geliþen 28 yaþýnda erkek hasta kliniðimize sol el 1. parmak interfalangial eklemini fleksiyona getirememe þikayeti ile baþvurdu.Hastanýn yapýlan elektromyografi tetkikinde anterior interosseöz sinir tuzak nöropatisi tespit edildi. Hastaya antienflamatuar tedavi ile beraber eklem hareket açýklýðýný korucuyu rehabilitasyona baþlandý. Altý hafta sonunda tam iyileþme saðlanan hastada bir yýllýk takip neticesinde nüks saptanmadý.

In this report, a 28 year-old male patient with acutely developing muscle weakness in the flexor pollucis longus is described. The patient presented with inability to flex his left interphalangeal joint. Electromyelographic studies showed anterior interosseous nerve entrapment neuropathy, and antiinflammatory drug therapy was initiated. Complete remission was achieved at the end of six weeks and no recurrence was observed during the one year follow-up.

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