Amaç: Hepatit A ülkemizde önemini halen korumakta olan, özellikle çocukluk çaðýnda görülen bir enfeksiyon hastalýðýdýr. Bu çalýþma Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Çocuk Saðlýðý ve Hastalýklarý polikliniðine baþvuran faklý sosyo¬ekonomik düzey ve farklý yaþ gruplarýndaki çocuklarda anti- HAV seroprevalansýný saptamak ve aþý stratejisini belirlemek üzere yapýldý.
Gereç ve Yöntem: Çalýþma içiýý 2002 Nisan-2002 Eylül aylarý arasýnda çeþitli sebeplerle polikliniðimize baþvuran, klinik olarak belirgin sardýk geçirme öyküsü olmayan 606 vakada, mikro ELISA yöntemiyle anti-HAV total çalýþýldý.
Bulgular: Anti-HAV total düzeyine göre yapýlan incelemede 319 (%52,6) vaka seropozitif 287 (%47,4) vaka seronegatif bulundu. Seropozitiflik 2-3 yaþ grubunda en az %34,7, 14-15 yaþ grubunda en fazla %88,3 olarak saptandý. Seropozitifliðin yaþ, evde yaþayan kiþi sayýsý ve kardeþ sayýsý artýkça an¬lamlý derecede arttýðý saptandý (p<0.001). Cinsiyetler arasýnda anti-HAV total seropozitifliði açýsýndan anlamlý bir farklýlýk bulunmadý (p>0.05). Sosyoekonomik düzey kötüleþtikçe anti-HAV seropozitifligin artýðý saptandý (p<0.001).
Sonuç: Batý illerimizde yapýlan çalýþmalar okul çaðma gelen çocuklarýn %80’den fazlasýnýn HAV’a duyarlý olduðunu göstermektedir. Bizim çalýþmamýzda da polikliniðe baþvuran çocuklarýn topluma açýldýklarý okul ya da anaokulu çaðýnda %50-%55 oranýnda HAV’a duyarlý dýr. Bu çocuklarýn aþýlanmasýnýn, tenýas riskinin yüksek olduðu dönemde hepatit A’ya karþý korunmalarýný saðlayacaðýný düþünmekteyiz.

Objective: Hepatitis A virus (HAV) infection especially acquired during childhood.This infection still an important health problem in our country. We studied anti-HAV Ig G antibody levels in the members of different age groups and different socioeconomic status groups children and adolescents that administrated Þiþli Etfal Hospital Pediatrics policlinics for determining anti-HAV Ig G seroprevalance and Hepatitis A vaccination strategy.
Study Design: During the period of April 2002-September 2002, 606 children and adolescents administrated pediatrics policlinics for any reasons that tested for anti-HAV Ig G antibody. None of them hadn’t jaundice. Blood samples were tested by micro enzyme linked immunosorbent assay (ELÝSA). We used Bio-Rad kit to detect anti-HAV Ig G.
Results: 319 (%52,6) patients were seropositive. 287 (%47,4) patients were seronegative. In the age group of 2-3 years old seropositivity was the most decreased. %34,7 patient in this age group was seropositive. In the 14-15 age group seropositivity rate was the most increased. Seropositivity rate of this group was %88. Seropositivity rate is inceased by many factors such as low level socioeconomic status, older age groups, families which have lots of members (p<0.001). No seropsitivity difference found between male and female groups (p>0.05). When the socioeconomic status got become worst anti- HAV IgG seropositivity was increased (p<0.01).
Conclusions: Studies which were done in our western areas shows that over % 80 of school age children are sensitive for HAV infection.In our study children who were at preschool age are sensitive for hepatitis A virus infection. In this groups sensitivity rate is %50-55. In our opinion Hepatitis A vaccine may be advised to the seronegative preschool age groups.

Tüberküloz menenjit erken taný konulamadýðýnda, yüksek oranda mortalité ve morbiditeye sebep olmaktadýr. Bu amaçla klinik olarak tüberküloz menenjit olduðu düþünülen 32 hasta retrospektif olarak incelendi. Hikaye, fizik muayene, BOS ve kraniyal tomografi bulgularý kaydedildi. 21 hasta beþ yaþ altýndaydý, tüberkülozlu olduðu bilinen bir vakayla temas öyküsü 13 (%40) hastada, Mantoux deri testi pozitifliði 9 hastada (%2B) saptandý. BCG aþýsý 9 (%28) hastaya yapýlmýþtý. 6 hastada (%J8) göðüs radyogramýnda anormallik saptandý. Hastalarýn %57’si ilk baþvuruda Evre ÝT de, %31’i Evre III’ deydi. 3 hastada BOS ya da açlýk mide suyunda Mycobacterium tuberculosis kültürde üretildi, 3 hastada asiclo rezistan boyamayla basil saptandý. Kraniyal tomografide 14 hastada (%43) hidrosefali, 4’ünde (%12) bazitler tutulum, 5’inde (%15) tüberküloma tespit edildi. Nörolojik semptom ve bulgularý olan ve tüberküloz için risk faktörü taþýyan tüm çocuklarda ilk akla gelen MSS tüberkülozu olmalýdýr.

Tuberculous meningitis is associated with high morbidity and mortality if there is a delay in diagnosis. 32 children clinically suspected to have tuberculous meningitis were included in this study. History, examination, CSF findings and CT scan were recorded 21 patients were younger than five years, a contact source was identified in 13 patients (%40). Previous BCG had only been given to 9 (%28). The Mantoux reaction was positive in 9 (%28), abnormalities of the chest X- ray were found 6 (%18). %57 percent of these patients presented with stage II and 31 percent of the patients presented with stage III. Mycobacterium tuberculosis was either culture or identified by acid-fast stain from CSF and early morning gastric aspirates in six patients. Cranial tomography scans of the patients showed hydrocephalus in fourteen patients (%43) and basillar enhancement in four patients, Tuberculoma in five patients. The diagnoisis of CNS tuberculosis should be considered in all children with neurologic signs and symptoms of, and risk factors for tuberculosis.

Amaç: Lenfatik haritalama, tümörün drene olduðu efferent lenfatik kanalýn açýklýðý ilk lenf nodunun (sentinel lenf nodu “SLN" ) tayin edilmesidir ve metastatik hastalarýn mevcudiyetini araþtýrmada kullanýlan ve halen üzerinde çalýþýlan bir yöntemdir. Bu çalýþma, lenfatik haritalama yönteminin evreleme ve tedaviyi yönlendirmedeki rolünii araþtýrmak amacý ile planlandý.
Gereç ve Yöntem: Son 1,5 yýkla kliniðimizde lenfatik haritalama yöntemini 5 malign melanomlu hastada evreleme ve tedaviyi. yönlendirme amacý ile kullandýk. Tc 99m ile iþaretlenmiþ albümin kolloid perilezyoner olarak intradermik enjekte edildikten sonra lenfosintigrafi çekildi. Operasyon sonrasýnda Neoprobe 1500 ile tespit edilen sentinel lenf nodlarmýn çýkarýlmasý ve patolojik incelemesi sonrasý bölgesel lenf nodu diseksiyonýý yapýlýp yapýlmayacaðýna karar verildi.
Bulgular: Olgularýmýzda melanomlarm yerleþimleri occipital bölge, sað crýýris, epigastrik bölge, sol supraclaviküler ve sað latéral planlar bölgedeydi. Birinci olguda klinik lenfadenopati mevcuttu. Patolojik incelemeler sonrasý ilk üç hastaya bölgesel lenf diseksiyonu uygulandý. Lenfadenopatisi olan ve sonradan metastaz geliþen ilk olgu haricinde diðer hastalarda 1,5 yýllýk izlem sonrasýnda nüks tümör oluþumuna rastlanmadý.
Sonuç: Lenfatik haritalama - sentinel lenfadenektomi çalýþmasý prognoz tayininde gerçek evrelemenin yapýlabilmesini ve adjuvan terapi için hasta seçimini saðlar. Ayrýca hastalarýn gereksiz ameliyat olmalarýný engelleyerek, morbidité, komplikasyon riskleri ve maliyeti azaltýr. Özel ekipman ve tecrübe gerektiren hu teknik malign melanomlýý vakalarýmýzda tedaviyi yönlendirmek için kullanýmýmýza girmiþtir.

Lymphatic mapping is a method used for determining sentinel lymph node “SLN” which is the first lymph node that efferent lymph canal drained and for searching existence of metasta¬tic disorder, and is still being studied. We used the method of lymphatic mapping on five patients with malignant melanoma for staging and direction the treatment in last 1,5 years, in our clinics. The lymphositography was taken, after perilesioner and intradermal injection of albumin colloid marked with Tc 99m. During the operation, it was decided to excision of SLN which were fixed with Neoprene 1500 and whether to proceed the regional lymph node dissection after pathological study. In our cases, the localization of melanomas were at occipital area, right cruris, epigastric area, left supraclavicular and right lateral plantar area. In the first case, clinical lymphadenopathy could be detected. Regional lymph node dissection were performed first three patients after pathological study. Except the first case which had clinical lymphadenopathy and developed metastases, none of the patients had recurrent disease in 1,5 year follow up period. Lymphatic mapping-sentinel lymphadenectomy study helps decide for proper patient "ion to proceed for regional lymph dissection. Furthermore, it prevent unnecessary operations and reduce morbidity, complication risks and costs. This tecnique which need special equipment and experience has been in use in our clinic in management of melanoma patients.

Amaç: Beta blokerlerin kardiyoprotektif etkisi ve irýfarkt alanýnda azalmaya yol açtýðý bilinmektedir. Karvedilolün de bu etkiye sahip olduðu yapýlan çalýþmalarda gösterilmiþtir. Amacýmýz Myokard infarktusü sonrasý hastalarda bir alfa-I + non-selektif beta bloker olan karvedilol ile selektif beta blokaj etkisine sahip olan metoprololün insülin direnci ve serum li- pid düzeyleri üzerine olan etkilerini karþýlaþtýrmaktýr.
Gereç ve Yöntem: Bu çalýþma tek merkezli, rcýndomize, açýk, prospektif bir çalýþma olarak planlanmýþtýr. Koroner Yoðun Bakým Ünitesi‘ ne aðrýsýnýn ilk 24 saatinde baþvurmuþ, ST elevasyonlu MI tanýsý almýþ, vücut kitle indeksi (VKI) =25-30 kg/m2 olan, 30-70 yaþ arasý toplam 40 hasta çalýþmaya alýn¬dý. Hastalara standart ASA, romipril nitrat ve atorvastatiýý te¬davisi ile beraber metoprolol 50mg/gün (Grup I, n=20) veya karvedilol I2.5mg/giin (Grup 2, n=20) þeklinde beta bloker tedavisi düzenlendi. Tüm hastalar 12 hafta boyunca izlendi. Hastalarda baþlangýç, 4. ve 12.hafta sonunda açlýk kan þekeri, serum lipid profili, VKI, C-peptid, insülin ve HOMA-IR deðerleri bakýldý.
Bulgular: Metoprolol grubunda HOMA-IR, insülin ve C-pep¬tid düzeyinde 12.hafta sonunda baþlangýca (p=0.002, p=().0()8 ve p=0.000, sýrasýyla) ve 4.Iýafta sonuna göre (p=0.00I, p=0.64 ve p=0.014, sýrasýyla) anlamlý bir artýþ saptandý. HOMA-IR, C-peptid ve insülin düzeyleri karvedilol grubunda 12.hafta sonunda anlamlý düzeyde azalmýþtý (p=0.002, p=0.000, p=0.008, sýrasýyla).
Sonuçlar: Çalýþmamýz myokard infarktüsü sonrasýndaki hastalarda baþlanan karvedilol tedavisinin insülin direncinde düzelme saðladýðýný göstermiþtir.

Objective: Cardioprotective effects and diminishing the in¬farct size in myocardium is well known features of beta bloc¬king agents. Previous studies showed that cardevilol has the same effects. The aim of our study was to compare the effects of carvedilol; an alpha-] and non "ive beta blocking agent and metoprolol, a "ive beta blocking agent, on insulin resistance and serum lipid levels in patients after myocardial infarction.
Study Design: Forty patients aged between 30 to 70 and BMI=25-30 kg!m2; who attended to our coronary intensive care unit within 24 hours of their angina and diagnosed as myocardial infarction with ST segment elevation are included in our study. Metoprolol 50mg/day (group I, n=20) or carvedilol 6.25mglday (group 2, n=20) was added to their combined therapy of acetylsalicilic acid, ramipril, isosorbide mononitrate and atorvastatin. Patients were followed up for 12 weeks. Baseline to week 4 and week 12 in fasting blood glucose, serum lipid profile, BMI, C-peptide, insulin and HO¬MA-IR levels were measured.
Results: In group 1, after 12 weeks of metoprolol therapy HOMA-IR, insulin and C-peptide levels were significantly higher than baseline (p=0.002, p=0.008 ve p=0.000, respectively) and week 4 (p=0.00I, p=0.64 ve p=0.014, respectively). In group 2, after 12 weeks of carvedilol therapy we observed the significant reduction of HOMA-IR, insulin and C- peptide (p=0.002, p=0.000, p=0.008, respectively).
Conclusion: The data of this study showed that in patients after myocardial infarction, an added carvedilol therapy provided an improvement in insulin resistance.

Amaç: Bu çalýþma, diðer oral antidiyabetiklerle kombine olarak ya da insülin tedavisine ek olarak kullanýlan roziglitazon tedavisinin glisemik kontrol ve insülin doz ihtiyacý üzerine olan etkinliðini deðerlendirmeyi amaçlamýþtýr.
Gereç ve Yöntem: Bu çalýþma tek merkezli, randomize, açýk, prospektif bir çalýþma olarak planlanmýþtýr. Toplam 90 tip 2 diyabet‘ýk hasta çalýþmaya dahil edildi. 37-32 yaþ arasýnda, libAlc seviyeleri > %7, C-peptid seviyeleri > 0.6 ng/ml, vü¬cut kitle indeksi (VKÝ)=20-40 kg!m2 olan hastalar çalýþma grubunu oluþturdu. Dýþkýma kriterleri; angina pektoris, kalp yetersizliði, renal yetersizlik, herhangi bir düzeyde hepatik hastalýk idi. Hastalar daha önceden oral antidiyabetik (OAD) kombinasyonu (Grup I, n-40) ya da ikili insülin (Grup 2, n=50) tedavisi almakta olup en az 3 aydýr kötü glisemik kont¬role sahiptiler (HbAlc > %7). Tüm hastalar benzer yaþ ve VKÝ deðerlerine sahiptiler Hastalarýn önceki tedavilerine roziglitazon (Avandia®, Glaxo Smith Kline, UK) 4mglgün tedavisi eklendi. Tiiný hastalar 24 hafta boyunca takip edildi.
Bulgular: Birinci grupta eklenen roziglitazon tedavisi 24.hafta sonunda HbAlc düzeylerini baþlangýca göre %1.63 oranýnda düþürdü (p=0.000). Ýkinci grupta eklenen roziglitazon tedavisi 24.hafta sonunda HbAlc düzeylerini baþlangýca göre %0.83 oranýnda düþürdü (p=0.000). Serum HDL kolesterol seviyeleri çalýþma sonunda anlamlý olarak arttý (p=0.000).
Sonuçlar: Çalýþmamýz roziglitazon tedavisinin oral antidiyabetik ya da insülin tedavisi altýnda olan kötü kontrole sahip tip 2 diyabetiklerde etkili olduðunu göstermiþtir.

Objective: This study tries to evaluate the efficacy of use of rosiglitazone in combination with other oral antidiabetic agents (at least two) or insulin treatment.
Study Design: This was a single centre, randomized, controlled, open, prospective trial. A total number of 90 type 2 diabetic patients, 37-82 years old were eligible for the study if they had HbAlc values over 7%, C-Peptide level greater than 0. 6 nmol/L, BMl between 20-40 at screening. Exclusion criteria were patients with angina or cardiac insufficiency, renal impairment, hepatic disease. Patients has already been treated with OADs (group 1, n=40) or insulin (group2, n=50) twice daily and had similar age and BMl, and a poor metabolic control (HbAl c>7%) under at least 3 months of therapy. A rosiglitazone maleate 4mg/day therapy was added to their previous therapies. All patients were followed up for 24 weeks.
Results: In group 1, additional rosiglitazone therapy reduced HbAlc from baseline by 1.63 percentage points (p=0.000) af¬ter 24weeks. In group 2, additional rosiglitazone therapy reduced HbAlc from baseline by 0.83 percentage points (p=0.000) after 24weeks.
Conclusion: Our study showed that rosiglitazone treatment is both effective in combination OAD or insulin treated patients with type 2 diabetes who have poor metabolic control.

Amaç: Alt oblik kcýsý hiperfonksiyonu olgularýnda uygulanan cerrahi giriþimlerin etkinliklerinin deðerlendirilmesi.
Gereç ve Yöntem: 15 hastanýn 23 gözü çalýþma kapsamýna alýndý. Tüm olgularýn preop ve post-op horizontal kayma dereceleri prizma örtme ve Krimsky testleri ile belirlendi. Alt oblik hiperfonksiyon miktarlarý pupillanýn üst. kapakla iliþkisine göre (+1 - +4) derecelendirildi. +2 ile +4 arasýnda hiperfonksiyon tespit edilen gözlerde, alt obliklere geriletme, myektomi veya myotomi uygulandý. En az 6 aylýk takip süresi sonunda tam düzelme veya +1 alt oblik hiperfonksiyonu tespit edilmesi cerrahi baþarý olarak kabul edildi.
Bulgular: Olgularýmýzýn 11’i primer, 4‘ii sekonder alt oblik hiperfonksiyonu olarak deðerlendirildi. 13 hastada alt oblik hiperfonksiyonuna horizontal kayma eþlik ediyordu. 14 göze geriletme, 5 göze myektomi, 4 göze Z myotomi uygulandý. Hastalar ortalama 21 ay (en az 6 ay) takip edildi. Geriletmede %79, myektomide %60 ve Z myotomide %75 baþarý elde edildi.
Sonuç: Her üç. cerrahi yöntem alt oblik cerrahisinde kullanýlan etkin yöntemler olmakla birlikte, bu çalýþmada en baþarýlý sonuçlar geriletme yönteminde elde edildi. Diðer yöntemlere göre daha kesin ayarlama yapýlabilmesi ve gereðinde tekrar operasyona olanak vermesi geriletme yöntemini tercih edilir kýlmaktadýr.

Purpose: To evaluate the effectiveness of surgical tecniques performed for inferior oblique muscle overaction.
Methods: 23 eyes of 15 patients was included in this study. In all patients the angle of deviation was measured with prizm cover test and Krimsky test. Overaction of the inferior oblique muscles was graded from +J to +4 according to the relationship of the pupil with the upper lid. Recession, myectomy or Z myotomy was performed on eyes having +2 to +4 overaction. Complete loss of overaction or +1 overaction at the end of follow up of at least 6 months was considered as surgical success.
Results: Among 15 patients 11 had primary overaction while 4 had secondary overaction. In 13 eyes inferior oblique overaction was combined with horizontal deviation. 14 recessions, 5 myectomies and 4 Z myotomies were performed. Patients were followed for 6 months to 3 years. Surgical sucsess rates were 79% in recession, %60 in myectomy and %75 in Z myotomy.
Conclusion: All three procedures are effective in weakening the inferior oblique muscle. In our study recession was the most successful. Recession tecnique is our choice of surgery because measurements can be made during surgery and re operation is possible if needed.

Amaç: Sigara, koroner arter hastalýðýnýn baðýmsýz ve deðiþtirilebilir risk faktörlerinden birisidir. Her ne kadar geliþmiþ toplamlarda bu konunun önemini kavrayýp sigara karþýtý çalýþmalar yapýlsa da, sigara içimi halen tiim dünyada en yay¬gýn ve önemli toplumsal saðlýk problemlerinden biri olarak varlýðýný sürdürmektedir. Bugiin elimizde varolan en önemli bilgilerden biri, sigaranýn lipid metabolizmasýna etki edebilen baðýmsýz bir risk faktörü olduðudur. Bu çalýþmada sigaranýn býrakýlmasý ile lipid profilinde oluþan deðiþiklikler zamana baðlý olarak deðerlendirilmiþtir.
Gereç ve Yöntem: Bu çalýþma hastanemize kontrol amacý ile baþvuran sigara içeýý ve sigarayý kesin olarak býrakmak iste¬yen 60 kiþi üzerinde yapýlmýþtýr. Bireylerin total kolesterol, HDL kolesterol düzeyleri 12-14 saatlik açlýktan sonra, sabah alýnan kaýý örneklerinde tayin edilmiþ ve tiim bireylerin Total Kolesterol!IIDL kolesterol oranlarý hesaplanmýþtýr. Daha sonra sigarayý býrakan bu bireyler: lipid profilleri açýsýndan 1 ve 3 ay sonra tekrar deðerlendirilmeye alýnmýþtýr.
Bulgular: Çalýþma grubunda yer alan bireylerin yaþ ortala¬masý 40.3±11.4 yýl, sigara içme süresi I6.7±7.0 yýl, sigara tüketimi ise (tane/gün) 21.9±6.07 olarak tespit edilmiþtir. Si¬garayý býrakmadan öýýce bakýlan total kolesterol deðeri ile si¬garayý býraktýktan sonra I. ve 3. ayda bakýlan total kolesterol deðerleri arasýnda anlamlý bir fark elde edilmemiþtir. Ancak sigarayý býrakmadan önce bakýlan HDL deðeri ile, býraktýk¬tan 1 ay sonra bakýlan HDL deðeri arasýnda istatistiksel ola¬rak ileri derecede anlamlý bir deðiþme kaydedilmiþtir. HDL kolesterol deðerinin 1. ve 3. ay deðerleri arasýnda ise anlamlý bir fark tespit edilememiþtir.
Sonuç: Sigara içimi lipid metabolizmasýnda ciddi deðiþikliklere neden olmaktadýr. Ancak sigaranýn etkisi kalýcý deðildir. HDL kolesterol düzeyleri üzerindeki geçici depresif etkisi; sigara içiminin kesilmesi ile 30 gün içinde düzelmeye baþlamaktadýr.

Purpose: Cigarette is one of the independent and alterable risk factors of Coronary Artery Disease. Despite the importance of this matter has been well comprehended and efforts against cigarette smoking performed in developed societies, it is still an important societal problem. Today, a clear data in our hand is that cigarette smoking is an independent risk factor which can affect the lipid metabolism.In this study.changes in lipid profile in relation to time by giving up smoking have been evaluated.
Materials and methods: This study was conducted on 60 people who smoke cigarettes and are willing to give up smoking out of our hospital staff (physician, nurse and assistant health personnel) and their relatives. Total cholesterol and HDL- cholesterol levels of the individuals were determined in blood samples taken in the morning after 12 to 14 hours of fasting. And the ratios of total cholesterol to HDL- cholesterol of all the subjects were calculated. These individuals were assessed for lipid profiles again I month and 3 months later.
Findings: Mean age, smoking period and daily cigarette consumption of the subjects in our study were 40,3 ± 11,4 years, 16,7 ± 7,0 years and 21,9 ± 6,07 cigarettes per day respectively. There was no significant difference between total cholesterol levels tested before and 1 month and 3 month after giving up smoking. On the other hand, in HDL- cholesterol levels, a statistically highly significant increase was detected / month after giving up smoking compared to before giving up. And there was no statistically significant difference in HDL- cholesterol levels of the individuals between 1 month after and 3 months after giving up smoking.
Conclusion: Cigarette smoking causes serious alterations in lipid metabolism. However the effect of smoking is not permanent. Temporary depressive effect on 11DL- cholesterol levels begins to recover in 30 days after stopping cigarette smoking.

Malign disfajilerin tedavisinde, Self-Expanding Metal Stent (kendiliðinden geniþleyen metal stent) uygulamasý inoperahl hastalarda önemli bir tedavi modalitesi olarak kullanýlmaktadýr. Biz kliniðimizde ösefagus tümörü tanýsýyla, disfajisi bulunan bir hastaya baþarýlý bir þekilde uygulanan steýýt uygulamasýnýn bildirerek, bu güncel yaklaþýmý literatür eþliðinde irdelemeyi amaçladýk.

Self-expanding metal stent placement is an important treatment modality in patients with inoperable tumors and malignant disphagia. In this article we reported a succesfull stent placement in a patient with esophageal tumor causing disphagia and aimed to discuss this current approach.

Fokal nodüler hiperplazi (FNH), kavernöz hemanjiomlardan sonra ikinci en sýk görülen benigýý karaciðer tümörüdür ve otopsi serilerinde primer karaciðer tümörlerinin % S’ini meydana getirmektedir. Olgu bildirimizde karaciðerde tipik manyetik rezonans görüntüleme (MRG) özellikleri gösteren iki adet FNH lezyonunu tanýmladýk. Ayrýca literatürde bildirilen olgulara benzer þekilde eþlik eden bir hemanjiom ile multipl sayýda kistlerin varlýðým gösterdik. MRG ile FNH olgularýnda kesin taný konulabilmesi biopsi gereðini ortadan kaldýrmaktadýr.

Focal nodular hyperplasia is the second most common benign liver tumor after cavernous hemangioma, constituting 8 % of primary liver tumors in autopsy series. In our case report, we have described two focal nodular hyperplasia lesions with typical magnetic resonance imaging features. Besides, similiarly to cases in the literature, we have demostrated a concomitant hemangioma and multiple cysts in the liver. Due to magnetic resonance imaging provides a definitive diagnosis in FNH cases, there is no need biopsy.

Ýnterstisyel ektopik gebelik naclir görülmekle birlikte, mortalitesinin yüksek olmasý nedeniyle önem taþýr, interstisyel gebeliðe acil yaklaþýmda, radikal ya da konservatif, açýk ve laparoskopik cerrahi tedavi seçenekleri vardýr. Kliniðimize baþvu¬ran iki interstisyel gebelik olgusunda acil cerrahi giriþim gerekli görülmüþ ve laparatomi ile kornual rezeksiyon baþarýyla uygulanmýþtýr. Ýnterstisyel gebeliðe acil cerrahi yaklaþýmda konservatif açýk cerrahi güvenle uygulanabilecek bir tedavi yöntemidir.

Interstitial ectopic pregnancy is a rare but disasterous antity because of its high mortality rate. Immediate management of interstitial pregnancy includes radical or concervative open and laparoscopic surgical options. For two patiens with interstitial pregnancy who administered to our clinic, surgical treathment was indicated and cornual resection with laparotomy was performed successfuly. Concervative open surgical treatment is a safe prosedüre for immediate treatment of interstitial pregnancy.

Herni uteri inguinal e olarak da bilinen Persistan Müller Ka¬nal Sendromu (PMKS) internal erkek pseudohcrmafroditizmi- nin bir formudur ve AMH (Antimüllerian hormon) yetmezliði, AMH reseptör defekti veya sekresyonunda zamanlama defek- tine baðlý olarak geliþir. Bu sendrom familyal olup muhteme¬len otozomal resessif veya X’ e baðlý resesif geçiþlidir. PMKS’li hastalar fenotipik erkeklerdir. Bilateral kriptoorþitizm veya unilateral testiküler ektopi ile iliþkili kontrlateral inguinal herni mevcuttur. Utenis ve tubalarýn varlýðý genelde cerrahi sýrasýnda farkedilir. Kriptoorþitizm ön tanýsýyla opere edilen iiç aylýk erkek çocukta operasyon materyalinin incelenmesi sonucu PMKS tesbit edildi. Literatür bilgileri eþliðinde olguyu araþtýrmak ve birlikte tartýþmak amacý ile sunuldu.

Persistent mullerian duct syndrome also named as hernia uteri inguinale is a form of internal male pseudohermafroditsm and may result from the failure of synthesis or release of AMH, defect of AMH receptors or the defect in the timing of the release of AMH. This syndrome is an inherited disorder, it is usually transmitted as a recessive autosomal trait or X linked trait. Patients affected with PMDS are phenotypic males with either bilateral cryptoorchidism or unilateral testicular ectopia associated with inguinal hernia on the contralateral side. The presence of uterus and tubes is usually discovered at surgery. Three month old male child operated for cryptoorchidism and found out to be PMDS after the examination of the operation material is reported. This is a comprehensive review of the literature with evaluation of the clinical features.