Amaç: Bu çalýþmada,midazolam,morfin,meperidin ve fentanil ile yapýlan premedikasyoýý, sedasyon düzeyi ile arterkaýý gazý ve periferik oksijen saturasyonunda neden olduklarý deðiþiklikler açýsýndan incelendi.
Materyal-metod: Genel anestezi uygulanacak ASA I-II grubuna dahil 60 hasta çalýþmaya alýndý. Rastgele 15‘er kiþilik gmba ayrýlan hastalardan Gmp Te 0.1 mg/kg Midazolam, Gmp lîye 0.1 mg/kg morfin, Gnýp lîTe 1 mg/kg meperidin ve GntpIVe 1 mcg/kg fentanil ÝM olarak uygulandý. Premedikasyoýý yapýlmadan önce ve premedikasyondan 45 dksonra kan gazý deðerleri, periferik 0: satürasyonu ve sedasyon deðerleri kaydedildi. Ýstatikselanalizde student-t testi kullanýldý.
Bulgular: Sedasyon deðerleri incelendiðinde Gmp rde ileri derecede anlamlý, Gmp IITte ise anlamlý artýþ görüldü. Gmp ide ileri derecede anlamlý, Gmp IITte ise anlamlý artýþ görüldü.Gmp T de PaCO/de anlamlý artýþ saptandý(p <0.05)
Sonuç: Meperidin ve özellikle midazolam sedasy’oýý yönünden en etkin premedikasyoýý ajanlarý olarak bulundu. Ancak, midazolamýn kan gazýnda oluþturabileceði deðiþiklikler nedeniyle temkinli kullanýlmasý gerektiði düþünüldü.

Objective: In this study, the effects of administration of midazolam, morphine, mepheridine and fentanyl premedication on patients sedation levels, arterial blood gases and peripheral oxygene saturation were compared.
Study Design: Sixty patients from ASA I,II grade were "ed. Patients were randomly divided in to four groups. 0.1 mg/kg midazolam, 0.1 mg/kg morphine, 1 mg/kg mepheridine and 1 pgr/kg fentanyl were administered., IM to the groups I, II, III and IV consecutively. Before and 45 minutes after premedication, levels of sedation, arterial blood gases and peripheral oxygene saturation values were recorded. Results were evaluated statistically with Student-t test.
Results: In Group I, an increase in sedation score was observed (P<0.001). Sedation score of Group III was statistically significant (p<0.05).The increase in Pa CO, in Group I was statistically significant (p <0.0 5)
Conclusions: In our study, mepheridine and particularly midazalom provided sufficient sedaton during premedication. But midazolam, should be used care fully because.

Amaç: Hastanemizin farklý Yoðun Bakým Ünitelerinden izole edilen non-fermantatif gram negatif bakterilerin antibiyotik duyarlýlýk patentlerinin ortaya konulmasý amaçlandý.
Materyal-metod: Bu çalýþmada Þiþli Etfal Eðitim ve Araþtýrma Hastanesi‘rýin farklý yoðun bakým ünitelerinde yatan hastalardan gönderilen klinik örneklerden izole edilen Acýýýetobacter ve Pseudomonas türleri standart mikrobiyolojik yöntemlerle tanýmlandý. Antibiyotiklerin þuþlara invitro etkinliði National Committee for Clinical Labaratory Standards (NCLLS) kriterlerine uygun olarak disk difüýzyon yöntemi ile araþtýrýldý ve orta derecede duy arlýlar dirençli olarak kabul edildi.
Bulgular: Çalýþmamýzda deðiþik klinik örneklerden izole edilen 45‘i Acinetobacter spp, 32‘si Pseudomonas spp olmak üzere toplam 77 bakteri araþtýrýldý. Acinetobacter ve Pseudomonas þuþlarý için en etkili antibiyotiklerin karbapeýýem grubu olduðu, antipseudomonal antibiyotiklerin etkinliðinin ise belirgin olarak azaldýðý görüldü.
Sonuç: Yoðun Bakým Üniteleri antibiyotiklerin en sýk kullanýldýðý hastane birimleridir ve bu ünitelerde ortaya çýkarý dirençli etkenlerin neden olduðu enfeksiyonlarýn prognozu daha kötüdür. Ampirik tedaviye yön verebilmesi ve hastane enfeksiyonlarýna karþý gerekli önlemlerin alýnabilmesi için her hastanenin kendi verilerini elde etmesi gerekmektedir.

Objective: We aimed to evaluate the antibiotic susceptibility pattern of non-fermantative gram negative bacteria isolated from different Intensive Care Units.
Study Design: In this study, Acinetobacter and Pseudomonas species isolated from samples sent by different Intensive Care Units of Þiþli Etfal Training and Research Hospital were identified with conventional microbiological methods. The activity of the antibiotics to the species in vitro was perfoimed by using disc diffusion method according to NCCLS criteria and these intermediately susceptible were accepted as resistant.
Results: In our study totally 77 bacteria Acinetobacter spp and 32 Pseudomonas spp respectively isolated from different samples were evaluated. Carbapenems were the most active antibiotics for both Acinetobacter and Pseudomonas species whereas the activity of other antipseudomonal antibiotics was definitely diminished.
Conclusions: Intensive Care Units are hospital units where antibiotics are frequently used and the prognosis of infections caused by resistant organisms is worse. For optimal "empirical treatment and in order to prevent nosocomial infections any hospital should assume its own data for antibiotic susceptibility

Amaç: Bu çalýþmada, alt abdomiýýal cenalýi sonrasýpostoperatif aðrý saðaltýmýnda tramadol ile fentanil‘in intravenöz hasta kontrollü aneljezide (HKA) etkinliklerinin ve komplikasyonlarýnýn karþýlaþtýrýlmasý amaçlandý.
Materyal-metod: 20-60 yaþlarý arasýnda alt abdomiýýal elektif cerrahi geçirecek 40 hasta (ASA I-II) iki eþit gnýba ayrýlarak tek kör, prospektif olarak gerçekleþtirildi. Tüm hastalara standart genel anestezi uygulandý. HKA cihazý ile I. Gruba (Gnýp F) (ýý=20) IVfentanil (100pgr yükleme dozu, 5 pgr bolus ve 10 dk. kilitli kalýna süresi ), II. Gruba (Grup T), (ýý—20) IV tramadol (100 nýgyükleme dozu, 20 nýg bolus ve 15 dk kilitli kalma süresi) uygulandý. Aðrý þiddeti visuel aðn skalasý (VAS) (en iyi.O, en kötü: 10 olacak þekilde), sedasyon düzeyi ve komplikasyonlar postoperatif 6,12,24. saatlerde kaydedildi.
Bulgular: Her iki grupta VAS deðerleri baþlangýç deðerlerine göre anlamlý düþük idi (p<0.05). Postoperatif 6. saatte VAS deðeri tramadol gmbunda fentanil grubundan istatiksel olarak anlamlý düþük bulundu (p<0.05). Her iki grupta belirgin sedasyon gözlenmedi. Fentanil gmbunda idrar retansiyonýý tramadol grubuna göre daha fazla gözlendi (p<0.05). Toplam ilaç kullanýmý Grup Fde: 270.1 ± 10.9, Grup T de 310.7± 18.9 olarak belirlendi.
Sonuç: Postoperatif aðn tedavisi için ITKA‘da tramadol ve fentanil güvenli ve benzer etkinlikte olduðu, tramadolün opioidlere iyi bir alternatif olabileceði kanýsýna varýldý.

Objective: In this study, our aim was to evaluate effectiveness and side effects of tramadol and fentanyl with patient control analgesia after lower abdominal surgery.
Study Design: Forty patient (ASA I-II) aged between 20-60 years who underwent elective lower abdominal surgery were enrolled. A standart general anesthesia was used. Fentanyl and tramadol were administered in group F ve T respectively with intravenous PCA (loading dose was 100p.gr and 100 mg, bolus dose was 5p.gr and 20 mg, lockout time was 10 and 15 minutes, respectively). Visuel analog score (VAS), sedation scores and siae effects were recorded at postoperative 6,12,24 hours. Total consumption of the both dmgs was also recorded.
Results: VAS Decreased continyously in 24 hours. VAS was significantly lower in the group T than group F at postoperative 6 th hour (p <0.05). Sedation scores were similar in both groups Urinary retention was obseived higher in group F (p<0.05). Total fentanyl and tramadol consumptions were 270.1 ±10.9 and 310.7 ± 18.9 respectively.
Conclusion: Fentanyl and tramadol are effective and safe analgesics for use in PCA. We concluded that the lower rate of respiratuar depression for tramadol makes it the ding of alternative to agonist opioids.

Amaç: von Willebrand Faktör (vWf) ateroslderozuý indir ek belirtecidir. Birçok klinik ve deneysel çalýþýna göstermiþtir ki yüksek vWf düzeyleri eýýdotel hasarýný veya endotelyal disfonksiyonu yansýtýr. Hipertansiyonlularda vWf düzeyleri yüksek bulunmuþtur. Biz bu çalýþmamýzda retinopatisi olan ve olmayan hipertansif hastalan saðlýklý kontrollerle vWf düzeyleri açýsýndan karþýlaþtumayý amaçladýk
Materyal-metod: Çalýþmaya katýlaýýlar 3 gnýba aynldý. Grup I retinopatisi olan hipertansif hastalar, Gnýp II retinopatisi olmayan hipertansif hastalar ve Grup III saðlýklý kontrol grubu. Her 3 grubun ortalama yaþlan benzerdi. Sonuçlar Dunýýet çoklu karþýlaþtýrma testi ve Tukey-Kranýer çoklu karþýlaþtýrma testleri ile karþýlaþtýrýldý.
Bulgular: vWf düzeyleri grup rde 2.41 ± 1.49 U/ml, grup Hde 1.34 ± 0.41 U/ml, ve grup IH te 1.18 ± 0.25 U/ml idi. Çalýþma gruplan kendi aralanýýda ve kontrol gnýbu ile karþýlaþtýnldýðýnda istatistiksel fark gnýp I ve II ve grup I ve III arasýnda anlamlý iken (p<0.05), grup II ve III arasýnda anlamlý fark kaydedilmedi.
Sonuç: Sonuç olarak vWf hipertansif retinopatili hastalarda deðerli bir belirleyici olabilir.

Objective: von Willebrand factor (vWf) is a useful indirect indicator of atherosclerosis. Numerous clinical and experimental reports suggest that high vWf levels reflect damage to the endothelium or endothelial dysfunction. Levels of vWf are increased in patients with hypertension. In our Study we evaluated vWf levels in hypertensive patients with and without retinopathy comparing with control group.
Study Design: The Subjects were divided into three groups. Group I was composed of hypertensive patients with retinopathy, ingroup IIwere hypertensive patients without retinopathy and group III was formed as the control group. Mean ages of the groups were similar. The results were assessed by Dunnet multiple comparison test and Tukey-Kramer multiple comparison test.
Results: Mean vWf level in group I was 2.41 ±1.49 U/ml, in group II 1.34 ± 0.41 U/ml and in group III 1.18 ± 0.25 U/ml. When groups were compared with control group and with each other, the difference was significant between group I and III (p>0.05).
Conclusion: As a result, vWfmay be a valuable indicator of retinopathy in hypertensive patients.

Amaç: Çalýþmamýzda, Ýdiopatik trombositopenik purpuralý (ITP) olgularda trombosit profillerinin ve ledaviye dirençli olgularda splenektomi endikasyonlannýn belirlenmesi amaçlanmýþtýr.
Materyal-metod: Sekonder trombositopenili olgular dýþýnda kalan, yaþlanl8-48 arasýnda deðiþen, Tsi bayan, 2‘si erkek 9 olgu deðerlendirmeye alýndý. Olgulann kanlannda trombositlerin mm3 ‘deki kantitatif titýasyonýý, periferikyaymalanndaki trombosit sayýsý ve moýfolojisi, kemik iliklerindeki megakaryosit sayýsý ve morfolojisi, antirombositler antikor titrasyonýý yapýldý. Bu olgulann kortikoterapiye cevabý araþtýrýldý. Cevapsýz olgularda ise elektif splenektomi sonuçlan deðerlendirildi.
Bulgular: 9 olgunun Tünde trombosit sayýsý 4.000- 5.0, 4‘ ünde 10.000, 2‘ sinde 35.000 - 40.000mm* bulundu. Kemik iliðinde bir olguda %3,3 olguda % 5, kalan 5 olguda ise 4 adet nýegakaýyosit saptandý. Olgulann 2‘ sinde antitrombosit antikor titresi yüksekti. Olgulann klinik seyirlerinde bayan hastalanýl Sinde vagiýýal kanama, diðer olgularda peleþi, ekimoz, bir hastada ise epistaksis geliþti.
Sonuç: Düþük Trombosit profili gösteren bu ITP ‘li olgulara kortikoteýapi uygulandý. Olgulann Tünde trombositopeni ve klinik bulgular tedavi ile düzelmedi. Elektif splenektomi uygulanan bu olgularda klinik ve labaratuar düzelme gözlendi.

Objective: In our study, our goal was to define platelet profiles in ITP and endication of splenectomy in resistant cases.
Study Design: We observed 9 cases, who hadn‘t seconder thrombocytopenia, were between 18 - 48 ages. 7 of them were female and 2 of them were male. We evaluated, their platelet counts in mm? of blood, platelet counts and morphology in peripheral blood, megakaryocyte counts and morphology in bone marrow,quantitative measurements of antiplatelet antibody. We researched the answer to corticotheraphy of these patients and evaluated the results of elective splenectomy in resistant cases.
Results: In 3 of 9 cases, platelet counts were 4.000- 4 of them were10.000, 2 of them were 35.000- 40.000 mm’ there were %3 megakaryocytes in 1 case, %5 in 3 cases and %4 in the rest 5 cases. Antiplatelet antibody was high in 2 cases. In clinical progress we obseived, vaginal bleeding in 5 of women; Petechiaes, ecchymoses in the rest of patients and epistaxis in 1 of them.
Conclusion: We used corticotherapy in patients who had low platelet profile in ITP but there wasn‘t any improve in 3 of them. After elective splenectomy, they recovered in clinical and laboratory.

Amaç: Çalýþmamýzda genç myokard infarktüsü olgulannýn farklý klinik ve labaratuar özellikler gösterdiðini ve tedavilerinin de bu farklýlýklar nedeniyle önem taþýdýðýný belirtmeyi amaçladýk.
Materyal-metod: Hastanemiz Koroner Yoðun Bakým Ürýitesi‘nde Ocak 1999- Ocak 2000 tarihleri arasýnda takip ettiðimiz, klinik ve labaratuvar sonuçlarýmla göre MI tanýsý almýþ 466 olgunun 46‘sý genç MI olarak çalýþmaya katýldý. Olgulann yaþlarý, cinsiyetleri, meslekleri,risk faktörleri, mevsimsel daðýlýmlarý, infarktýn lokalizasyotýu, tedavi yaklaþýmlarý deðerlendirildi.
Bulgular: Çalýþma gnýbumuzda erkek cinsiyet, stresli bir meslekte çalýþýyor olmak, koroner arter hastalýðý açýsýndan risk faktörlerinden sigara içimi, hipertansiyon, aile ananýnezinin diðer risk faktörlerine oranla daha yüksek bulunuþu, daha önce genç MTlar üzerinde yapýlmýþ büyük ölçekli çalýþmalarla (GISSI-2, GISSI-3) uyumluydu (3), (4). Farklý olarak elde edilen sonuçlar ise mevsimsel daðýlýmýnda ilkbahar aylarýndaki yoðunluk, iýýferior lokalizasyonun yüksek olmasý ve tedavide trombolitik ajan kullanýmýnýn olmasý gerekenden düþük bulunuþu idi.
Sonuç: Trombolitik tedavi günümüzde MI tedavisinin temel ve vazgeçilmez unsumdur ve genç MTlarda mortalité ve morbidité üzerine olumlu etkisi daha belirgindir (5). Ülkemizde hala olmasý gerekenden az kullanýlan bu tedavi þeklini yaygýnlaþtýrmak için baþta eðitim olmak üzere çeþitli konularda düzenlemelere gidilmesi gerektiði düþünülmektedir

Objective: In our study, we aimed to emphasize that the young myocardial infarction (MI) cases had different clinical and laboratory features and their therapies were important due to these differences.
Material and Methods: 46 of 466 cases, which were followed by our Coronary intensive Care Unit in between January 1999-2000 and were diagnosed as MI considering the clinical and the laboratory results, were included the study as young MI cases. The ages,genders,jobs,risk factors,seasonal distributions, localization of the infarction, the therapy modality were evaluated. Results: in our study group the presence of, being male, being working in a stressful job, smoking as one of the risk factors for the coronary heart disease, hypertension and the family history at the higher rate than the other risk factors were correlated with the prior laige studies (GISSI-2,GISSI-3) which were carried out with theyoung MI cases. The different results were the intensity in spring at the seasonal distribution, the higher incidence of the inferior localization and the less usage of thrombolytic agents on therapy rather than the expected one.
Conclusions: Recently, the thrombolytic therapy is the essential and the basic element of the therapy of MI and its positive effect, on the mortality and the morbidity at young MI cases, is more prominent. It has been thought the managements on many fields aimly the education should have been carried out to make spread this therapy which has been used less than the expected one in our country.

Amaç: Açýk prostatektomi sonrasý free ve total PSA deðiþikliklerinin belirlenmesi ve daha sonraki izlemler için bazal bir PSA deðerinin saptanmasý.
Materyal-metod: Son 3 yýl içinde tratýsvesikal prostatektomi yapýlan, patoloji sonucu BPH gelen ve aþaðýdaki kriterlere uyan 30 hasta çalýþmaya dahil edildi. Akut retansiyonla gelen hastalarda PSA sistostomiyi takiben 3 hafta sonra bakýldý. Son 6 hafta içinde akut bakteriyel prostatit tanýsýyla tedavi edilen hastalar, BPH ön tanýsýyla firýasterid tedavisi alanlar, son 6 haftada TRUS kýlavuzluðunda prostat biyopsisi uygulananlar çalýþma dýþý tutuldu. PSA‘ýýýn yaþa uyumlu PSA deðerinden yüksek olanlara TRUS ve biopsi yapýldý. PSA tüm olgularda monoklonal Taýýdem R yöntemi ile bakýldý. Açýk prostatektemi sonrasý PSA ölçümü 3‘üncii ay yada daha sonra yapýldý. Ýstatistiksel analizde ki -kare testi kullanýldý.
Bulgular: Öpere edilen hastalannyaþ ortalamasý 67(49- 88), operasyonda çýkarýlan ortalama adeýýom prostat aðýrlýðý 81,5 gr., preoperatif total PSA ortalamasý 8(0.47-54.5) ng/ml, preoperatif free PSA ortalamasý 1.4 (9.5-0.33) ng/ml, orialama free/total PSA 0.12ng/ml olarak bulunurken, postoperatif total PSA ortalamasý 3(0.11-3.36) ng/ml, postoperatif free PSA ortalamasý 0. 18(0.05-0.92) ng/ml, ortalama free/total PSA 0.14 ng/ml olarak bulundu. Postoperatif total PSA‘da ortalama %89 azalma, postoperatif ortalama free PSA‘da %87 azalma tespit edildi (p<0.05).
Sonuç: Açýk prostatektomi sonrasý bazal ortalamaPSA seviyesi 1,3 ± 0,99ng/ml olarak saptandý.

Objective: To determine the changes of free and total PSA and to find a baseline for PSA value for next observations after open prostatectomy.
Material and Methods: In the last 3 years, thirty patients who undeiwent transvesical prostatectomy, detected BPH after pathology and complying the following criterias are included in this research. For the patients with acute retention, PSA has been measured after 3 weeks from the cystostomy procedure. Patients who are cured due to acute bacterial prostatites in the last 6 weeks, treated with firýasterid for diagnosis ofPBH applied prostate biopsy were excluded from the study. TRUS biopsy has been done to those of them whose PSA level is more than appropriate PSA level in respect of age. PSA level has been measured with monoclonal Tandem R method in all subjects. After open prostatectomy, the measurement of PSA has been done in 3 months later or more, chi-square test was used for statistical analyses.
Results: While it was found that the patients operated on avarage age is 67(49-88) years old, weight of average prostate adenom in the operations is 81.5 g., the average of preoperatif total PSA is 11.8(0.47-54.5) ng/ml, the average of peroperatif free PSA is 1.4 (9.5-0.33) ng/ml, average free /total PSA is 0.12 ng/ml; the average of postoperatif free PSA 0.18(0.05-0.92)ng/ml, average free/total PSA as 0.14 ng/m was found. 89% reduction in postoperatif average free PSA has been observed (p<0.05). Total PSA, 87 % reduction in post operative average free PSA has been observed (p<0,05). The level of baseline PSA after open prostatectomy was detected as 1,3 ±0,99 ng/ml.

Amaç: TUR yapýlan hastalarda genel anestezi ile spinal anestezinin hemodinamik etkilerini ve kaýý biyokimyasý deðiþiklerini karþýlaþtýrmayý amaçladýk.
Materyal -Metod: Üroloji kliniðine baþvuran,elektif TUR-P planlanan 60-80yaþ arasý (ASA I-III) 30 hasta çalýþmaya alýndý. Tüm hastalara premedikasyonda 5 mg diazem ve 500 ml Ringer laktat ile prelýidrasyon yapýldý. Hastalar iki gnýba aynldý. Spinal anestezi grubuna 3 ml marcaine heavy %0.5 verildi. Genel Anestezi grubunda ise; indiiksiyon tiopental 5-7 mg/kg rocuronyuný 0,6 mg/kg ve fentanyl 1,5 mg/kg ÝV ile saðlandýktan sonra, idamede; %30 O> + %70 NO2 içinde %2 sevofloraýýe ile saðlandý. OAB, KTA, spöý, CVP, Htc, [Na+J, [If ]deðerlerine indüksiyondatý önce, irrigasyon sývýsýndan önce, inigasyotý sývýsýndan 30dk sonra ve postoperatif 60 dk.‘da bakýldý. Ameliyat süresi, rezeke edilen prostat aðýrlýðý ve kullanýlan irrigasyon sývýsý miktarý kaydedildi.
Bulgular: Genel anestezi grubunda OAB indiiksiyon öncesi deðere göre, irrigasyon öncesinde anlamlý azaldý (p<0.05). Ayrýca,her iki grubun, indüksiyon öncesi deðerleri ile karþýlaþtýrýldýðýnda postoperatif 60. dakikada ki deðerlerinde anlamlý azalma vardý (p<0.05). CVP deðeri spinal anestezi gýubunda indüksiyon öncesine göre, inigasyonun 30. dakikasýnda anlamlý yükseldi (P<0.05). Gruplar arasý karþýlaþtýrmada, spinal anestezi grubunda irrigasyon öncesi CVP deðeri, genel anestezi grubuna göre anlamlý azalmýþ idi (p <0.05).
Sonuç: Prostatýn büyüklüðü, hastalarýn yaþ grubu, TUR‘un teknik özellikleri göz önüne alýnarak her iki anestezi yönteminin de tercih edilebileceði düþünüldü.

Objective: The aim is to compare the effects of general and spinal anesthesia on hemodynamic and biochemical changes during transurethral resection.
Study Design: 30 patints aged 60-80 years old (ASA I- III) who underwent TUR were enrolled. 5 mg diazepame and 500 ml ringer laktate solution were administered as a premedication. All patients divided two groups. Group spinal received 3 ml 0.5 % bupivacaine heavy, group general received standart ¦anesthesia with 5-7 mg/kg tiopentale, 0.6 mg/kg rocuronium and 1.5mcg/kg fentanyl. Anasthesia maintained with 30/70% O2/N2O and 2%sevorane. Hemodynamic and biochemical parameters were evaluated during perioperative and 60 min after posoperatively.
Results: In the group general, MAP decreased before administered irrigation solution‘s time while compare with before induction‘s time (p<0.05). In spinal group, CVP showed a lower value before irrigation (p<0.05). In spinal group, CVP showed a lower value before irrigation than the general group (p<0.05). Conclusion: These findings suggest that spinal and general anesthesia can be considered depend on patient‘s age, amont of prostate.

Amaç: Üreteroskopik litotripside ‘kýr-býrak‘ ile ‘kýr-arýndýr‘ yöntemlerini karþýlaþtýrmak
Hastalar ve Yöntem: Son 100 üreter taþý olgusu birebir sýralanarak çalýþmaya alýndý. Üreteroskopik giriþim 6,9 Fr. üreteroskop ile litotripsi ise pnömotik litotriptör ile yapýldý. Taþ arýndýrmada 3 Fr. Basket kaleter veya 3 Fr. Graspitýgforceps kullanýldý. 50 olguda litotripsi sonrasý fragmanlar spontan pasaja býrakýlýrken 50 olguda litotripsi sonrasý aksesuar giriþimlerle arýndýrma iþlemi basket kateter veya grasping forceps ile yapýldý. Litotripsi grubunda olgularýn kontrolü 15. günde DÜS grafisi ve USG ile yapýlýrken, arýndýmýa uyguladýðýmýz olgularda postoperatuar 1. Günde DÜS grafisi ve 15. günde USG gerekli olgularda ise ÝVP ile yapýldý.
Sonuçlar: Litotripsi yapýlýp spontan pasaja býrakýlan grupta, T. 50 n vakanýn 44‘ünde iþlem baþarý ile tamamlandý. 3 vakada sekonder üreteroskopik giriþim ile baþarýlý olundu. 3 vakada ise taþýn sert, mültipl ve/veya büyük olmasý, gibi sebeplerle açýk cerrahi uygulandý. Bu grupta giriþinýsel baþarý oraný %94 olup,: komplikasyon oraný %0‘dýý: Litotripsi yapýlýp arýndýrma uygulanan 50 vakanýn 49‘unda arýndýrma saðlandý. 1 vakada basket kateteriýý iireter içinde kopmasý sonucu açýk cerrahi uygulandý. Aýýçak 3 vakada basket kateter, çýkartýlmasý sýrasýnda ürelerde takýldý. 2 vakada 24/48 saat bekleme periyodu espasýnda traksiyonsuz olarak taþla birlikte çýktý. 1 vakada peroperatuar sýcak kesi yapýlarak kateter taþla birlikte kurtarýldý. 1 vakada üreteral meadan flep kalkmasý, peroperatuar soðuk kesi. ile, 1 vakada? postoperatuar saptanan üreteral mea darlýðý. ise transiüetral meatotomi ile tedavi edildi. Bu grupta ise giriþimsel baþarý oranýmýz %98 olup komplikasyon oraný % 12‘dir.
Yorum: Kýr-býrak ile kýr-arýndýr yöntemlerinin sonuçlarýnda baþarý oranlarý benzer görülmektedir, ancak hastayý ayný seansta stone-free hale getirme kaygýsý ile uyguladýðýmýz aksesuar giriþimler hem komplikasyon oranýný arttýrmakta hem de 150 ABD dolan ilave maliyet getirmektedir.

Objective: To compare tlýe methods of "breakand leave" and in ureteroscopic lithotripsy. Material and Methods: The last 100 patients with urolithiasis were randomly treated with miniureteroscope using the method of ‘‘break and leave "or " break and clean". A pneumotic. lithotrite was used as the power source. URS procedure was done by 6,9 Fr. Ureteroscope and 3 Fr basket catheter or 3 Fr. grasping forceps was used for cleaning procedure. KUB and USG were performed for the patients at fifteenth day of spontaneous passage following the lithotripsy. All patients were treated with cephaperazone+sulbactam forprophylaxy.
Results: This procedure was achieved in 44 of 50 patients who underwent to lihotripsy and spontaneous passage. In 3 cases secondary ureteroscopic intervention was performed successfully following the primaiy procedure. The remaining 3 cases were subjected to an open ureterolithotomy due. to the hard, multiple and/or big stones. Therefore, the success rate of intervention was 94%, whereas the complication rate was %0. During the ureteroscopy, an open surgery was performed for one patient who was subjected to accessorial interventions in addition to the primary lithotripsy because the basket catheter was broke in two withip ureter. In. one patient, a severe narrowness of ureteral meatus was detected during the postoperative checks, and transurethral meatotomy was petfoimed. In one patient, a detachment in the form of mucosal flap occured during the extraction of stone, and was treated with peroperatiye cold section, In three patients, the basket catheter was affixed during the extraction. In two of our these patients, the basket catheter was removed together with the stone without traction during the 24-48 hours spontaneous passage period, while in one patient the basket catheter was removed together with the stone using the method of peroperative unroofing. Jn 20 out of 50 patients, a 24-hour ureteral catheter was placed to avoid any possible trauma. Our inteiventional success rate was 98%, and the complication rate was 12%, Although using the "break and leave” method combined with cm accessorial tool for cleaning the pieces of stone operation seems to reach a similar success rate, both the high possibility of complications and additional cost of 150$per case should be reconsideved.

Amaç: Uterusun Malign mezenkimal tümörleri seyrek rastlanan neoplazmlardýr. Uterin sarkomlar tüm uterus malignitelerinin %3‘ünü oluþtururlar. Sitolojik ve yapýsal özelliklerine göre bunlar; malign düz kas tümörleri (leiomyosarkom), endometrial stromal sarkom, malign mikst müllerian tümörler, indifféransiye uterin sarkomlar ve diðer malign mezenkimal tümörlerdir. Leiomyosarkomlar tüm uterus sarkomlarýnýn 1/3‘ünü oluþtumrlar. Malign mezenkimal tümörlerin %10-15‘i endometrial stromal sarkomlardýr.Malign mikst müllerian tümörler ise tüm uterus malignitelerinin% 1,5‘undan azýný oluþtumrlar. Bu çalýþmada 1996-2000 yýllan arasýnda labaratuvanmýza gelen 21 tane uterin sarcom vakasý, retrospektif olarak deðerlendirilmiþtir.
Gereç ve Yöntem: Bu raporda 1996-2000yýllan arasýnda SSK Okmeydaný Hastanesi Patoloji Bölümü‘nde görülen 21 tane utems sarkomu vakasý, retrospektif olarak histopatolojik açýdan deðerlendirilmiþtir. Vakalar yaþ, tümör çapý, differansiasyon derecesi, mitoz, atipi, nekroz, selülarite, hücre tipi, makroskopik kesit yüzleri, tümör sýnýrlan, vasküler iýývazyon, eýýdoservikal iýývazyon gibi parametreler yönünden deðerlendirilmiþ; seçilmiþ vakalara da immünhistokimyasal çalýþma uygulanmýþtýr.
Sonuçlar: 21 vakanýn 10‘u leiomyosarkom (%47), 6‘sý malign mikst müllerian tümör (%29), 5‘i endometrial stromal sarkom (%24) idi.Malign mikst müllerian tümörler, son yýllarda immünhistokimyasal yöntemler sayesinde daha iyi tanýnmakta, dolayýsýyla bu tümörlerin görülme sýklýklan artmaktadýr. Vakalanmýz görülme sýklýklan bakýmýndan literatür bulgularý ile uyum göstermektedir.

Objective: Malignant mesenchymal tumors of the uterus are rare neoplasms. Uterine sarcomas comprises 3% of the whole uterine malignities. According to the architectural and cytopathological properties; these are malignant smooth muscle neoplasms (leiomyosarcomas), endometrial stromal sarcomas, malignant mixed müllerian tumors, undifferentiated uterine sarcomas and other malignant mesenchymal tumors. Leiomyosarcomas comprises 1 of 3 the whole uterine sarcomas. 10-15% of malignant mesenchmal tumors are endometrial stromal sarcomas. Malignant mixed müllerian tumors comprises less than 1,5% of the whole uterine malignities. This study evaluates retrospectively those patients diagnosed with malignant mesenchmal tumors of the uterus that came to our laboratory between 1996-2000.
Material and Method: In this report, 21 cases of uterine sarcomas, in evaluated Department of Pathology SSK Okmeydaný Hospital between 1996-2000, retrospectively evaluated with their histopathological properties. Cases were evaluated with paramétrés of the age, diametre of the tumor, degree of differentiation, mitosis, atypia, necrosis, cellularity, cell type, macroscopic properties of the cut surface, tumor borders, vascular invasion, endoservical invasion. Immunhistochemical study were applied for the chosen cases.
Results: Ten of these 21 cases were leiomyosarcomas (47%), 6 were malignant mixed müllerian, tumors (29%), 5 were endometrial stromal sarcomas(24%). With the aid of immunhistochemistry malignant mixed müllerian tumors are diagnosed more accurately, so incidence of them are getting increased. The incidence rate of our cases and the literature are concordant.

Amaç: Polikliniðimize baþvuran 24-28. gestasyonel haftalýk gebelerin gestasyonel diabet yönünden taranýp gestasyonel diabet sýklýðýnýn ortaya konmasý.
Materyal ve Metod: 24-28. gestasyonel haftalardaki (GH) 90 gebe çalýþma kapsamýna alýndý. Risk faktörü olarak anne yaþý, paritesi, obesite, ailede diabet öyküsü, glikozüri varlýðý, daha önce anomalili veya ölü doðum hikayesi, 4000 gr veya üzeri doðumlar araþtýrýldý. Tiim gebelerin HbAlc, rutin tam kan ve idrar analizleri, tansiyon arteriyel, alýnan kilo deðerleri kaydedildi. Obstetrik USG yapýldý. Olgularýn tamamýna 50 gr glukozla gestasyonel diabet (GDM) taramasý yapýldý. 130 mg/dl üzerinde kan þekeri deðeri gösteren gebelere 75groral glukoz tolerans testi (OGTT) uygulandý.
Bulgular: Olgular yaþla risk faktörü arasýnda iliþki açýsýndan incelendiðinde25 yaþýn üzerinde kil erde ve risk faktörü varlýðýnda GDM daha yüksek oranda görülmüþtür (p<0.01). Açlýk kan þekeri (AKS) 90 mg/dl üzeriýýdeolan bulgularýn hepsinde 50 gr glukoz tarama testi pozitifliði %100, 130 mg/dl üzerinde olanlarda ise tarama testi pozitifliði %24.5 olarak bulundu. Tarama testi (4) olanlara 75 gr glukozla OGTT uygulandýðýnda 6 olguda (%27.2) GDM tanýsý konuldu. HbAlc seviyeleriyle tarama testi ve GDM arasýndaki iliþki incelendiðinde, HbAlc ‘nin GDMlu olgularda anlamlý yüksek olduðu görülmüþtür (p <0,05).
Sonuç: 50 gr glukoz tarama testi, gebelikte 24-28. gestasyonel haftalar arasýnda rutin uygulatmasý gereken bir testtir. Tarama testi (+) olarý olgularda taný OGTT ve kan HbAlc düzeyi ölçümü ile desteklenmeli ve gebeler daha yakýndan izlenmelidir.

Objective: To find the frequency of gestational diabetes by searching the pregnants in 24-28 gestational week who come to our policlinic.
Material and Method: Ninety pregnant in 24-28. week are taken for the study. As the risk factors maternal age, parity, obesity, diabetes in study, glucosuri, mort fetus or fetal anomaly, 4000 gr or more fetal weight are taken obstetric USG applied. To every case 50 gr glucose gestational searching test, we apply 75 gr oral glucose tolerance test to the pregnants who have 130 or more blood glucose level.
Results: When the cases searched for the relation ofvthe age and risk factors we see that in the cases who carry the risk factors and more than 25 years old. GDM can be seen much more (p<0,01)in the cases whoose hungry blood glucose level>90 mg/dl we see that 50 gr glucose searching test is %100 positive. And the ones whoose hungiy blood glucose level >130 mg/dl searching vtest positivity is %24.5. When OGTT with 75 gr glucose is applied to the cases who havepositivityin searching test, in six cases take (%27.2) GDM diagnosis. When we search the relation between the HbAlc levels, searching test and GDM we see that in the cases with GDMHbAlc levelsare high.
Conclusion: 50 gr glucose searching test is in rutin tests that applied to the pregnants in 24-28. gestational week. The caseswhoose searching test is positive the diagnosis must be supported with HbAlc levels and pregnants must be followed well.

Amaç: Klinik bulgular ve renkli doppler ultrasonografý ile varikosel tanýsý konmuþ oligoastenospermili olgularda yüksek ligasyoýý varikoselektomiýýin, renkli doppler ultrasonografý ve spermiogram parametreleri üzerindeki etkisini araþtýrmak.
Hastalar ve Yöntem: Yaþ ortalamasý 27 olan, klinik ve renkli doppler ultrasonografý ile varikosel tanýsý almýþ oligoastenospermili 34 yetiþkindeki, 20‘si bilateral 54 olgu prospektif çalýþma kapsamýna alýndý. Varikosel tanýsý klinik bulgulara ek olarak tüm olgularda renkli doppler ultrasonografý bulgulan ile kondu. 1S(%33) olguda sýýbklinik varikosel belirlendi. Olgularýn tümüne yüksek ligasyoýý varikoselektomi operasyonu uygulandý. Renkli doppler ultrasonografý ayný radyoloji merkezinde gerçekleþtirildi. Operasyondan 6 ay sonra renkli doppler ultrasonografý ve spermiogram ile olgular yeniden deðerlendirildi.
Bulgular: Çalýþmada yer alan 54 olgunun 12‘sinde (%22) renkli doppler ultrasonografide bulgulannýn sürdüðü gözlendi. 18 subklinik varikosel olgusunun tümünde renkli doppler ultrasonografi bulgulan ortadan kalktý. Doppler ultrasonografý bulgulannýn sürdüðü olgularýn hiçbirinde sperm parametreleri düzelmedi. Bilateral varikoseli olan 14 hastanýn 8‘itýde olmak üzere toplam 34 hastanýn 20‘sinde (%59) spermiogram parametrelerinde düzelme bildirildi. Bilateral varikoselektomi operasyonu uygulanan 40 olgunun 6‘sýnda (%15) postoperatif olarak reflünütý devam ettiði, 34‘ünde(%85) ortadan kalktýðý gözlendi. Bu olgularýn 12‘sinde (%60) spermiogram parametrelerinin düzeldiði S‘itýde (%40) ise deðiþmediði veya kötüleþtiði saptandý. Tek taraflý varikoselektomi operasyonu uygulanan 14 olgunun 6‘sýnda (%43) reflünütý sürdüðü, S‘itýde (%57) ortadan kalktýðý gözlendi. Bu gruptaki olgularýn 6‘sýnda (%43) spermiogram parametreleri ayný kaldý ya da kötüleþti, 8 olguda (%57) ise spermiogram parametrelerinde düzelme gözlendi.

Objective: The effect of high ligation varicocelectomy in the color Doppler ultrasonography and spermiogram parameters in the clinically and radiologically diagnosed oligoasthenospeimic varicocele patients.
Patients and Methods: Clinically and radiologically diagnosed 34 adult patients (mean age 27) with oligoasthenospermia were included in the study. Total 54 varicocele units were operated and twenty of them were bilateral. The diagnosis of varicocele was made by clinical examination and with color doppler ultrasonography in all cases. Subclinic varicocele was found in 18(33%) cases. 26 of cases were classified as G2-3 varicoceles and 10 cases as G1 varicoceles. High ligation varicocelectomy was performed in all cases. All of the radiologic exams were made in the same department. Follow up was made after 6 months by examine of spermiogram and color doppler ultrasonography.
Results: The signs of reflux in the color Doppler ultrasonography were found postoperatively in twelve units out of 54 operated. In 18 subclinic varicocele units reflux were not found postoperatively. Spermogram parameters were not improved in patients whom Doppler ultrasonography findings were continued in postoperative period. In 12 out of 20 bilateral and 8 out of 14 unilateral varicocele patients (20 units out of 34 units, %59) spermiogram parameters were improved. In 6 (15%) out of 40 bilateral cases reflux was continued and in 34 cases was stopped. In 12 (60%) of these patients spermiogram parameters were improved. In 8 of them spermiogram parameters were not changed or worsened. In 6 (43%) out of 14 bilateral varicocele patients reflux was continued and in 8 (57%) of them was stopped. In 6 (43%) out of this group spermiogram parameters were similar or worsened in 8 patients spermiogram parameters were improved.

Amaç: Rosai - Dorfman Hastalýðý (Yaygýtý Letýfadenopatili Sinüs Histiyositozu) lenf nodlantýýn histiyosit proliferosyonuyla giden, özellikle servikal lenf nodlamýý tutan, idiopotik, nadir rastlanan bir hastalýðýdýr. Tipik klinik özellikleri bilateral aðrýsýz lenf nodýý büyümesi, ateþ, lökositoz, sedimantasyon artýþý, poliklonal hipergammaglobýýlinemidir. Genellikle benign reaktif bir dunundur, yavaþ klinik gidiþ gösterir, fakat oldukça deðiþken bir biyolojik davranýþa sahiptir. Çalýþmamýzda subglottik bölge ve submandibuler lenf bezleri yerleþimli bir Rosai Dorfman Hastalýðý (RDH) olgusu sunuldu ve literatür bilgileri ýþýðýnda tanýþýldý.

Objective: Rosai-Dorfmann Disease ( Sinus histiocytosis with massive Iymphadenopaty-SHML) is a rare, idiopathic, histiocytic proliferative disorder that most commonly involves the cervical lymph nodes. The typical clinical features of this disease include bilateral painless lymph node enlargement, fever, leucocytosis, elevated eiythrocyte sedimentation rate, policlonal hypergammaglobulinemia. Generally, this is a benign reactive disorder, have an indolent clinical course; but have a highly variable biological behaviour. Here we report a case of Rosai Dorfmann Disease affecting the subglottic area and submandibular lymph nodes and discussed in the view of the literature.