Sinir sistemi ya da çevre yapýlarýn cerrahi giriþimlerinde uygulanacak her türlü manipülasyon ve rezeksiyon giriþimlerinin nöral dokuya zarar verme riski yüksektir. Mevcut intraoperatif görüntüleme araçlarý ancak anatomik durum hakkýnda bilgi vermektedir. Bu araçlarýn nöral dokunun fonksiyonu hakkýnda bilgi verememesi hem hekimlerin hem de hastalarýn beklentilerini karþýlayamamaktadýr ve postoperatif dönemlerde ek nörolojik hasarlar görülebilmektedir. Nörofizyolojik iþlevselliði eþ zamanlý deðerlendirmesi açýsýndan intraoperatif nörofizyolojik monitörizasyon (ÝONM) kullanýmý önem arz etmektedir. Diðer cerrahi branþlarda da kullanýlmaktadýr. Bu derlememizde ÝONM kullanýmýnýn nöroþirürjideki önemi ve avantajlarýndan bahsedeceðiz.

Any manipulation or resection procedures during surgery of neural system or its surrounding structures carries a high risk of causing damage to the neural tissue. Existing intraoperative imaging tools provide only information about anatomic situation. Because of this insufficiency, both physicians and patients are displeased with additional neural deficits. Using intraoperative neurophysiological monitoring (IONM) that evaluate neurological function simultaneously is very important. It is also used in other surgical operations. In our article, we report importance and advantages of IONM in neurosurgical operations

The majority of otolaryngologists perform parotid gland surgery. The understanding of facial nerve anatomy and meticulous surgical technique has always been the prerequisite for this procedure. However, complications still occur by even the most experienced surgeons. Facial nerve monitoring is an adjunctive method available to a surgeon during parotid surgery to assist the functional preservation of the facial nerve. This review describes the goals, applications, technique and benefits of electrophysiologic facial nerve monitoring during parotid surgery.

Kulak burun boðaz doktorlarýnýn büyük kýsmý parotis cerrahisini uygulamaktadýrlar. Fasiyal sinirin anatomisini anlamak ve titiz bir cerrahi teknik, bu prosedür için gereklidir. Ancak en deneyimli ellerde dahi komplikasyonlar olmaktadýr. Fasiyal sinir monitörizasyonu, fasiyal sinirin fonksiyonel olarak korunmasýna yardýmcý olmak için parotis cerrahisi sýrasýnda cerrah için kullanýlabilir yardýmcý bir yöntemdir. Bu derlemede parotis cerrahisi sýrasýndaki hedefleri, uygulamalarý, tekniði ve elektrofizyolojik fasiyal sinir monitörizasyonu kullanýmýnýn yararlarýndan bahsedilmektedir.

Voice changes after thyroid surgery are frequent and one of the most important complications. Both the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) must be preserved to minimize the patient’s voice and respiratory problems after surgery. Intraoperative neuromonitoring (IONM) is a method based on dynamically evaluating motor function of the nerve during surgery in addition to the visual identification of the nerve. Intraoperative neuromonitoring was introduced 50 years ago in thyroid surgery and IONM via endotracheal tube with surface electrodes has become a standard applied method for reasons such as convenience, simplicity, non-invasiveness and safety, and nowadays is used in thyroid surgery. The use of IONM for RLN and EBSLN is increasing in thyroid surgery. Experience and standardization is essential for proper use of IONM for both anesthesiologist and surgeon. In this context, the learning curve for both surgeons and anesthetists is about 50-100 cases. Intraoperative neuromonitoring makes a significant contribution to the identification and functional evaluation of both RLN and EBSLN. RLN monitorisation can be performed intermittently with the monitoring probe or continuously with the aid of a probe applied to the vagus. Standardization of RLN monitoring includes the vocal cord examination via preoperative laryngoscopy (L1), getting signals from ipsilateral vagus prior to RLN dissection (V1), stimulation of RLN at the first point found in the tracheoesophageal groove (R1), stimulation of the RLN from the most proximal point it was revealed after the dissection was completed (R2), vagus stimulation after surgical site bleeding control is complete (V2), vocal cord examination via postoperative laryngoscopy (L2). V2 is the most appropriate test to predict postoperative vocal cord function. In the intermittent IONM of RLN, only the nerve stimulated by the probe and the point that the nerve is stimulated inform about the function of the distal part. Continuous IONM allows continuous follow-up of RLN function while dissecting the thyroid gland by continuous stimulation of the RLN with the probe applied to the vagus at the neck before RLN leaves the vagus. Primarily in EBSLN monitoring, the contraction of the cricothyroid muscle, which is located in the surgical field and whose motor neuron is EBSLN, is evaluated. Intraoperative neuromonitoring is a method that contributes to many aspects of thyroidectomy and increases the standards of thyroidectomy, together with significant contribution to the detection and functional evaluation of both RLN and EBSLN.

Tiroit cerrahisi sonrasý oluþan sesle ilgili problemler sýk ve en önemli komplikasyonlardandýr. Cerrahi sonrasý hastanýn ses ve solunum problemlerini minimalize edebilmek için hem reküren laringeal sinirin (RLS) hem de süperior laringeal sinirin eksternal dalýnýn (SLSE) korunmasý gerekir. Ýntraoperatif nöromonitorizasyon (ÝONM) sinirin gözle görülmesine ek olarak ameliyat sýrasýnda sinirin motor fonksiyonlarýnýn dinamik olarak deðerlendirilmesi temeline dayanan bir yöntemdir. Tiroit cerrahisinde ÝONM 50 yýl önce kullanýlmaya baþlanmýþ ve yüzey elektrotlu endotrakeal tüp ile ÝONM; amaca uygunluk, basitlik, noninvazif olma ve güvenlilik gibi nedenlerle standart uygulanan yöntem haline gelmiþ olup, günümüzde tiroit cerrahisinde bu yöntem kullanýlmaktadýr. Tiroit cerrahisinde RLS ve SLSE için ÝONM kullanýmý giderek artmaktadýr. ÝONM’nin uygun kullanýmý için hem anestezist hem cerrah için deneyim ve standardizasyonu þarttýr. Bu baðlamda hem cerrahlarýn hem de anestezistler için öðrenme eðrisi yaklaþýk 50-100 arasý olgudur. ÝONM hem RLS hem SLSE’nin bulunmasýnda ve fonksiyonel olarak deðerlendirilmesinde önemli katký saðlar. RLS monitorizasyonu monitorizasyon probu ile aralýklý veya vagusa uygulanan prob yardýmý ile sürekli olarak uygulanabilir. RLS monitorizasyonunun standardizasyonu; preoperatif laringoskopi ile vokal kord muayenesi (L1), RLS diseksiyonu öncesi ayný taraf vagustan uyarý alýnmasý (V1), RLS’nin trakeaozefageal olukta ilk bulunduðu noktada uyarýlmasý (R1), diseksiyon bittikten sonra RLS’nin ortaya konduðu en proksimal noktasýndan uyarýlmasý (R2), cerrahi alanda kanama kontrolü tamamlandýktan sonra vagusun uyarýlmasý (V2), postoperatif laringoskopi ile vokal kord muayenesini (L2) içerir. V2 postoperatif vokal kord fonksiyonunu öngörmede en uygun testtir. RLS aralýklý ÝONM’sinde sadece sinirin probla uyarýldýðý an ve sinirin uyarýldýðý nokta distalinin fonksiyonu hakkýnda bilgi verir. Sürekli ÝONM ise RLS’nin vagustan ayrýlmadan önce boyunda vagusa uygulanan probla yapýlan devamlý uyarý sayesinde cerraha tiroidi diseke ederken RLS fonksiyonunun sürekli takip edilmesini saðlar. SLSE monitorizasyonunda primer olarak ameliyat sahasýnda bulunan ve SLSE’nin motor siniri olduðu krikotiroid kasýn kasýlmasý deðerlendirilir. ÝONM hem RLS hem SLSE’nin bulunmasýnda ve fonksiyonel olarak deðerlendirilmesinde önemli katký saðlamasý ile birlikte tiroidektomiye birçok açýdan katký saðlayan ve tiroidektominin standartlarýný arttýran bir yöntemdir.

Yaþamýn ilk 28 günü içerisindeki ateþli yenidoðan bebeklerin önerilen yönetimi tartýþmalýdýr. Yenidoðan döneminde yüksek oranda ciddi bakteriyel enfeksiyon görülmesi nedeniyle bir çok uzman, bebeklerin sepsis yönünden deðerlendirilmesini ve yatýrýlarak antibiyotik baþlanmasýný savunmaktadýr. Son yýllarda ateþli yenidoðan bebeklerin antibiyotiksiz yatarak izlemi veya yatýrýlmadan izlemi ile ilgili görüþler ortaya atýlmaktadýr. Derlememiz; ateþli yenidoðan bebeklerde, ciddi bakteriyel enfeksiyonu tanýmlamada kullanýlan yöntemlerin güvenilirliði hakkýndaki bulgularý deðerlendirilecektir.

The recommended management of febrile neonates, in first 28 days of life is controversial. Given that the overall prevalence of serious bacterial infection is higher in the neonate, most experts would advocate for a full sepsis evaluation, and hospitalization for giving antibiotics. In recent years, opinions have been raised regarding the follow-up without hospitalization and antibiotics or followup even without hospitalization in febrile newborn infants. In our review the evidence for diagnostic accuracy of screening methods for identification of serious bacterial infection in febrile neonates will be evaluated.

Amaç: Tiroid ve paratiroid bezlerinin cerrahisinde, intraoperatif nöromonitörizayon (ÝONM) uygulamasý sýrasýnda sinyal kaybý yaþanmayan olgularda postoperatif vokal kord bakýsýnýn gerekliliðini ve standardizasyondaki yerini irdelemeyi amaçladýk.
Gereç ve Yöntemler: Kliniðimizin endokrin cerrahisi bölümünde, Ocak 2014-Ocak 2017 tarihleri arasýnda, ÝONM uygulanmýþ ve sinyal kaybý yaþanmamýþ tiroidektomi ve paratiroidektomi hastalarý geriye dönük olarak incelendi.
Bulgular: ÝONM eþliðinde sinyal kaybý saptanmayan 171 hasta ele alýndý. Hastalarýn 94’ünün (%55) en az bir kere ameliyat geçirdiði, 77’sinin (%45) ise ilk ameliyatý olduðu gözlendi. Hastalardan 91’ine sürekli, 80 hastaya ise aralýklý ÝONM uygulandý. Tüm hastalarýn ameliyat öncesi larinks muayeneleri ile ameliyat sonrasý larinks muayenelerinin ayný olduðu, ameliyat sonrasý dönemde hiç bir hastada vokal kord sorunu olmadýðý gözlendi.
Sonuç: ÝONM uygulanan ve sinyal kaybý olmayan olgularda rezeksiyon sonrasý nervus vagustan alýnan sinyal postoperatif vokal kord fonksiyonlarýný göstermede yeterince duyarlýdýr. Bu hastalara postoperatif vokal kord bakýsýnýn ihmal edilebileceði kanýsýndayýz.

Objective: We aimed to evaluate the necessity and the worthiness of postoperative vocal cord examination in cases with no loss of signal during intraoperative nerve monitoring (IONM) in thyroid and parathyroid surgery.
Material and Methods: We retrospectively evaluated cases that had no loss of signal during intraoperative nerve monitoring in cases who underwent thyroid and parathyroid surgery in our endocrine surgery unit, between January 2014 – January 2017.
Results: A total of 171 patients were analyzed who had no loss of signal during IONM. It was observed that 94 of the patients (55%) had at least one previous surgery and 77 (45%) underwent their first operation. Ninetyone patients were monitored with continuous-IONM and 80 with intermittent-IONM. All patients’ preoperative and postoperative laryngeal examinations were identical and no postoperative vocal cord problems were observed.
Conclusion: The signal from the vagus nerve is sufficiently sensitive to show the postoperative vocal cord functions after resection in patients having no loss of signal during IONM. We support the idea that postoperative vocal cord examination may be neglected in these patients.

Amaç: Tiroidektomi esnasýnda rekürren laringeal sinirin (RLN) yaralanma mekanizmalarýný ve devamlý intraoperatif sinir monitorizasyonunun (D-ÝONM) cerrahi strateji üzerine etkisini deðerlendirmek
Gereç ve Yöntemler: Haziran 2014-Ocak 2016 arasý total veya hemitiroidektomi yapýlan ardýþýk 364 hastanýn verileri prospektif olarak deðerlendirildi. Tüm hastalar D-ÝONM kullanýlarak ameliyat edildi. RLN yaralanma mekanizmalarý, kombine olaylar (KO) ve sinyal kayýplarý (SK) deðerlendirildi.
Bulgular: Üç yüz altmýþ dört hastanýn 6’sýnda (%1.6) KO geliþti. Elektromiyografideki (EMG) amplitüd azalmasý ve latensdeki artýþ medial manevraya dönülmesinden sonra tüm hastalarda düzeldi. Yedi hastada (%1.9) SK saptandý. SK’nýn mekanizmasý; 1 hastada (%14.3) sinir ön dalýnýn baðlanmasý, 4 hastada (%57.0) ise gerilmeydi. Ýntratorasik büyük guatrý olan 2 hastada (%28,6) ise SK’nýn muhtemel mekanizmasý aþýrý gerilme veya transeksiyon olarak deðerlendirildi. Bu yedi hastanýn 1 tanesinde (%14.3) SK ameliyat esnasýnda 20 dakika bekleme sonrasý düzeldi. Kalan 6 hastanýn (%85.7) ise ameliyat sonrasý yapýlan laringoskopik muayenelerinde vokal kord paralizisi (VKP) saptandý. Tüm hasta grubunda tek taraflý geçici ve kalýcý VKP oraný sýrasýyla %1.6 (n=6) ve %0.8 olarak saptandý. Hiçbir hastada kalýcý VKP saptanmadý. D-ÝONM, bir hastada (%0.3) bilateral VKP’yi önledi.
Sonuç: D-ÝONM’nin en büyük avantajý RLN hasarý durumunda cerrahý anýnda uyarmasýdýr. KO geliþebilecek SK’ný gösteren patognomonik bir bulgudur. Bu durumda cerrah ters yöne doðru bir manevra yaparak kalýcý hasar geliþmesini önler. D-ÝONM ayrýca tiroidektomi esnasýnda RLN yaralanmasýný anýnda gösterir. Böylece cerrah etkilenen sinir bölgesine yönelik rahatlatýcý bir harekette bulunabilir. Kalýcý SK’da ise bilateral SK’yý önlemek için aþamalý tiroidektomi planlanabilir.

Objective: To evaluate the mechanisms of recurrent laryngeal nerve (RLN) injury during thyroidectomy and the impact of continuous intraoperative nerve monitoring (C-IONM) on surgical strategy.
Material and Methods: The data of 364 consecutive patients who underwent total or hemithyroidectomy between June 2014 and January 2016 were evaluated prospectively. All patients underwent thyroidectomy by using C-IONM. The mechanisms of RLN injury and the outcomes of the patients with combined events (CE) and loss of signal (LOS) were evaluated.
Results: Combined events (CE) occurred in 6 (1.6%) of these 364 patients. The reduced electromyographic (EMG) amplitude and prolonged latency recovered in all patients intraoperatively by the reversal of the medial traction maneuver. Loss of signal (LOS) occurred in 7(1.9%) patients. The mechanisms of LOS was ligation of the anterior branch of the nerve in 1 (14.3%) patient and traction in 4(57%) patients. The probable mechanism of LOS was traction or transection in 2 (28.6%) patients in whom LOS occurred during the dissection of the intrathoracic portion of large substernal goiter. Of these 7 patients, LOS recovered intraoperatively after 20 minutes of waiting in 1(14.3%) patient. In the remaining 6 (85.7%) patients, unilateral vocal cord paralysis (VCP) was verified on the postoperative laryngoscopic examination. The overall temporary and permanent unilateral VCP rates were 1.6% (n=6) and 0.8% (n=3), respectively in these 364 patients. No bilateral VCP was recorded. Continuous intraoperative nerve monitoring (C-IONM) prevented bilateral VCP in 1 (0.3%) patient.
Conclusion: The major advantage of C-IONM is to alert the surgeon for imminent RLN injury. Combined event (CE) is a pathognomonic sign of impending nerve injury that may progress to LOS. This situation enables the surgeon to adverse (reverse) the surgical maneuver before permanent damage to the nerve sets in. Continuous intraoperative nerve monitoring (C-IONM) can also immediately spot RLN injury during thyroidectomy. This property of C-IONM gives the surgeon the opportunity for an early corrective action to release the affected nerve promptly. In case of permanent LOS, staged thyroidectomy could be planned to prevent bilateral VCP.

Amaç: Gergin omurilik sendromu, konus medullarisin normal seviyesinden daha aþaðýda sonlanmasý veya konus medullarisin fizyolojik olarak normal seviyesine gelmesine engel olan lezyonlarýn genel adýdýr. Mikronöroþirürjikal müdahale ile gergin olan konus serbestleþtirilir. Bu cerrahi sýrasýnda, anestezi sonlandýrýldýðýnda ya da postoperatif takiplerde geçici veya kalýcý nörolojik defisitler oluþabilmektedir. Ýntraoperatif nörofizyolojik monitörizasyon (ÝONM) kullanýmý bu riski azaltmaktadýr. Bu çalýþmamýzda kliniðimizde opere edilen olgular üzerinden intraoperatif nörofizyolojik monitörizasyon kullanýmýnýn önemini ve klinik sonuçlarýmýzý bildirmeyi amaçladýk.
Yöntem ve Gereçler: 2015-2016 yýllarý arasýnda kliniðimizde ameliyat edilen 30 olgunun ÝONM bulgularý, preoperatif ve postoperatif nörolojik bulgularý deðerlendirilerek sonuçlar bildirildi. Gergin omurilik ameliyatlarýnýn hepsinde intraoperatif nörofizyolojik monitörizasyon (ÝONM) kullanýldý. Somatosensoriyal potansiyeller (SEP), motor uyarýlmýþ potansiyeller (MEP), free-run EMG yanýtlarý, eksternal sfinkter kasý MEP ve prob ile direkt uyarýlan sinir dokusu potansiyelleri kaydedildi.
Bulgular: Vakalarýn 20’si erkek, 10’u kadýn hasta, yaþ ortalamasý 9.03 idi. Olgulardan sadece 1‘inde SEP deðerlerinde artýþ gözlendi. Olgulardan 3 tanesinde ek nörolojik hasar geliþti. Bunlardan 1 tanesi 48 saat süreyle geçici seyretti, diðer iki olguda ise kalýcý nörolojik hasarlar gözlendi.
Sonuç: Gergin omurilik sendromu ameliyatlarýnda, çalýþmamýzda ve literatürde de gösterildiði üzere deneyimli bir ekip ve uygun monitörizasyon ile nörolojik hasar görülme ihtimali azalabileceðinden, tüm modaliteleri ile ÝONM kullanýmý önerilir

Objective: The tethered cord syndrome (TCS) refers to lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Tight conus medullaris is untethered by microneurosurgical operation. Patients may have additional persistent or transient neurological deficits in postoperative follows. The use of intraoperative neurophysiological monitoring (IONM) reduces risks of being neurological deficits. In our article, we aimed to show the importance of using intraoperative neurophysiological monitoring with results of cases operated in our department.
Material and Methods: The results of IONM findings, preoperative and postoperative neurological findings of 30 patients who were operated in our clinic between 2015-2016 were reported. Intraoperative neurophysiological monitoring (IONM) was used in all cases with tethered cord sydrome. Somatosensory evoked potential (SEP), motor evoked potential (MEP), free-run EMG responses, external sphincter muscle MEP and direct monopolar probe-evoked potentials were recorded.
Results: There were 20 male and 10 female patients with a mean age of 9.03 in our study. There was an increase in SEP values in only one of the cases. Additional neurological deficit arised in three cases; 1 transient (48 hours) and 2 persistent.
Conclusion: As our and other studies in literature has shown that using appropriate monitorization with experienced team decreases the risk of developing neurological injury; IONM should be used with its all modalities

Amaç: Saðlýk çalýþanlarýnýn gebe ve emziren anneye D vitamini desteði hakkýndaki bilgi ve tutumlarýný belirlemek.
Gereç ve Yöntem: Çalýþmamýz Nisan - Mayýs 2015 tarihleri arasýnda, saðlýk alanýnda halen aktif hizmet veren 752 saðlýk çalýþanýnýn (pediatri uzmaný, pediatri asistaný, uzman aile hekimi, aile hekimi asistaný, pratisyen aile hekimi ve hemþire) katýlýmý ile yapýldý. Çalýþmanýn anket formu araþtýrmacýlar tarafýndan deneyimler ve literatür bilgileri doðrultusunda oluþturuldu. Etik kurul onayý alýndý. Ankette katýlýmcýlara demografik özellikleri ile birlikte, gebe ve emziren annelere D vitamini desteði konusundaki bilgi ve uygulamalarý soruldu. Veriler
yüzdelik ve ki-kare testleri ile deðerlendirildi.
Bulgular: Çalýþmamýza 574 hekim (%76.4) ve 178 hemþire (%23.6) katýldý. Katýlýmcýlarýn 418’i (%55.6) gebelere D vitamini desteði önermekteydi. Uzman aile hekimlerinin (%66.7) gebelere D vitamini desteði önerme oraný diðer gruplardan yüksekti (p<0.001). Gebelere D vitamini en yüksek oranda (%23.4) 800-1000 IU/gün dozunda önerilmekteydi. Katýlýmcýlarýn 451’i (%60.0) emziren annelere D vitamini desteði önermektedir. Pediatri asistanlarý (%70.0) ve pediatri uzmanlarýnýn (%63.6) emziren annelere D vitamini verme oraný diðer gruplardan yüksekti (p<0.001). Emziren annelere en yüksek oranda (%27.0) 800-1000 IU/gün dozunda D vitamini önerildiði belirlendi. Saðlýk Bakanlýðýnýn önerisine uygun gebelere 1200 IU/gün D vitamini öneren oraný %6.0, emziren annelere 1200 IU/gün D vitamini önerenlerin oraný %4.5 idi.
Sonuç: Çalýþmamýzda saðlýk çalýþanlarýnýn emziren annelere ve gebelere D vitamini desteði önerme oranýnýn ve dozunun düþük olduðu belirlendi. D vitamini yetersizliðinin önlenmesi için saðlýk çalýþanlarýna yönelik eðitim programlarýnýn düzenlemesi gerektiði belirlenmiþtir.

Objective: To determine the knowledge and attitudes of healthcare professionals regarding vitamin D supplementations in pregnant and breastfeeding mothers.
Material and Method: Our study was conducted between April and May 2015 with the participation of 752 healthcare professionals (pediatrician, pediatric resident, specialist family physician, family physician resident, general family practitioner and nurse). The study questionnaire was created by researchers in accordance with experiences and literature information. Ethics committee approval was obtained. In questionnaire along with the demographic characteristics of the participants, the knowledge and practices on vitamin D supplementation for pregnant women and nursing mothers were asked. The data were analyzed by percentage and chi-square tests.
Results: A total of 574 physicians (76.4%) and 178 nurses (23.6%) participated in our study. Of these, 418 (55.6%) participiants suggested vitamin D supplementation to pregnants. The ratio of family physician specialists’ recommendations of vitamin D supplementation (66.7%) was higher than the other groups (p<0.001). The highest dose of vitamin D supplementation suggested to pregnants was 800-1000 IU/day with a rate of 23.4%. A total of 451 of participiants (60.0%) recommend vitamin D supplementation to breastfeeding mothers. Pediatric residents and specialists’ recommendations of vitamin D supplementation rate (70.0% and 63.6%, respectively) were higher than the other groups (p<0.001). Highest rate of vitamin D supplementation recommended to breastfeeding mothers was 800-1000 IU/day with a rate of 27.0%. The rate of recommendation according to the Ministry of Health’s recoomendations to pregnant women with 1200 IU/day of vitamin D was 6.0% and breastfeeding mothers with 1200 IU/day of vitamin D was 4.5%.
Conclusion: We found that the rate of recommendation and doses of vitamin D supplementation to breastfeeding mothers and infants by healthcare professionals were low in our study. It has been determined that training programs for healthcare professionals should be organized in order to prevent vitamin D deficiency.

Amaç: Astým çocukluk çaðýnda dünyada en sýk görülen kronik havayolu inflamatuvar hastalýklarýndan biridir. Atopi varlýðýnda astým þiddeti ve kontrolünün deðiþiklikler gösterdiði ileri sürülmektedir. Biz bu çalýþmada astým tanýsý ile izlenen çocuklarda atopinin astým þiddeti ve kontrolü üzerine etkisini inceledik.
Gereç ve Yöntem: Kasým 2015-Ocak 2016 tarihleri arasýnda alerji ve çocuk göðüs hastalýklarý kliniðinde astým tanýsý ile izlenen yaþlarý 6-17 yýl arasýnda olan olgular alýndý. Tüm olgularýn demografik ve klinik özellikleri kayýt altýna alýndýktan sonra astým þiddeti belirlendi ve astým kontrol testi (AKT) uygulandý. Atopi varlýðýný belirlemek üzere IgE düzeyleri, deri prik testi ve inhalan panel testi sonuçlarý kayýt altýna alýndý. Olgularýn deri prik testi, IgE yüksekliði ve inhalan panel pozitifliði ile astým kontrol düzeyi ve astým þiddeti kýyaslandý.
Bulgular: Çalýþma 60’i (%56.6) erkek, 46’sý (%43.0) kýz olmak üzere toplam 106 hasta ile yapýldý. Yaþ ortalamasý 11.2±2.7 yýl idi. Atopi varlýðý ile astým kontrol düzeyi arasýnda anlamlý bir iliþki saptanmadý. (p=0.764). Aðýr persistan astýmlý vakalarda IgE yüksekliði, cilt testi ve inhalen panel pozitifliði anlamlý olarak yüksekti (p=0.022).
Sonuç: Atopi varlýðý ile astým kontrol düzeyi arasýnda bir iliþki saptanmazken atopi varlýðý ile astým þiddeti arasýnda anlamlý bir iliþki saptadýk.

Objective: Asthma is the most common chronic inflammatory disease of airways in children worldwide. It was speculated that in the presence of atopy, asthma severity and control show alteration. In this study we aim to investigate the association between atopy and asthma control
and asthma severity.
Material and Methods: Children between 6-17 years of age with diagnosis of persistent asthma, being followed in pediatric allergy and pulmonology clinics between November 2015 and January 2016 were involved. At enrollment, sociodemographic and asthmatic characteristics were investigated and asthma severity were determined and asthma control test (ACT) were administered.In order to determine the presence of atopy, the IgE levels, skin prick test and inhalant panel tests were obtained from the records. The IgE levels, skin prick tests, and inhalant panel tests were compared to asthma severity and asthma control.
Results: Out of 106 patients, 60 (56.6%) were male and 46 (43.0%) were female. The mean age was 11.2±2.7 years. There was no association between the presence of atopy and asthma control (p=0.764). The serum IgE levels, skin prick tests and serum specific inhalant allergens were significantly high in patients with severe persistant asthma (p=0.022).
Conclusion: There is an association between the presence of atopy and asthma severity but there is no association between the presence of atopy and asthma control.

Amaç: Ateroskleroz diabetes mellitus (DM) hastalarýnda çok yaygýndýr. Biz tip 2 DM hastalarýnda ‘endojen nitrik oksit sentaz inhibitörü’ olarak bilinen asimetrik dimetil arjinin (ADMA) ile ateroskleroz arasýnda bir iliþki olup olmadýðýný araþtýrdýk.
Gereç ve Yöntemler: Tip 2 DM tanýsý alan, yaþ ortalamasý 55.73±8.78 yýl olan toplam 85 hasta (%48.2 [n: 41] erkek) çalýþmaya dahil edildi. ADMA plazma seviyeleri, lipid profili, HbA1c gibi laboratuvar parametreleri deðerlendirildi. Aterosklerozun bir göstergesi olan karotis intima-media kalýnlýðý (IMT) ölçüldü. Hastalar, yüksek ve düþük ADMA düzeyleri olarak iki gruba ayrýldý.
Bulgular: Ýstatistiksel olarak serum ADMA düzeyleri ile total kolesterol (r=0.045; p=0.684), trigliserid (r=-0.067; p=0.544), LDL kolesterol (r=0.142; p=0.194) ve HDL kolesterol (r=0.085; p=0.085) arasýnda anlamlý iliþki saptanmadý. ADMA düzeyi ile HbA1c arasýnda (r=0.376; p=0.001) ve serum ADMA düzeyi ve karotis-intima media kalýnlýðý arasýnda (r=0.321; p=0.003) istatistiksel olarak anlamlý bir
iliþki saptandý.
Sonuç: Serum ADMA düzeyi karotis IMT ile iliþkilidir. Tip 2 DM hastalarýnda ADMA düzeylerinin deðerlendirilmesi koroner arter hastalýðý gibi aterosklerotik hastalýklarý öngörmede yararlý olabilir.

Objective: Atherosclerosis is very common in patients with diabetes mellitus (DM). We aimed to investigate the relationship between asymmetric dimethylarginine (ADMA) which is known as ‘an endogenous inhibitor of nitric oxide synthase’ and atherosclerosis among patients with a diagnosis of type 2 DM.
Material and Methods: A total of 85 patients with a diagnosis of type 2 DM (48.2% [n: 41] male) with a mean age of 55.73±8.78 years were enrolled in this trial. Plasma levels of ADMA, and laboratory parameters such as lipid profile and HbA1c were evaluated. Carotid intima-media thickness (IMT), a marker of atherosclerosis was measured. The patients were classified into two groups as cases with
high and low ADMA levels.
Results: No statistically significant correlation was found between serum ADMA levels and total cholesterol (r=0.045; p=0.684), triglyceride (r=-0.067; p=0.544), LDL cholesterol (r=0.142; p=0.194) and HDL cholesterol (r=0.085; p=0.085). A statistically significant correlation was determined between serum ADMA level and HbA1c (r=0.376; p=0.001) and between serum ADMA level and carotid-intima media thickness (r=0.321; p=0.003).
Conclusions: Serum ADMA level is correlated with carotid IMT. Evaluation of ADMA levels in type 2 DM patients may be helpful in predicting atherosclerotic diseases such as coronary artery disease.

Amaç: Spontan rektus kýlýf hematomu akut karýn aðýsýnýn nadir görülen ve sýklýkla gözden kaçan bir nedenidir. Bu çalýþmamýzda rektus kýlýf hematomu nedeniyle konservatif tedavi uyguladýðýmýz hastalarýmýza ait sonuçlarýmýzý sunmayý amaçladýk.
Gereç ve Yöntem: Çalýþmamýzda Ocak 2010 - 2016 tarihleri arasýnda hastanemiz acil servisine karýn aðrýsý þikayeti ile baþvuran, spontan rektus hematomu tanýsý konulup konservatif tedavi uygulanan 9 hastanýn demografik verileri, baþvuru þikayetleri, týbbý geçmiþleri ve uygulanan tedaviye ait veriler retrospektif olarak hasta dosyasý, bilgisayar kayýt sistemi ve görüntüleme arþivlerinden tarandý.
Bulgular: Çalýþmaya katýlan 9 hastanýn K/E oraný 1/2 olup ortalama yaþ 48.8 yýl idi. Hastalarýn hepsi acil servise karýn aðrýsý þikayeti ile baþvurdu. Özgeçmiþlerinde 3 hastada oral antikoagulan kullanýmý, 3 hastada hipertansiyon, bir hastada da kronik obstrüktif akciðer hastalýðý öyküsü mevcut iken diðer iki hastada herhangi bir predispozan faktör saptanmadý. Toplam 4 hastada þikayetlerinden önce þiddetli öksürük hikayesi olduðu öðrenildi, diðer hastalarda bu duruma neden olabilecek öksürük, travma veya bir operasyon öyküsü yoktu. Rektus hematomu tanýsý alan 5 hastaya yatarak, 4 hastaya da ayaktan takip ile konservatif tedavi uygulandý. Hastalarýn ortalama yatýþ süresi 3 gündü. Bir hastada taburcu edildikten 2 hafta sonra kalýcý hasar býrakmayan serebrovasküler enfarktüs geliþti. Diðer hastalarýn hiçbirinde ek morbidite ve mortalite gözlenmedi.
Sonuç: Spontan rektus kýlýf hematomu özellikle antikoagulan tedavi alan hastalarda, öksürük nöbetinden sonra oluþan karýn aðrýsý þikayetinde ayýrýcý tanýda göz önüne alýnmalýdýr. Vakalarýn etyolojiye yönelik yapýlan konservatif tedaviye iyi cevap verdiði düþünülmektedir.

Objective: Spontaneous rectus sheath hematoma is a rare and often overlooked cause of acute abdominal pain. In this study, we aimed to present the results of patients with rectus sheath hematoma who received conservative treatment.
Materials and Methods: In this study, the demographic data, complaints, medical history, and data pertaining to the treatment provided to 9 patients were retrospectively retrieved from the computerized patient record system and imaging archives. The included patients presented with abdominal pain to our hospital’s emergency room between January 2010 and 2016, were diagnosed with spontaneous rectus hematoma, and received conservative treatment.
Results: The female/male ratio of the 9 patients who participated in this study was 1: 2, and the average age was 48.8 years. All the patients were admitted to the emergency department with abdominal pain. Three patients had a history of oral anticoagulant use, 3 patients had a history of hypertension, and 1 patient had a history of chronic obstructive pulmonary disorder. No predisposing factor was detected in the other 2 patients. There was a history of severe cough in 4 patients prior to their complaints; however, there was no history of coughing, trauma, or a surgery that would lead to this condition in the other patients. Five of the 9 patients received conservative treatment as inpatient treatment for rectus hematoma, while 4 patients received it as outpatient treatment. The average duration of hospital stay of the patients was 3 days. A cerebrovascular infarction that did not cause permanent damage developed in 1 patient 2 weeks after discharge. No additional morbidity or mortality was observed in any of the other patients.
Conclusion: Spontaneous rectus sheath hematoma should be considered in the differential diagnosis of abdominal pain that occurs after a persistent cough, particularly in patients receiving anticoagulant therapy. It is thought that the cases respond well to conservative treatment for etiology.

Amaç: Göbek deliði karýn ön duvarýnýn önemli bir parçasýdýr. Abdominoplasti ameliyatlarýnda göbek deliðinin boyutu, pozisyonu, derinliði, ve þekli en az nedbenin yeri kadar önemlidir. Estetik olarak güzel göbek deliði elde etmek için birçok teknik tarif edilmiþ olsa da, cerrahlar sýklýkla nedbenin görünmesi ve çekilme yapmasý gibi birçok problemle karþýlaþmaktadýr. Biz bu çalýþmada bu tarz sorunlarý engellerken estetik göbek deliði kriterlerini karþýlayan yeni bir umblicoplasti tekniðini sunduk.
Gereç ve Yöntem: 2011 ve 2014 yýllarý arasýnda, 18 kadýn hastanýn sonuçlarý incelendi. Hastalara abdominoplasti ve ayný seansta umblikoplasti yapýldý. Abdominoplasti sýrasýnda, göbek deliði karýn ön duvarýndan üç kollu yýldýz þeklinde ayrýldý. Göbek deliði karýn ön duvarýnda yeni yerine çýkartýlýrken ise Y þekilli bir insizyon kullanýldý. Hastalar yeni göbek deliklerinin þeklini, derinliðini, yerini ve izlerini
deðerlendirmek açýsýndan sorgulandýlar.
Bulgular: Ortalama takip süresi 20 aydýr. Hipertrofik nedbe gibi herhangi bir göbek deliðine baðlý bir komplikasyon gözlenmedi. Hastalarýn %80’i sonuçlardan memnuniyet durumuna 10 üzerinden 8 puan verdiler.
Sonuç: Tanýmlanan teknikte, göbek deliði küçük, sýð ve ovaldi. Nedbe daha az görünürdü. Nedbe çekilmesi, göbek deliðinin daralmasý gibi sýk görünen problemler bizim güvenli tekniðimizde daha az görünmekteydi.

Objective: The umbilicus is a significant component of the abdomen. The size, position, depth, and shape of the umbilicus, as well as the location of the scar, are very important. While various techniques have been described in order to obtain an aesthetically appealing umbilicus, surgeons still frequently encounter complications such as visible scars and scar contractures. We present a technique that can
avoid these complications while also fulfilling the aesthetic umbilicus criteria.
Materials and Methods: Between 2011 and 2014, 18 female patients underwent both abdominoplasty and umbilicoplasty, which was performed using our technique. During abdominoplasty, the umbilicus was separated from the abdominal skin as a three-armed star and inserted in a Y-shaped incision. The patients were asked to evaluate and rate their new umbilici in terms of shape, depth, location, and
scaring.
Results: The mean follow up period was 20 months. No umbilical complications, such as hypertrophic scarring, were observed. In general, 80% of the patients gave the procedure an 8-point rating out of a possible high of 10-point rating, indicating their satisfaction with the results.
Conclusion: In this described technique, the umbilicus is small, shallow, and oval, and the scar is less visible. The incidence of the most frequent complications, such as scar contracture and umbilical stenosis, occurs less often in our safe and versatile technique.

Amaç: Kortikosteroid (KS) tedavisi multipl skleroz (MS) akut ataklarýnda yaygýn olarak kullanýlan standart bir tedavi yöntemidir. Femur baþý avasküler nekrozu (AVN) KS tedavisine baðlý geliþen uzun dönem komplikasyonlardan biridir. Çalýþmamýzda femur baþý AVN’ un MS hastalarýnda görülme sýklýðý ile uygulanan yýllýk ve kümülatif KS miktarý ile olan iliþkisi araþtýrýlmýþtýr.
Gereç ve Yöntemler: Çalýþmamýzda MS polikliniðinden takipli intravenöz metilprednizolon (IVMP) tedavi almýþ 60 MS tanýlý hasta grubu ile IVMP tedavisi almamýþ 22 MS hasta (Kontrol I) ile 25 saðlýklý olgudan (Kontrol II) oluþan iki kontrol grubu oluþturuldu. KS tedavisi alan 60 hasta sadece IVMP, IVMP ve interferon, IVMP ve Glatiramer asetat (GA) kullanan 20’þer olguluk üç alt gruba ayrýldý. Tüm
olgularýn nörolojik muayeneleri ve tüm demografik verileri kaydedildi. Hasta ve kontrol gruplarýnda femur baþý AVN varlýðý, manyetik rezonans görüntüleme (MRG) ile Ficat Evreleme sistemi kullanýlarak deðerlendirildi.
Bulgular: Femur baþý AVN sadece KS tedavisi alan 4 MS hastasýnda (%6.7 oranýnda) gözlendi. Hastalarýn ortalama yýllýk KS dozu 8.07 gr, ortalama kümülatif KS dozu 31 gr bulundu. Femur baþý AVN olan hastalar ile olmayan hastalar arasýnda yýllýk ve kümülatif IVMP doz miktarlarýnda belirgin bir fark gözlenmekle birlikte istatistiksel anlamlýlýk saptanmadý (sýrasýyla p=0.085 ve p=0.246).
Sonuç: Elde ettiðimiz veriler MS hastalarýnda femur baþý AVN geliþiminin KS yýllýk doz miktarý ile artabileceði fikrini desteklemektedir. Femur baþý AVN’de erken evrede taný ile tedavinin mümkün olmasý nedeniyle özellikle KS tedavisi alan MS hastalarýnýn bu açýdan da takibi ve MRG ile birlikte deðerlendirilmeleri önem kazanmaktadýr.

Objective: Corticosteroid (CS) therapy is widely used as the standard treatment for acute exacerbations of multiple sclerosis (MS). Avascular necrosis (AVN) of the femoral head is one of the long–term complications related to CS therapy. Our study aims to investigate the association between annual and cumulative doses of CS treatment and radiographic assessment of AVN of the femoral head in MS.
Material and Methods: One patient group and two control groups were formed. The study group consisted 60 MS cases treated with intravenous methylprednisolone (IVMP) and the 2 control groups consisted 22 MS patients (Control I) without CS treatment and 25 healthy controls (Control II). Sixty patients who underwent CS treatment were divided into 3 subgroups of 20 cases each, treated with either IVMP only, IVMP and interferon, and IVMP and glatiramer acetate (GA). Neurological examinations and demographic data of all cases were recorded. The presence of AVN of femoral head in patient and control groups was evaluated using magnetic resonance imaging and Ficat staging system.
Results: Avascular necrosis (AVN) of femoral head was observed in 4 (6.7%) MS patients who were treated with CS. The mean annual CS dose was 8.07 g and mean cumulative dose was 31 gr. There was a significant but no statistical difference, in annual and cumulative IVMP doses between patients who have and don’t have AVN of femoral head (p=0.085 and p=0.246, respectively).
Conclusion: Our all data support the idea that annual dose of CS may increase AVN of femoral head development in MS patients. It is important to evaluate the CS-treated MS patients with MRI in this respect, due to the possible treatment of early-stage AVN of femoral head.

Amaç: Simfizis pubis diastazý hastada ciddi sýkýntýya yol açabilen nadir bir perinatal komplikasyondur. Gebe bir kadýnda, simfizis pubis aralýðýnýn eklemi destekleyen baðlarýn hormonlara baðlý meydana gelen gevþekliði nedeni ile en az 2-3 mm arttýðý düþünülmektedir. Simfizis pubis ayrýþmasýnýn tanýsý semptomlarýn varlýðý ve direkt grafide simfizis pubis ayrýþmasýnýn 10-13 mm arasýnda olmasý ile konur.
Olgu sunumu: Biz bu çalýþmamýzda 34 yaþýnda, yaklaþýk 40 haftalýk multigravida ve gestasyonel diyabeti bulunan, zor doðum sonrasý yürümekte zorluk çeken ve spontan pelvik aðrýsý olan ve simfizis pubis ayrýþmasý tanýsý konan bir olguyu sunmayý amaçladýk.
Sonuç: Doðum sonrasý gebede kalça hareketleri ile artan aðrý ve aðrýya baðlý olarak uzamýþ hareketsizlik durumunda simfizis pubis ayrýþmasýndan þüphenilmeli ve bu yönde ileri tetkik yapýlmalýdýr.

Objective: Symphysis pubis diastasis is an uncommon peripartum complication that might result in a serious distress to the patient. With pregnancy, the gap increases by at least 2 to 3 mm, which is thought to be caused by the slackness of ligaments supporting the joint. The diagnosis of diastasis is based on the persistence of symptoms and a symphysis pubis separation of more than 10 to 13 mm on imaging.
Case report: We report a 34-year-old multigravida woman with gestational diabetes at nearly 40 weeks of gestation and is presented with a spontaneous onset of pelvic pain, difficulty in walking after a shoulder distosi labor and diagnosed symphysis pubis diastasis.
Conclusion: After child birth if there is increasing pain with hip movement and pain causing prolonged immobilization, symphysis pubis diastase should be suspected and further investigation is recommended.