Amaç: Çalýþmamýzda 3. trinýeþterdc preeklamptik gebelerde seruýu troponin / ve CKMB deðerleri normotensif gebeliklerle karþýlaþtýrýlmýþtýr
Gereç ve Yöntem: 01 Ocak 2005 - 31 Aralýk 2005 tarihleri arasýnda Þiþli Etfal Eðilim ve Araþtýrma Hastanesi 2.Kadýn Hastalýklarý ve Doðum Antenatal Polikliniðine rutin gebelik muayenesi için gelen kardiyak ve obstetrik açýdan herhangi bir problemi olmayan üçüncü irime ster 30 gebe ve travayda olmayan hafif preeklamptik 30 gebe çalýþmaya dahil edildi. Hastalarýn yaþý, gravida ve pariteleri, gebelik haftasý, dahili hastalýk ve ilaç kullaným hikayeleri, kan basýncý, hemogram, biyokimya, kreatin kinaz MB, troponin 1 ve idrar tetkikleri incelendi.
Bulgular: Ýki grup arasýnda CK-MB düzeyleri açýsýndan anlamlý fark yokken (p>0.05) preeklamptik gurupta troponin I deðerleri anlamlý olarak yüksek saptandý (p<0.001).
Sonuç: Troponin I preeklampside oluþan minör miyokardiyal hasarý tayin etmede iyi bir parametre olabilir, ancak preeklampsi prognozunun takibi için klinik düzeyde yapýlacak ileri çalýþmalara ihtiyaç vardýr.

Objective: In this study, we aimed to determine if there were any changes in serum troponin / and CK-MB levels between normotensive and preeclapmtic women during the third trimester.
Study Design: Thirty normotensive women with no cardiac or obstetric problem during the third trimester and 30 preeclamptic women who were not in active labor attending the antenatal outpatient clinic of Sisli Etfal Training and Research Hospital 2. Gynecology and Obstetric Clinic between 01.01.2005 and 31.12.2005 were recruited into study. Obstetric history, gestational age, drug usage, blood pressure levels. blood count, biochemical charts, any kind of diseases, CK-MB and troponin I levels along with urinary analysis of the patients were evaluated for this study.
Results: Among the two groups, no significant difference was found concerning CK-MB levels (p>0,05). In terms of troponin I levels, the preeclamptic group was found to be statistically higher than the other group (p<(),()()l).
Conclusion: Troponin I may he a good precursor to determine minor myocardial injury, but further clinical researches are needed to follow up preeclampsia prognosis.

Amaç: Rekürran aftöz stomatit (RAS) þikayetiyle yelen hastalarda. Behçet hastalýyý ve kompleks aftozis sýklýðýyla, RAS’lý ve kompleks aftozisli hastalarýn, klinik özelliklerini araþtýrmaktý.
Gereç ve Yöntem: Rekiirran oral aft þikayetiyle baþvuran 50 hasta çalýþmaya alýndý. Hastalar Behçet ve kompleks aftozis acýsýndan araþtýrýldýktan sonra, klinik tip, lokalizasyon, aftlarýn oluþma sýklýðý, iyileþme ve hastalýk süreleri, siyara ve protez kullanýmý, atopi ve aile hikayesi, sistemik ve dermatolojik hastalýklar açýsýndan soryulandý.
Bulgular: Elli hastanýn ikisi(%4) Behçet, dokuzu(%l8) kompleks aftozis, 39’u(%78), RAS’tý. En sýk minör aft görülürken (%75,38), herpetiform aft görülmedi. Aftlarýn en sýk yerleþim yeri dudaklardý(%44,61). En geç majör aftlar iyileþirken, en sýk tekrarlama ve en uzun hastalýk süresi majör ve minör aftý olanlar idi. Minör aft kadýnlarda(%75), majör aft erkeklerde(%75) daha fazlaydý. Oniiç hastada(%33,33) aile, beþ hastada(% 12,82) atopi hikayesi vardý. Yedi hasta(%!7,94) siyara, altý hasta(%l5,2) protez kullanýyordu. Paterji testi bir hastad.a(%2,56) pozitifti.
Sonuçlar: RAS þikayeti ile yelen hastalarda kompleks aftozis nispeten sýktýr. RAS‘lý hastalarda klinik özellikler daha önce yapýlan çalýþmalardan farklýlýk göstermemektedir.

Objective: To investigate the frequency of Behçet’s disease and complex aphthosis in the patients complaining of recurrent aphtous stomatitis and clinical features in the patients with recurrent aphtous stomatitis.
Materials And Methods: Fifty patients who presented with recurrent aphtous stomatitis were included. Patients were investigated for both Behçet’s disease and complex aphthosis, then, were interrogated about clinical presentation, localization, the frequency of aphthae, the duration of both healing and disease, the use of prosthetic material, smoking, atopy, family history, associated with systemic and dermatologic disease.
Results: 2 Patients out of 50 (%4) had Behcet’s disease, nine patients out of 50 had complex aphthosis(%18), and 39 had RAS(%78). While observing minor aphthae in most cases (%75,38), we didn’t observe any Herpethiforme aphthae. Aphthae were localized on lips in most of the cases (%44,6I). While major aphthae were observed to heal the la¬test lesion, major and minor aphthae had the longest duration and, highest repetition. Female studies had more minor aphthae(%75), whereas males had more major aphthae(%75). Thirteen patients had a family history (%33,33), and five patients had atopy (%12,82). Seven patients were smokers (%I7,94), six patients were using oral prothesis (%I5,2). Patergy testing was positive in only one patient (%2,56).
Conclusion: Complex aphthosis was relatively frequent in patients suffering from RAS. The clinical features in patients with RAS, showed no difference from other trials reported before.

Amaç: Çalýþmamýzda, orta kulak cerrahisi anestezisinde remifentanil ile kombine edilen propofol ve midazolamýn peroperatuar kanama, hemodinami, postoperatuar derlenme üzerine etkilerinin karþýlaþtýrýlmasý amaçlanmýþtýr.
Gereç ve yöntem: Timpanoplasti uygulanacak 30 olgu çalýþmaya dahil edilerek, 8 mÝ/kg kristaloid infüzyomý sonrasý, rasgele iki gruba ayrýldý. Anestezi indüksiyonunda remifentanil. Grup l’de propofol. Grup IVde midazolam uygulandý. Anestezi idamesinde: 02/N20, remifentanil infüzyonýý, Grýýp Vde propofol, Grup IVde midazolam infiizyonlarý kullanýldý. Sistolik, diastolik, ortalama arter basýnçlarý (SAB. D AB. O AB), kalp atýný hýzý (KAH) takibi indiiksiyon öncesinde ve peroperatuar 10’ar dk aralýklarla yapýldý. Peroperatuar OAB, baþlangýç deðerinin %25 altýnda olacak þekilde ilaç dozlarý ayarlandý. Hedeflenen OAB’ye ulaþýlamayan olgularda gliserol trinitrat infüzyonuua haþlandý. Cerrahi sahadaki kanama, derlenme kriterleri, yan etkiler kaydedildi. Veriler vaýyans analizi, student t ve ki kare testleriyle deðerlendirildi. P<0.05 anlamlý kabul edildi.
Bulgular: Ýstenen hipotansiyon deðerine ulaþma süresi Grup Vde Grup IVye göre anlamlý olarak kýsaydý (p<0.05). Grup IVde hedeflenen OAB deðerine ulaþmak için 10 olguda gliserol trinitrat kullanýldý (p<().()5). Grup Vde Grup II‘ye göre OAB ekstübasyon öncesi yüksek, KAH ekstübasyon sonrasý düþüktü (p<0.05). Cerrahi sahadaki kanama, derlenme kriterleri, yan etkiler gruplar arasýnda benzerdi.
Sonuç: Orta kulak cerrahisi anestezisinde, rcmifentanilin propofolle kombinasyonunun midazolamla kombinasyonundan daha iyi koþullar saðladýðý kanaatine vardýk.

Objective: The aim of this study was to compare the effects of propofol and midazolam combined with remifentanil on peroperative bleeding, haemodynamy and postoperative recovery characteristics when used for anaesthesia in middle ear surgery.
Study design: Thirty patients undergoing tympanoplasty were included the study and randomly assigned two groups after infusion of 8 mil kg cry staloid solution. Anaesthesia was induced with remifentanil and propofol in Group I or midazolam in Group II. In the maintenance of anaesthesia combination of 02/N20, remifentanil continuous infusion and propofol continuous infusion in Group / or midazolam continuous infusion in Group II were used. Systolic, diastolic, mean arterial pressure (SAP, DAP, MAP), heart rate (HR) values were recorded before induction and at 10 min intervals per operatively. Drug dosages were adjusted to maintain the peroperative MAP below %25 of basal MAP. Glyserol trinitrat was used when marked MAP was unachieved. Bleeding in the surgical field, recovery characteristics and adverse effects were recorded. Results were analysed with analyses of variance, student‘s t and chi sguare tests, p<0.05 was considered as signifi¬cant.
Results: The time to achieve marked MAP value was significantly shorter in Group / than Group 11 (p<0.05). Glyserol trinitrat was used in 10 patients in Group II to achieve marked MAP (p<0.05). MAP was higher before extubation and HR was lower after extuhation in Group I than Group II (p<0.05). Bleeding in the surgical field, recovery characteristics and adverse effects were similar between the groups.
Conclusion: In conclusion; combination of propofol with remifentanil provided better results than midazolam when used for anaesthesia in middle ear surgery.

Amaç: Rejyonel anestezi,cerrahiye endokrin ve metaholik cevabý, kan kaybrýn ve tromboembolik komplikasyonlarý azalttýðý için majör ait ekstremde cerrahisinde özellikle tercih nedenidir (I). Sürekli periferik sinir blok kataterleri ve teknikte ki geliþmeler daha az opioid tüketimi, daha çabuk hasta rehabilitasyonu ve daha yüksek hasta memnuniyetini de beraberinde getirdiðinden rejyonel anestezi gerek cerrahlar gerekse hastalar için daha çekici hale gelmiþtir (2,3). Bu çalýþmayý planlarken biz de anestezi pratiðimizi deðerlendirmeyi ve rejyonel anesteziye ilgimizi araþtýrmayý amaçladýk.
Gereç ve Yöntem: 2000-2004 yýllarý arasýndaki anestezi klinik kayýtlan retrospektif olarak gözden geçirildi.
Bulgular: Kliniðimizde 2000-2004 yýllarý arasýnda uygulanan ortopedik cerrahide ki rejyonel anestezi oranýmýz % 21.98 idi ve en çok tercih edilen rejyonel anestezi yöntemi spinal anestezi idi. Kliniðimizin ortopedik cerrahideki rejyonel anestezi baþarý oraný % 97.48 bulundu.
Sonuçlar: Kliniðimiz uygulamalarýnda genel anestezi ortopedik cerrahide halen birinci tercihdir. Rejyonel anestezi uygulamasý yýllar içinde giderek azalan bir orana sahiptir. Spinal anestezi hala kliniðimizde en çok tercih edilen rejyonel anestezi tipidir.

Objective: Regional anesthesia is the method of choice in the major lower extremity surgery. While it is blunted of the endocrine and metabolic response to surgery, it also decreases blood loss and tromboembolic complications (I). Regional anesthesia is more attractive to patients and surgeons due to the recent introductions of improved techniques and catheters for continuous peripheral nerve blocks which brings less opioid consumption, earlier patient rehabilitation and higher patient satisfaction (2,3). In this retrospecive sucly, we aimed to evaluate current anesthetic practice and regional anesthesia enthusiasm in our clinic.
Study Design: Our clinic documentations belong to 2000- 2004 years are analysed with retrospectively.
Results: Our range of regional anaesthesia was 21.98 % in between 2000-2004 years. The most preferable type of regional anaesthesia was found to be spinal anaesthesia. Our success rate in regional anesthesia for orthopedic surgery was found to be 97.48 %.
Conclusions: General anestesia has sf.il first choice in orthopedic surgery in our clinic managements. Using of regional anesthesia has got respectively decreased ratio through these years.Spinal anesthesia has still most preferable choice in regional anesthesia in our practise.

Giriþ ve Amaç: Týrnakta renk deðiþiklikleri (kromoniþi) pek çok dermatolojik veya sistemik hastalýðýn tanýsýný destekleyen yardýmcý bir bulgudur. Literatürde kromoniþi ile ilgili olgu bildirileri mevcuttur ancak, kromoniþinih sýklýðý ve etyolojisiyle ilgili çalýþmalar bulunmamakladýr. Bu çalýþmada polikliniðimize baþvuran hastalarda kromoniþi ve hamladaki renk deðiþikliðinin sýklýðýný araþtýrmak amaçlanmýþtýr.
Gereç ve Yöntem: Açýk ve randomize yapýlan çalýþmamýza Ocak 2005 ve Mart 2005 aykýrýnda Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Dermatoloji polikliniðine baþvuran 1627 hasta randomize olarak alýndý. Bunlarýn arasýndan týrnaðýnda renk deðiþikliði olan hastalarýn tum týrnaklarý muayene edildi. Yaþ, cinsiyet, týrnak rengi ve þekli ile ilgili özellikler kaydedildi ve fotoðraf çekildi.
Bulgular: Çalýþmaya alman 1627 hastanýn 538’inde kromoniþi saptandý (%20,7). Kromoniþiye neden olan en sýk üç renk deðiþiklikleri sýrasýyla sarý renk (%47,3), beyaz renk (%25,l) ve kýrmýzý renk (%I5,6) olarak saptandý. Kromoniþiye neden olan en sýk üç hastalýk ise onikomikoz (%42,3), lökoniþi (%25,l) ve kýnaya baðlý (%I5,3) renk deðiþikliði olarak bulundu.
Sonuç: Kromoniþi farklý etyolojik faktörlere baðlý oluþmaktadýr. Týrnakta renk deðiþiklikleri sistemik ve dermatolojik hastalýðýn bir göstergesi olabilir. Bu nedenle hastalardan detaylý anamnez alýnmalý ve dikkatli muayene yapýlmalýdýr.

Background and objective: Nail discolouration (chromonychia) may be a helpful diagnostic tool as a part of confirmation of dermatological and systemic disease.There are a few case reports in the literature to date.However, there are no reports about prevalance or etiological factors of chromonychia. We aimed to determine the prevalence and features of chromonychia in our outpatient clinic.
Material and Method: In our open study a total of 1627 patients were randomly recruited from the outpatient clinic of Sisli Etfal Research and Training Hospital, Istanbul, Turkey. Age, sex, race and chief complaint were recorded for each patient. The photographs of the nails of the patients were taken. Results: Chromonychia was present in 338 patients (20.7%) of 1627 patients. The most frequent colours which caused chromonychia were yellow (47.3%), white (25.1%) and red (%15,6). The most frequent disease were onychomycosis (42.3%), leukonychia (25.1%) and henna (15.3%).
Conclusion: Chromonychia includes various etiological factors. Pigmentation abnormalities of nails may suggest systemic and dermatological disease. A careful examination should he made and a wise clinical history should be taken from patients.

Amaç: Osteoporoz clýþý nedenlerle hastanemize baþvuran erkeklerde kemik mineral yoðunluk (KMY) ölçümlerini irdelemek.
Gereç ve Yöntem: Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Fizik Tedavi ve Rehabilitasyon Polikliniði’ne baþvuran erkek hasta ve/veya yakýnlarýna lomber (L2-4) vefemur boyým bölgelerinden DEXA yöntemiyle kemik yoðunluk ölçümleri yapýldý. Hastalar sekunder osteoporoz nedenlerini dýþlamaya yönelik sorgulandý.
Bulgular: Çalýþmaya sekunder osteoporoz nedenleri ekarte edilen 180 kiþi alýndý. Hastalar dekadlara göre gruplara ayrýldý. 20-29 yaþlarda 38, 30-39 yaþlarda 34, 40-49 yaþlarda 29, 50-59 yaþlarda 31, 60-69 yaþlarda 27 ve 70-79 yaþlarda 2/ kiþi mevcuttu. Osteoporoz ve osteopeni tanýlarý Dünya Saðlýk Örgütü konsensüsünü göre konuldu. 20-29 yaþ hastalarda %7,9, 30-39 yaþlarda %3, 40-49 yaþlarda %I3,8,50-59 yaþlarda %/9,4, 60-69 yaþlarda %7,4 ve 70-79 yaþlarda %38,l oranlarýnda osteoporoz tespit edildi. Bu de kodlarda osteopeni oranlan sýrasýyla % 39,5, %47,l, %31, %51,6, %44,4 ve %33,3 saptandý.
Sonuç: Erkeklerde özellikle femurda KMY’nin yaþla birlikte gittikçe azaldýðý, lomberde ise en kötü KMY deðerinin 50-59 yaþlarý arasýnda bulunduðu, ancak erken yaþlarda da osteopeninin baþladýðý saptanmýþtýr.

Objective: To evaluate the bone mineral density (BMD) in men who have applied for other causes than osteoporosis to our hospital.
Method: We measured by DEXA the BMD’s of the lomber (L2-4) and femoral neck region of the male patients and/or relatives who have applied to the Department of Physical Medicine and Rehabilitation. Patients were questioned to exclude the causes of secondary osteoporosis.
Results: We included in our study ISO persons in whom causes of secondary osteoporosis were excluded. The patients were separated in groups according to decades. There were 38 persons between 20-29 ages, 34 persons between 30-39 ages, 29 persons between 40-49 ages, 31 persons between 50-59 ages, 27 persons between 60-69 ages, 21 persons between 70-79 ages. Osteoporosis and osteopenia was defined according to Workl Health Organisation guidelines. We noticed osteoporosis in 7,9% of the patients in the second decade, in 3 % of the patients in the third decade, in 13,8% of the patients in the fourth decade, in 19,4% of the patients in the fifth decade, in 7,4% of the patients in the sixth decade and in 38,1% of the patients in the seventh decade. Osteopenia rates were established respectively as 39.5 %, 47.1%, 31%, 51.6%, 44.4% and 33.3 % at these decades.
Conclusion: In our study group of males the BMD especially in the femur decreased as they got older. In the lumbar region the worst BMD value was found to be between the ages of 50- 59. However osteopenia was observed even in younger ages.

Prostat spesmenlerinin incelenmesinin artmasýyla prostat hipertrofisi nedeniyle operasyon uygulanan olgularda insidental karsinom yakalama oraný da artmýþtýr. Prostatýn endometrioid adenokarsinomu ise prostat tümörleri arasýnda oldukça nadir görülen bir formdur. Benign prostat hipertrofisi nedeniyle öpere edilen bir hastanýn prostat spesmeninde insidental olarak endometrioid tip adenokarsinom tespit edildi. Tümör, immmunhistokimyasal olarak prostat spesifik antijen (PSA) ile pozitif boyanma gösterdi. Daha önceden prostatýn endometrioid karsinomunun Müllerian orijinli olduðu kabul edilmesine raðmen günümüzde pek çok çalýþma bu karsiýýomun primer duktus kaynaklý olduðunu göstermektedir.

With the increased number of the prostate specimens submitted for pathologic examination, the detection of incidental prostatic carcinoma and the variety of lesions discovered in prostate tissue has widened. The endometrioid adenocarcinoma of prostate is very rare. An endometrioid adenocarcinoma is incidentally detected in a transvesical prostatectomy specimen. Immunohistochemically the tumor showed positive staining with PSA. In position to the earlier arguments suggesting the endometrioid carcinoma of the prostate as of Mullerian remnant origin, many studies indicate that it is actually an adenocarcinoma of primary duct origin.

Adenomyomlar gastrointestiýuýl sistemde nadir görülür. En sýk midede daha az sýklýkla duodenumda tanýmlanmýþtýr, ince harsakta ise çok daha nadirdir. Nodüler görünümdeki bu benign lezyonlar ekzokrin tip duktlardan ve hipertrofik düz kas liflerinden meydana gelirler. Çalýþmada 5 aylýk bir erkek çocukta invajinasyona neden olan ileum yerleþimli adenomyom sunulmuþtur. Küçük çocuklarda ohstriiksiyona neden olabilen, büyük yaþlarda ise adenokarsinomlarla karýþabilen bu nadir lezyonlarýn ayýrýcý tanýda akýlda tutulmasý gerekmektedir.

Adenomyomas are rare in the gastrointestinal system. They are more commonly seen in the stomach, than in the duodenum. Ileal adenomyomas are much less common. These nodular, benign lesions are composed of exocrin ducts and hypertrophic smooth muscle bundles. In this study, an ileal adenomyoma, causing intusseption, in a 5 month old boy is described. Ileal adenomyomas may lead to obstruction in children and may be confused with adenocarcinoma in old patients. So these rare tumors should be considered in differential diagnosis of such clinic presentations.

Konjenital adrenal hiperplazi (KAH), adrenal steroidlerin yapýmýndaki enzimatik defcktdeýý, en sýk da 21- hidroksilaz enzim eksikliðinden kaynaklanýr. Bu enzim eksikliði azalmýþ kortizol yapýmýna ve hormon ara ürünlerinin birikmesi, and rojenik etkilere neden olur. Biz bu olgu bildirisinde, prepubertal dönemde manifest hale yelmiþ olan KAH‘ lý bir olgunun tanýsýndaki ultrasonografi bulgularýný sunmayý ve tedavinin takibinde ultrasonografinin önemli rolüne deðinmeyi amaçladýk.

Congenital adrenal hyperplasia (CAH) results from an enzymatic defect in the biosynthetic pathway of adrenal steroids, mostly 21 hydroxilase. This enzyme deficiency results in reduced production of cortisol and the accumulation of hormonal precursors, some of which produce androgenic effects. In this case report, we aimed to present the ultrasonographic findings in a prepubertal boy manifesting with CAH and to emphasize the role of ultrasonography in the follow up of treatment.