Amaç: Intrapartum intravenöz sývý verilen hastalarda glukozým umbilikal kord asid haz dengesi üzerine etkilerini araþtýrdýk.
Materyal ve Metod: 2002 Þubat-2002 Haziran tarihleri arasýnda Þiþli Etfal Hastanesi 2. Kadýn Hastalýklarý ve Doðum Kliniðinde takip edilen düþük obstetrik riske sahip gebelere intrapartuný %5 dekstrozla ringer laktat solüsyonu ve dekstrozsýýz ringer laktat solüsyonu verilerek umbilikal kord asit baz deðerleri ölçüldü.
Bulgular: Çalýþýnaya 158 gebe intrapartuný gebe ile baþlandý.22 hasta kriterlere uymadýðýndan çalýþma dýþý býrakýldý.Çalýþmaya alman hastalar arasýnda her iki grupta da demografik daðýlým açýsýndan istatistiki bir fark yoktu. 72 hastaya %>5 glukozlu ringer laktat solüsyonu. 64 hastaya dekstrozsýýz ringer laktat solüsyonu uygulandý.Kord arteriel glukoz düzeyleri arasýnda istatistiki olarak anlamlý fark yoktu. (Grup 1.92.6 mg/dl;Grup 2: 86.7 mg/dl) Yenidoðan açlýk kan þeker düzeyleri Grup 1: 56.3 mg/dl;Grup 2: 52.8 mg/dl. Umbilikal arter pH deðerleri iki grup arasýnda belirgin olarak farklýydý ancak istatistiki anlamlýlýk yoktu p=0.08. pC02 ortalamasý istatistiki olarak farklýydý p<0.05.
Sonuç: Bu bulgular eþliðinde intrapartuný intravenöz sývý uygulamasýnda %5 glukoz içeren solüsyonun daha çok tercih edilmesi gerektiðini düþünüyoruz.

Objective: We repearclied the effect of glucose on acid base status of umbilical cord on the patients that were given intravenous fluid in intrapartum.
Material and method: Umbilical cord acid-base values were measured by giving intrapartum 5% dextrose ringer lactcit solution and ringer lactate solution without dextrose to the pregnants who have minimum obstetric risk, followed by the Sisli Etfal Hospital 2. Gynecology and Obstetrics Department between 2002 February-2002 June.
Results: The study was started with 158 intrapartum pregnants.22 of them were left out of the studybecause of not matching the criters. There was no statistical difference for the demographic distribution between the two groups of the patients taken into the study. 5% glucose ringer lactat solution was given to the 72 patients and ringer lactat solution without dextrous was given to the 64 patients. There was no significant difference between the levels of cord arterial glucose.(Group 1: 92.6 mg/dl;Group 2: 86.7mg/dl)Newborn Fastino blood glucose levels Group 1: 56.3 mg/dl;Group 2: 52.8 mg/dl. Umbilical arter pH values were different significantly between the two groups but there was no statistical difference p=0.08.pC02 avarage was different statistically p<().05.
Conclusion: We think that the solution containing 5% glucose must be preferred much more in the intrapartum intravenous fluid application accompanied with these findings.

Bu çalýþmada süt çocukluðu döneminde sýk rastlanan bir sorun olan bronþiyolit tedavisinde nebulizer ile verilen tek baþýna salbutamol, salbutamol+ budesonid ve salbutamol+ budesonid+ipratropiyum bromür tedavilerinin etkinlikleri karþýlaþtýrýlýn ýþtýr. Çalýþmaya toplam 42 çocuk alýnmýþ ve hastalar hastaneye baþvuru sýralarýna göre rastgele olarak bu tedavi protokollerinden birine alýnmýþlardýr. Hastaneye yatýrýlan hastalar akciðer grafýsi, nabýz sayýsý, solunum sayýsý, oksijen satiirasyonu ve semptom skorlarý ile izlenmiþlerdir. Çalýþmanýn sonunda hastalarýn her üç tedavi þeklinden de kýsmen yarar gördüðü ancak gruplar arasýnda hastanede kalýþ süresi ve hastalýðýn þiddeti yönünden fark olmadýðý sonucuna varýlmýþtýr.

In this study we have compared the effectiveness of salbutamol with salbutamol plus budesonide or salbutamol plus budesonide and ipratropium bromide in the treatment of bronchiolitis which is a common health problem in infancy. The study group consisted of 42 children and the patients were admitted to one of the study groups in the sequence of hospital admission. The hospitalized patients were followed with chest radiographs, pulse rates, respiration rates and oxygen saturation in addition to symptom scores. In the end of the study all patients in three groups improved mildly but no significant difference was observed among the groups for symptom scores and other criteria.

Amaç: Bu çalýþmanýn amacý 2 ay-2 yaþ arasý bakteriyel pnömoni tanýsý ile hastaneye yatýrýlan süt çocuklarýnda, penisilinG+kloramfenikol, ampisilin +sulbaktam ve seftriakson gibi geniþ spektrumlu antibiotiklerin tedavi etkinliði ve maliyetini belirlemektir.
Gereç ve Yöntem: Bu çalýþma 3. Çocuk Kliniði ’ine bakteriyel pnömoni tanýsý ile yatýrýlan 2 ay - 2 yaþ arasý hastalarýn prospektif takibi ile yapýldý. Çalýþmaya 50 hasta alýndý ve hastalara üç farklý antibiyotik tedavisinden biri rastgele tek kör yöntemle verildi ve 10 günlük tedavi sonunda tedavi modellerinin etkinliði deðerlendirildi.
Bulgular: Her üç ilaç grubunda da antibiyotik tedavisi etkin bulundu (P<0.001). Gruplar arasýnda klinik, laboratuar ve radvografik iyileþme açýsýndan anlamlý bir fark saptanmadý. PenisilinG+kloramfenikol grubunda ilaç maliyeti anlamlý olarak düþük, ancak hemþire viziti açýsýndan diðer iki gruptan iki kat fazla bulundu.
Sonuçlar: 2 ay- 2 yaþ arasý çocuklarda bakteriyel pnömoni tedavisinde penisilinG+kloramfenikol, ampisilin + sulbaktam ve seftriakson seçeneklerinin her üçü de etkilidir. Penisilin G + klorenfenikol ilaç maliyeti olarak daha düþük olmasýna karþýn hemþire viziti açýsýndan daha fazla yük getirmektedir.

Objective: The diagnosis and the treatment of community> acquired bacterial pneumonia is a serious child health problem in Turkey and many other developing countries. The aim of this study is to evaluate the cost and the effectiveness of three different antibiotic combinations in the treatment of community? acquired bacterial pneumonia among infants aged 2-24 months.
Study design: We enrolled 50 infants (aged 2-24 months) with bronchopneumonia in a randomized-controlled trial of 10 days of treatment with penicillin G+chloramphenicol, ampicillin+sulbactam and seftriakson. We evaluated the clinical improvement and the cost of therapy at the end the study.
Results: The cure rates were similar in each group and the antibiotic combinations in all therapy groups were found effective (P<0.001).
Conclusions: Antibiotic treatment in all three groups were as same as effective. The cost of the penicillin G + chloramphenicol treatment was cheaper in drug price but much expensive in nurse visiting.

Amaç: Krup ya da akut larengotrakeabronþit, çocuklarda en sýk görülen üst havayolu darlýðý sebebidir. Acil tedavisinde soðuk buhar, nebulize rasemik epinefrin ve steroidler kullanýlmaktadýr. Steroid tedavisi oral, inhaler veparenteral yoldan uygulanabilir. Bu çalýþmada krup tanýsý konan 60 hastada steroid tedavisi iiç farklý yoldan verilerek etkinlikleri karþýlaþtýrýlmýþtýr.
Gereç ve Yöntem: Yaþlarý 6 ay- 36 ay arasýnda yaþlarý deðiþen 60 hasta dört gruba ayrýldý. Bu gruplardan birincisine nebulize budesonid, ikinci gruba oral, üçüncü gruba ise pareýýteral deksametazon verildi ve bunlar plasebo verilen dördüncü grupla karþýlaþtýrýldý. Tiim hastalar “ Westley Krup Skoru ” ile, ilk baþvuruda (0. saat), 24, 48 ve 72. saatlerde deðerlendirildi.
Bulgular: Steroid tedavisi alan hasta gruplarýnýn krup skorlarýndaki düzelme plasebo grubuna göre istatistiksel olarak daha anlamlý bulundu. Fakat oral, inhaler ve intramuskuler steroid uygulamalarý arasýnda istatistiksel olarak anlamlý fark bulunmadý.
Sonuç olarak: Krup tedavisinde her üç yoldan verilen steroid de etkili bulunmuþ olup ilaç seçimi hastanýn bulunduðu koþullara ve hekimin tercihine göre yapýlmalýdýr.

Objective: In this study the effectiveness of nebulized budesonide, intramuscular and oral dexamethasone are compared in the treatment of croup.
Study design: We conducted a randomized- placebo controlled clinical trial among children aged 6-36 months (N=60 ) admitted to hospital with croup. We divided 60 patients in four groups. The first group was treated with nebulized budesonide, second with oral and third with intramuscular dexamethasone. The effects of all treatment models are evaluated with “Westlev Croup Score " and compared with placebo group.
Results: At the end of study the croup scores of all steroid treatment groups were significantly better than placebo group, but there was no statistically difference between three treatment groups.
Conclusions: In the croup treatment inhaler, oral and parenteral steroids have the same effectiveness and the choice depends on conditions of the patient and his doctor.

Amaç: Klinik ve laboratuvar olarak koroner arter hastalýðý(KAH) olan postmenopozal kadýnlarda serum serbest testosteron ve östradiol düzeyleri ile mevcut koroner iskemi arasýnda iliþki olup olmadýðý araþtýrýldý.
Materyal ve Metod: KAH’lý 94 kadýn ve 46 saðlýklý kadýn alýndý. Gruplar klinik, biyokimyasal, anjiografýk, egzersiz testleri ve SPECT sonuçlarýna göre normal, hafýf-orta ve ciddi iskemi olarak ayrýldý ve bunlarda östradiol ve serbest testosteron hormonlarý bakýldý.
Bulgular: Östradiol düzeyi ciddi iskemik grupta diðer gruplara göre anlamlý þekilde azalmýþ bulundu(p<(),01).Serbest testosteron düzeyi ciddi iskemik grupta diðer gruplara göre anlamlý derecede yüksek iken(p=0,02),total testosteron açýsýndan fark bulunmadý.
Sonuç: Bu çalýþmamýzýn sonuçlarý,ciddi KAH olan postmenopozal kadýnlarda hormon replasman tedavisinin ne derecede gerekli olduðunu vurgulayýcý ve tereddütleri giderici niteliktedir.

Objective: This study prospectively evaluated the association between endogenous serum sex hormone levels and the degree of myocardial ischemia in postmenopausal women with established as clinical and laboratory coronary heart disease.
Material and Methods: 94 women with coronary artery disease and 46 healthy women were included in the study.These groups were enrolled as clinic,biochemical,angiographic,exercise test and SPECT findings. The two groups were seperated as normal,mild- moderate and severe ischemia according to the results of the tests.Serum estradiol and free testosteron levels were measured in the last two groups and compared.
Results: The estradiol levels were significantly lower than other groups in the severe ischemic group(p<(),01). Free testosteron levels were significantly higher than other groups in the severe ischemic group(p=(),()2).No difference was found in total testosteron levels between all groups

Büyük can ve mal kaybýna yol açan felaketler arasýnda depremler önemli bir yer tutmaktadýr. Ülkemizin 1999’da yaþadýðý Marmara depreminde hastanemize baþvuran 163 hasta ile ilgili tecrübelerimiz ve deprem sýrasýnda yaþanan organizasyon sorunlarý bu çalýþmada deðerlendirilmiþtir.

Earthquakes has an important place among other disasters resulting with life and property loss. After the Marmara earthquake that occured in 1999, 163 patients applied to our hospital. In this paper we evaluated our experiences with these patients and organisation problems that have been faced after the earthquake.

Amaç: Bu çalýþmada 174 Akciðer Kanserli epidermoid karsinom histopatolojive sahip hastalarýn redrospektf olarak aldýklarý tedavilere ve evrelere göre ortalama ve median saðkalýmlar yönünden deðerlendirilmesi amaçlandý.
Materyal ve Metod: 1996-1999 yýllarý arasýnda Þiþli Etfal Hastanesi Radyasyon Onkoloji Kliniðinde tedavi ve takipleri yapýlan 174 Akciðer kanserli epidermoid karsinom histopatolojive sahip hastalar redrospektif olarak deðerlendirildi.
Bulgular: Takip edilen 174 akciðer kanserli hastalarýn yaþ daðýlýmýnda en çok 61 yaþ ve iizeri olup, hastalarýn 53 ’ü Evre IHA. 71 ‘i EvrelIIB. 32 ‘si EvrelV’diir. Evre 1-11: 9 hastaya sýnýrlý cerrahi ( segmentektomi ) sonrasý RT ( 50Gy ) uygulandý. 3 hasta medikal inoperabl kabul edilip sadece RT ( 50Gy). 1 hastaya ise cerrahi sonrasý adjuvan tedavi uygulanmadý.Evre IIIA: 6 hastaya cerrahi sonrasý RT+KT, 4 hastaya cerrahi sonrasý RT. 32 hastaya RT+KT, 11 hastaya tek baþýna KTuygulandý.Evre IIIB: 2 hastaya RT, 55 hastaya RT+KT. 16 hastaya tek baþýna KT uygulandý.Evre IV: 11 hastaya tek baþýna KT, 13 hastaya RT+KT uygulandý. 8 hastaya palyatif RT yapýldý.
Sonuç: En az 6 ay takip edilen hastalarýn 2 yýllýk ortalama saðkalým oraný: Evre 1-11 ‘de %61, Evre ÝHA ’da %60, Evre IIIB ‘de %45.Evre IV‘cle %18 olarak bulunmuþtur. Yaþ, Stage. Performans durumu prognozu belirleyen en önemli faktörlerdir.

Objective: In this study, it is aimed that evaluation of 174 lung cancer patient with epidermoid hystopathologic type to their treatment and survivals, retrospectively.
Study Design: The years of 1996-1999, 174 epidermoid lung cancer patient who had been treated and followed up in Þiþli Etfal Hospital are evaluated retrospectively.
Results: All of the patients, the peak age was 61 (33-31). 174 of patiets were male and 2 of patients were female. Treatment methods are; Stage 1-11: 9 patients were received surgery ( segmentectomy ), than RT ( 50Gy ). 8 patients were medical inoperabl and they were received only RT ( 50Gy), 1 patients were not received any adjuvan treatment after surgery.Stage IIIA: 6 patients were received adjuvan RT+KT after surgery, 4 patients were received RT, 32 patients RT+KT, 11 patients were received only KT. Stage IIIB: 2 patients were received RT, 53 patients RT+KT, 16patients were received only KT. 114 of patients were given conventionel radiotherapy, 8 of patients were given pallative radiotherapy. Survival was 15.7 months in stage 1, 14.6 months in stage 3A, 11.3 months in stage 3B and 10.12 months in stage 4 patients.

Amaç: Karotis-kavernöz siniis fistülü, infernal karotis arter kavernöz parçasý ile çevreleyen venöz pleksýýs arasýnda anormal bir irtibat geliþmesi sonucunda oluþur. Travmaya sekonder veya spontan meydana gelebilir. Oluþan fýstülizasyon sonucunda etkilenen vende arteryelize akým oluþur ve venöz basýnç yükselir. Hastalarda proptozis, motilite bozukluklarý, pulsátil ekzoftalmus, keýnozis, görmede azalma, episkleral ve konjuktival kan damarlarýnda geniþleme gibi klinik belirtiler ortaya çýkar. Çalýþmamýzda bir spontan karotis-kavernöz sinüs fistülüne radyolojik yaklaþým tartýþýldý.

Carotid-cavernous sinus fistula is an abnormal communication between internal carotid artery and the veins of cavernous sinus. This fistulas usually occur as a result of blunt trauma or can be occur spontaneously. Consequently arterialized flow occurs in the affected vein and venous pressure increases. Clinical symptoms such as proptozis, motility disturbances, pulsating exopthalmous, chemosis, decrease in vision, dilatation of episcleral and conjuctival blood vessels can be detected. In our study, radiological approach to a spontaneous carotid-cavernuos sinus fistula is discussed

Plasenta implantasyon bozukluklarý plasenta akreta (%78), plasenta inkreta (%17) ve perkreta (%>5) olarak üçe ayrýlýr. Plasenta akreta en sýk görülen insersiyon anomalisidir. Son yýllarda sectio sezaryen ile doðum oranlarýnýn artmasý plasenta akreta insidansýnda artýþlara yol açmýþtýr. Risk faktörü taþýyan hastalarda akla getirilmeli, voðýýn bakým koþullarýnýn olduðu merkezlerde, gerekli preoperatif hazýrlýklar yapýlarak müdahale edilmelidir.

Disorders of placental implantation is divided into three as placenta accreta (78%). increta (17%>) and percreta (5%). The most frequent ion anomaly is placenta accreta. In recent years, the increase in cesarean section has caused an increase in the incidence of placenta accreta. It should be kept in mind in cases with risk factors and requiered preoperative precautions must be provided before intervention in centers with intensice care units.

Jüvenil skleroderma. tipik bulgýýsýt ciltte kalýnlaþma olan nadir bir çocukluk çaðý hastalýðýdýr. Biz cildinde yaygýn kalýnlaþma olan i yaþýnda bir skleroderma olgusunu sunmaktayýz. Hastamýzda cilt kalýnlýðý yüksek frekanslý ultrasoýýografi ile ölçülmüþtür. Tedavidepenisilcýmin verilen hastada tedavi süresince net bir klinik cevap alýnamamýþtýr.

Juvenile scleroderma is a rare disease of childhood. The main clinical characteristic is the presence of skin sclerosis. We report a case of scleroderma, in ci 3 year girl who presented with tight skin over her all body. Skin thickness was measured with high frequency ultrasound equipment in our patients. We gave her D-penicillamine but no significant improvement was achieved in her condition during the therapy.

15 yaþýnda sað infaorbital rabdomiyosarkom nedeniyle tümör eksizyonu yapýlan, niiks geliþince kemoterapi ve radyoterapi uygulanan erkek hasta, 1.5 yýlda kitlenin büyüyerek tüm sað yüz yarýsýný kaplamasý üzerine kliniðimize baþvurdu. Kafa tabanýna uzanan 20x25x10 cm. boyutlarýnda yüzeyi ýýekrotik ve miyazisli (kurtlanmýþ) yaklaþýk 4.5 kg. aðýrlýðýndaki tümör kitlesi rezeke edilerek, oluþan defekt, seçlý deriden hazýrlanan lokal flep ve kýsmi kalýnlýklý deri grefti ile onarýldý. Ameliyat sonrasýnda beslenmesi gastrostomi ile saðlanan hastanýn genel durumu hýzla düzeldi. Erken dönemde tümör niiksü görülmedi. Postoperatif 2. ayda gastrostomi bölgesinde enfeksiyon oluþmasý, peritonit ve genel durum bozukluðu üzerine, 7 gün yoðun bakýmda tedavi edilen hasta sepsis ve metcýbolikyetmezlik nedeniyle kaybedilmiþtir.

Fifteen years old male patient who was operated because of an infraorbital rhabdomyosarcoma and who received chemotherapy and radiotherapy after the tumor relapsed, admitted to our clinic. The tumor invaded all of right side of the patient‘s face in one and half years with its 20x25x10 cm. size and 4.5 kg. mass extending to cranial base and its outer surface was necrotic and wormy. A fter the resection; the defect was repaired with a local scalp flap and split thickness skin graft. In postoperative period, the patient nourished via gastrostomia and the patient‘s general health status improved rapidly. Tumor relaps was not seen in early period. In the postoperative 2 months, infection in gastrostomia region, peritonitis were detected, and the patient who was treated throughout 7 day in intensive care unit, died because of sepsis and metabolic insufficiency upon that serious infection.