Amaç: Çalýþmamýzda; sezaryen operasyonlarýnda genel anestezi ile kombine spinal epidural anestezinin, gebelerdeki hemodinamik deðiþiklikler ve yenidoðanýn APGAR skorlarý ile göbek kordonu venöz kan gazlarýna etkilerini karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Hastane Etik Kurulu izni ve yazýlý onamlarý alýnan, sezaryen operasyonu planlanan 30 miadýnda gebe, rasgele olarak genel anestezi (Grup GA) (n: 15) veya kombine spinal epidural anestezi (Grup KSE) (n: 15) grubuna dahil edildi. Non invaziv arteryel kan basýncý, kalp atým hýzý ve periferik oksijen satürasyonu anesteziden önce (bazal deðer) ve devamýnda cerrahi sonuna kadar 5 dk. aralýklarla ölçülerek kaydedildi. Doðumdan sonra göbek kordonunun bir bölümü klampe edilerek alýnan umblikal ven kan örneðinde, kan gazý deðerleri ile 1 ve 5. dk APGAR skorlarýna bakýldý.
Bulgular: Gruplararasý karþýlaþtýrmada ortalama kan basýncý (OKB) ve kalp atým hýzý (KAH), 5.dk.da Grup KSE’de Grup GA’ya göre anlamlý olarak yüksek bulundu (p<0.05). Grup içi OKB ve KAH deðerlerinde klinik olarak tedaviye ihtiyaç duyulmayan deðiþiklikler saptandý. Her iki grupta APGAR skorlarý ve umblikal ven kan gazý deðerlerinde anlamlý fark bulunmadý.
Sonuç: Sezaryen operasyonlarýnda genel anestezi ile kombine spinal epidural anestezi, gebede ve yenidoðanda oluþturduklarý etkileri bakýmýndan benzer olarak deðerlendirildi.

Objective: We aimed to compare the effects of general anaesthesia versus combined spinal epidural anaesthesia on maternal haemodynamic variables and APGAR scores and umblical vein blood gas parameter of newborns.
Study design: After the approval from Medical Ethics Committee and written informed consent, 30 parturients undergoing caesarean section
operation, randomly allocated to receive either general anaesthesia (in Group GA) (n: 15) or combined spinal epidural anaesthesia (Group CSEA) (n: 15) were included the study. Non invasive arterial blood pressure, heart rate and peripheral oxygen saturation values were recorded before anaesthesia (baseline) and thereafter with 5 min intervals until at the end of surgical procedure. Following delivery, a segment of the umblical cord was doubtly clamped and umblical vein blood gas samples were taken and APGAR scores were recorded at 1 and 5 min.
Results: Mean arterial blood pressure (MBP) and heart rate (HR) values were significantly higher in Group CSEA compared to Group GA at 5th min (p<0.05). In the changes in MBP and HR values no treatment were required clinically in groups. In both groups, there were no significant differences in APGAR scores and umblical vein blood gas analyses of newborns.
Conclusion: We concluded that; the effects of general anaesthesia and combined spinal epidural anaesthesia were similar on parturients and newborns in caesarean section operations.

Amaç: Travmatik kalça çýkýðý kalça eklem bütünlüðünün ve dolaþýmýnýn bozulduðu acil bir durumdur. Bu çalýþmada travmatik kalça çýkýðýnýn orta dönem sonuçlarý bildirilmiþtir.
Yöntem: 1995-2006 yýllarý arasýnda kliniðimize baþvuran 45 travmatik kalça çýkýðý olgusunun 18’ine ulaþýlarak artroz, avasküler nekroz ve siyatik sinir lezyonu varlýðý, radyografi ve klinik muayene bulgularý ile deðerlendirildi.
Bulgular: Olgularýn takip süresi daðýlýmý 12-126 ay olarak saptandý. Olgularýn 13’ü erkek 5’i kadýndý. Thompson Ebstein sýnýflandýrýlmasýna göre 2 olgu tip 1, 6 olgu tip 2, 4 olgu tip 3, 4 olgu tip 4 olarak sýnýflandýrýldý. Olgularýn hepsi kapalý olarak ilk 6 saat içerisinde genel anestezi altýnda redükte edildi. Olgulara 1,5 ay boyunca iskelet traksiyonu yapýldý ve toplam 3 ay yük verilmedi. Redüksiyon sonrasý stabil olmayan 3 olguya mevcut asetabulum kýrýðý için osteosentez yapýldý.
Tartýþma ve Sonuç: Travmatik kalça çýkýðý yüksek enerjili bir yaralanmadýr. Genellikle genç hastalarda, ek yaralanmalarla birlikte gözlenir. Olgularýmýz sýnýrlý sayýda olmasýna raðmen artroz geliþen 3 olgunun Thompson Ebstein’e göre 2’sinin tip 4 (%50), 1’nin tip 3 (%25) olmasý travmanýn enerjisiyle artroz riski arasýnda doðru orantýlý bir iliþki olabileceðini düþündürmektedir.

Objective: Traumatic hip dislocation is an urgent condition that integrity and circulation of the hip joint spoils. In this study midterm results of the traumatic hip dislocation are informed.
Study Design: 18 of the 45 traumatic hip dislocation cases which resorted our clinic between 1995-2006 years were reached and evaluated for existence of arthrosis, avascular necrosis and sciatic nerve lesion, radiography and clinical examination findings.
Results: The follow-up period of patients was 12-126 months. Thirteen of of patients were male, 5 of them were female. According to Thompson Ebstein classification patients were classified as 2 patients type 1, 6 patients type 2, 4 patients type 3, 4 patients type 4. All of the patients were reducted closedly under general anesthesia in first 6 hours. Skeletal traction was applied for 1,5 months and no load on their lower extremity was given for 3 months. In follow-up of 2 of these 3 patients arthrosis developed.
Conclutions: Traumatic hip dislocation is a high energy injury which is usually seen in young patients and accopanied by additional injuries.Although we have a limited number of patients,development of arthrosis in 3 patients that 2 of them were type 4 (25%) and 1 of them was type 3 (25%) according to Thompson Ebstein classification, may suggest a proportional relationship between the energy of trauma and the risk of arthrosis.

Amaç: Bu çalýþmada kronik el bileði aðrýsý yakýnmasý olan hastalarda uygulanan artroskopik giriþimin taný ve tedavideki etkinliði araþtýrýldý.
Hastalar ve Yöntem: Çalýþmamýzda kronik el bileði aðrýsý olan, 22’si erkek, 9’u kadýn, 31 hastanýn el bilekleri incelendi. Hastalarýn artroskopi öncesi tanýlarý ile giriþim sonrasý tanýlarý karþýlaþtýrýldý. Artroskopik olarak tedavi edilen yirmi bir hastanýn giriþim öncesi ve sonrasý dönemde günlük iþlevleri Q-DASH-T (Quick-Disabilities of the Arm, Shoulder and Hand Questionnaire-Türkiye)sorgulamasý ile deðerlendirildi. Belirtilen aðrýlar ise (VAS) görsel örnekleme cetveline göre deðerlendirildi. Hastalar cerrahiden sonraki üçüncü haftada kontrol edildi. Sonrasýnda altý hafta ara ile en az altý ay kontrollere çaðýrýldý.
Sonuçlar: Takip süresi 8 (daðýlým, 4-12) aydý. 24 (%96)hastanýn tanýlarý giriþim öncesi ve sonrasýnda uyumluydý. Kesin tanýsý konulamayan, el bilekleri aðrýlý altý(%19. 3) hastaya giriþim sonrasý taný konuldu. Kronik el bileði aðrýsý olan hastalarda triangular fibrokartilaj yapýdaki yýrtýklarýn en sýk rastlanan sorun olduðu görüldü. Hastalarýn 21(% 67.7)’i artroskopik yöntemle tedavi edildi. Görsel örnekleme cetveline(VAS) göre hastalar aðrýlarýný giriþim öncesinde 6 (daðýlým, 4-8) puan ile ifade ederken artroskopi sonrasýnda aðrý 1 (daðýlým, 0-3)puana geriledi. El bileði kavrama kuvvetleri giriþim öncesi 24 kg iken, giriþim sonrasý 26 kg olarak bulundu. Ýlk muayene sýrasýnda Q-DASH-T sorgulamasýnda 18 puan alan hastalar giriþim sonrasýndaki son kontrollerinde 11 puan aldý. El bileði kronik aðrýlarýnda uygulanan yardýmcý taný yöntemlerinin etkinliði %77.4 olurken, artroskopinin diðer taný yöntemlerine göre daha etkin bir tanýsal deðeri olduðu saptandý. Ayrýca VAS ve Q-DASH-T sorgulamalarý ile deðerlendirilen hastalarýn aðrý ve fonksiyonlarýnda artroskopik giriþim sonrasýnda anlamlý bir düzelme olduðu görüldü. On (%31) hastada artroskopi sonrasýnda açýk cerrahi gereksinimi oldu. Artroskopiden sonraki erken dönemde iki (%6.4) hastanýn eklem hareketlerinin ileri derecede kýsýtlandýðý ve iki (%6.4) hastada yapýlan dorsal ganglion rezeksiyonun tekrarladýðý görüldü.
Tartýþma ve Çýkarýmlar: Sonuç olarak, kronik el bileði aðrýsý olan hastalarda uygulanan el bileði artroskopisi taný ve tedavinin belirlenmesinde etkili olurken, cerrahi uygulamalarýnýn sonuçlarý baþarýlýdýr.

Purpose: In this study, the efficiency of arthroscopic approach employed in patients suffering from chronic wrist pain was analyzed in terms of diagnosis and treatment.
Patients and Method: The wrists of 31 patients who had chronic wrist pain were analyzed in our study. Pre-arthroscopy diagnoses of the patients were compared to those following the arthroscopic intervention. Pre- and postoperative daily functions of 21 patients who were treated arthroscopically were evaluated using the Q-DASH-T questionnaire. Indicated pain levels were evaluated according to the Visual Analogue Scale (VAS).
Results: The mean follow-up period was 8 months (range, 4-12 months). Pre- and post-operative diagnoses from 24 patients (96%) were coherent. Twenty-one patients (67.7%) were treated using arthroscopic techniques. While the patients had indicated a mean pre-operative pain score of 6 (range, 4-8) according to the Visual Analogue Scale (VAS), the mean the pain score went down to 1 point (range, 0-3) following the arthroscopic procedure. The mean pre-operative wrist grip strength of 24 kg was found to be 26 kg after the surgery. The patients who received a mean score of 18 points in the Q-DASH-T questionnaire during the initial examination got 11 points in their final examinations.Open surgery was required in ten patients (31%) subsequent to the arthroscopic procedure.
Discussion and Findings: In conclusion, wrist arthroscopy performed on patients with chronic wrist pain was found to be efficient in the assessment of diagnosis and treatment while successful results were attained through surgery.

Amaç: Temel ekzotropya tanýsý almýþ olgularda uygulanan tek taraflý geriletme-kýsaltma ve çift taraflý geriletme ameliyatlarýnýn sonuçlarýný karþýlaþtýrmak ve cerrahi baþarýyý etkileyen faktörleri araþtýrmak.
Yöntem: Temel ekzotropya tanýsý ile izlenen ve cerrahi tedavi uygulanan hastalarýn kayýtlarý geriye dönük olarak incelendi. Tek göz dýþ rektus kasýna geriletme-iç rektus kasýna kýsaltma cerrahisi uygulanmýþ 30 hasta (1.grup) ile her iki göz dýþ rektus kasýna geriletme uygulanmýþ 15 hasta (2.grup) çalýþma kapsamýna alýnarak ameliyat sonrasý cerrahi sonuçlar karþýlaþtýrýldý.
Bulgular: Hastalar ameliyat sonrasý ortalama 4,1 yýl ± 2,2 (daðýlým, 1-10 yýl) takip edildiler. Geriletme-rezeksiyon uygulanan 1.gruptaki 30 hastanýn 23’ünde (%76,3) baþarýlý sonuç elde edilirken çift taraflý geriletme uygulanan 2.gruptaki 15 hastanýn 7’sinde (%46,7) yapýlan cerrahi baþarýlý oldu. Baþarý açýsýndan iki grup arasýnda istatistiksel olarak anlamlý oranda fark bulundu (p=0,02).
Sonuç: Çalýþmamýzda temel tip ekzotropya olgularýnda geriletme-kýsaltma tekniðinin çift taraflý dýþ rektus geriletmesi tekniðine göre daha baþarýlý ve tercih edilmesi gereken cerrahi teknik olduðu sonucuna varýldý.

Objective: To compare the surgical results obtained by unilateral recession/resection and bilateral rectus recession tecniques for the
correction of exotropia.
Methods: The results of surgical treatment in cases with basic exotropia were retrospectively reviewed. Thirty patients who underwent unilateral recession/resection (group 1) and 15 cases who underwent bilateral rectus recession (group 2) were incluided in the study, and the postoperative surgical results were compared.
Results: The mean follow-up was 4.1 years ± 2.2 (1-10 years). From the 30 patients in group 1, success were obtained in 23 patients (%76.3) and from 15 patients in group 2, success were obtained in 7 patients (%46.7). There was stastistically significant difference between these two groups (p=0,02).
Conclusion: Unilateral recession/resection seemed to be more successful and effective surgical procedure for the correction of basic exotropia rather than bilateral rectus recession.

En sýk renal replasman tedavi seçeneði olan hemodiyaliz(HD) akut durumlarda yüksek komplikasyon oranýna sahiptir. Bu çalýþmada merkezimizde ilk kez diyalize alýnan hastalarýn etiyolojik, demografik, biyokimyasal parametreleri ve hastalarýn prognozlarýnýn deðerlendirilmesi amaçlanmýþtýr.
Çalýþma retrospektif ve kesitsel bir çalýþma olarak planlandý. 2008 yýlýnda ilk kez hemodiyalize alýnan 170 hasta (68 kadýn, ortalama yaþ 58,7±18 yýl) deðerlendirildi. Hastalar böbrek yetmezliklerinin akut (Grup 1: ABY) ve kronik (Grup 2: KBY) olmasýna göre iki gruba ayrýldý.
Yüzyetmiþ hastanýn 56’sýnda (18 kadýn, ortalama yaþ 58,4±16,9 yýl) akut böbrek yetmezliði(ABY) ve 114 hastada ise (50 kadýn, ortalama yaþ 58,8±18,6 yýl) kronik böbrek yetmezliði(KBY) vardý. Serum potasyum, parathormon ve C Reaktif Protein (CRP) düzeylerinde iki grup arasýnda anlamlý farklýlýk saptandý. Her iki grupta da en sýk kullanýlan vasküler yol femoral kateterizasyondu. Baþlýca diyaliz endikasyonlarý üremi, hiperpotasemi ve hipervolemiydi. KBY hastalarýnýn %48,8’inin diyalize alýndýðýnda hastalýklarýndan haberdar olmadýklarý saptandý. Son durumlarý deðerlendirildiðinde ABY olan hastalarýn %50’sinin exitus olduðu, %35’inin normale döndüðü, %12,5 hastanýn HD’e devam ettiði ve kalan %2.5 hastanýn ise transplantasyon olduðu saptandý. Kronik hastalarda mortalite hýzý %16,9 idi. Bu gruptaki hastalarýn %72’sinin hemodiyaliz tedavisine devam ettiði, %6,7’sine periton diyalizi ve %4,5 hastaya renal transplantasyon uygulandýðý saptandý. Akut tübüler nekroz ve postrenal etyoloji Grup 1’de en sýk etyolojik neden olarak saptandý. Diyabet ve hipertansiyon Grup 2’de en sýk etyolojik nedendi.
Sonuç olarak; hastalarýn çoðunluðunda tanýlarý KBY olmasýna raðmen bunlarýn yarýya yakýný hastalýklarýndan haberdar deðildi. Hastalarýn çok azýnda fistül vardý. ABY olan hastalarda ise halen mortalite oraný kronik hastalardan daha yüksektir.

Haemodialysis (HD) is the most used renal replacement therapy, and has a high complication rate under acute conditions. In this study we aimed to evaluate the etiologic, demographic, and biochemical parameters and the prognosis of patients who needed first dialysis in our center. The study was designed as a retrospective, cross-sectional study. We evaluated 170 patients (68 female, mean age 58,7±18 years) who were dialysed for the first time during 2008. Patients were divided into two groups according to diagnosed as acute (Group1: ARF) or chronic (Group 2: CRF) renal failure.
Fifty-six of 170 patients (18 female, mean age 58,4±16,9 years) had acute renal failure(ARF) and 114 patients (50 female, mean age 58,8±18,6 years) had chronic renal failure(CRF). There was statistically significant difference in serum potassium, parathormone, and C reactive protein (CRP) levels between two groups. Femoral catheterization was the most common vascular access in both groups. The major dialysis indications were uremia, hyperkalemia, and hypervolemia. In Group 2, 48.8% of patients were not aware of their illness until the dialysis started. In evaluation of current status, 50% of acute renal failure patients were died, 35% were alive with normal renal function, 12,5% were undergoing dialysis treatment, and 2,5% treated by transplantation. Among chronic patients mortality rate was 16,9%, 72% of patients were undergoing HD, 6,7% on peritoneal dialysis (PD), and 4,5% of patients had transplantation. Acute tubular necrosis and postrenal etiology were the most common etiology in Group 1. Diabetes mellitus and hypertension were the most common etiology in group 2.
In conclusion, although most of the patients had CRF, about half were not aware of their illness, while only small portion of patients who were aware had a fistula. ARF had still higher mortality rate than chronic patients.

Yenidoðanda over kisti sýk görülen bir patolojidir. Laparoskopik cerrahinin çocuk cerrahisindeki önemi artmaktadýr. Açýk yapýlan operasyonlara göre üstünlüðü; geniþ yara insizyonlarýnýn azalmasý, daha az sývý ve ýsý kaybý olmasý, ve dokularýn daha kolay iyileþmesidir. Yenidoðanlarda immatür solunum ve santral sinir sistemi; kardiyovasküler sistemin volatil anesteziklere karþý daha hassas olmasý ve sývý-elektrolit dengesizlikleri; hipoglisemi ve hipotermiye daha sýk rastlanmasý nedeniyle anestezi riski artmýþtýr. Biz de bu olgu sunumunda laparoskopik over kist operasyonu yapýlan yenidoðan olgumuzdaki anestezi deneyimimizi paylaþmayý amaçladýk.

Ovarian cyst is a common pathology in neonates. The role of laparoscopic surgery is increasing in paediatric surgery. It is superior to open surgical techniques because of absence of large scar areas, reducing fluid and heat lost and faster tissue healing. The immature respiratory and central nerve system; increased sensitivity of the cardiovascular system to volatile anesthetics and increased risk of fluid imbalance hypoglycemia and hypothermia makes anesthesia for neonates difficult. The aim of this case report is to share our anaesthetic experience to
laparoscopic ovarian cyst surgery in a neonate.

Peritonit periton diyalizinde (PD) mobidite ve mortaliteyi etkileyen en önemli komplikasyondur. Peritonit bakteryel, viral, mikotik gibi enfeksiyöz ajanlarla olabildiði gibi intraperitoneal yoldan uygulanan çeþitli ilaçlara baðlý non enfeksiyöz peritonit ataklarýda bildirilmektedir. Olgumuzda oral, parenteral, intravenöz veya intraperitoneal kullanýmý önerilmeyen antiseptik el dezenfeksiyonunun yanlýþlýkla intraperitoneal kullanýmý sonucunda peritonit oluþumu saptanmýþtýr. Þimdiye kadar insanlarda yanlýþlýkla dahi olsa alkol bazlý antiseptik solüsyonlarýn intraperitoneal kullanýmýna baðlý kimyasal peritonit olgularý bildirilmemiþtir.

Peritonitis is a common complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Although peritonitis is
generally due to infectious agents such as bacterial, viral and mycotic, have been reported that due to non-infectious agents such as intraperitoneal route is applied to various drugs. In our case, chemical peritonitis were found as a result of the accidentally intraperitoneal use of antiseptic hand disinfection solution that is not recommended use via oral, parenteral, intravenous or intraperitoneal. So far in humans, chemical peritonitis cases have not been reported that due to intraperitoneal use of alcohol-based antiseptic solutions even if accidentally.

Total anormal pulmoner venöz dönüþ oldukça seyrek görülen bir doðuþtan kalp hastalýðýdýr. Erken yenidoðan dönemde en sýk görülen klinik bulgular taþipne ve santral siyanozdur. Erken taný ve tedavi uygulamalarý ile prognoz oldukça iyidir. Merkezimize taþipne ve siyanoz bulgularý ile sevk edilen, yatýþýnýn ikinci saatinde total pulmoner venöz dönüþ anomalisi tanýsý konularak tam düzeltme ameliyatý yapýlan bir olgu sunularak, pulmoner venöz dönüþ anomalisinin yenidoðanýn solunum sýkýntýsý nedenleri arasýnda olduðunun vurgulanmasý amaçlanmýþtýr.

Total anomalous pulmonary venous connection (TAPVC) is a very rare congenital cardiovascular malformation. The most common clinical findings in the early neonatal period are tachypnea and central cyanosis. The prognosis is pretty good with early diagnosis and treatment. We aimed to emphasize the presence of TAPVC as one of the reasons of neonatal respiratory distress presenting a newborn admitted with the complaints of tachypnea and cyanosis to our center, diagnosed to have TAPVC and completely treated with surgery.

Sistemik kapiller kaçýþ sendromu (SKKS), ilk kez 1960 yýlýnda Clarkson ve arkadaþlarý tarafýndan tanýmlanmýþ nadir görülen bir hastalýktýr. Hipotansiyon, hipoalbüminemi ve hemokonsantrasyon kronik tekrarlayýcý epizodlardaki klasik triaddýr. Tedavi destekleyicidir ve prognoz kötüdür. Biz bu derleme ile yoðun bakýmda rastladýðýmýz 3 kapiller kaçýþ sendromlu olguyu tartýþmayý amaçladýk.

Systemic capillary leak syndrome is a rare diseases was first described by Clarkson et al in 1960. The syndrome is characterized by chronic recurrent episodes of a triad of hypotension, hypoalbuminemia and hemoconsentration. Supportive treatment is essential and prognosis is poor. In this report, we aimed to discuss 3 cases with systemic capillary leak syndrome.

Povidon iyod 1950’li yýllardan itibaren topikal antiseptik ajan olarak çeþitli amaçlarla kullanýlmaktadýr. Günümüzde bazý merkezler tarafýndan yenidoðan döneminde göbek bakýmý için önerilmeye devam edilmektedir. Ýyodofor adý verilen bu dezefektanlarýn en önemli toksik etkisi iyodun emilimine baðlý olarak gerçekleþen tiroid hormon fonksiyonlarýnda bozulmadýr. Yenidoðan döneminde fazla miktarda iyod alýnýmýnda kardiyak iletimde bozukluklara, laktik asidoza, akut renal yetmezliðe ve hipokalsemiye neden olabilmektedir. Bu yazýda annesi tarafýndan kaza sonucunda aðýzdan povidon iyod verilen bir yenidoðan olgusu sunulmuþtur.

Povidone iodine are used topical antiseptic agents for various purposes from the 1950s. Nowadays, they have been recommended for continue umblical care by some centers in the neonatal period. Called the most important desenfections iodoform toxic effect that occur depending on the absorption of iodine in the thyroid hormone function is broken. They should be cardiac conduction disorders, lactic acidosis, acute renal failure and hypocalcemia if they have been take excess iodine in neonatal period. In this article was presented for given oral povidone iodine by his mother as a result of an accident in a newborn.