AMAÇ: Hirsutizm olgularýnýn tedavisinde anitandrojen ajanlar olan siproteron asetat ve spironolaktonun klinik ve laboratuar etkilerinin araştýrýlmasý amaçlandý.
MATERYAL VE METOD: Hirsutizmli 43 kadýn klinik ve laboratuar yönünden değerlendirildikten sonra randomize olarak iki gruba ayrýldý: 24 olguya siklusun 1-10. günleri arasýnda 100 mgrlgün siproteron asetat ve siklusun 5. -25. günleri arasýnda 2 mgr/gün siproteron asetat 0.035 mgrlgün etinil östradiol verildi. 19 olguya 100 mgrlgün spironolakton ve trifazik oral kontraseptif verildi. Her iki tedavi rejimi 6 aylýk süre sonunda klinik, laboratuar ve yan etkileri yönünden değerlendirildi.
BULGULAR: Siproteron asetat ve spironolaktonun 6 ay süreyle kullanýmý sonucu her iki tedavi grubunda Ferriman-Gallway skorlarý anlamlý olarak azaldý (sýrasýyla p<0.001, p<0.001). Siproýoron asetata kullanan olgularda serbest testosteron, androstenedion ve DHEA-S seviyeleri anlamlý olarak düşerken FSH, LH seviyelerinin değişmediği, SHBG seviyelerinin anlamlý olarak arttýğý saptandý (sýrasýyla p<0.01, p<0.001, p<0.01, p>0.05, p>0.05, p<0.01). Spironolakton kullanan olgularda serbest testosteron seviye- sinin anlamlý olarak düştüğü, androstenedion, DHEA-S, FSH, LH seviyelerinin değişmediği, SHBG seviyelerinin anlamlý olarak arttýğý belirlendi (sýrasýyla p<0.01, p>0.05, p>0.05, p>0.05, p>0.05, p<0.01 ).
Her iki gruptaki olgularda tedaviyi kesmeyi gerektire- cek önemli bir yan etki gözlenmedi.
SONUÇ: Spironolakton ve siproteron asetanýn hirsutizm tedavisinde halen etkili ve güvenilir ilaçlar olduğu kanýsýna varýlmýştýr.

OBJECTIVE: Clinical and biochemical effect of antriandojen agents, siproteron acetate and spironoactone, in the treatment of hirsutism were studied. STUDY DESIGN: Forthy-three hirsutic women were clinically and biochemical/y evaluated aýýd randomly divided in to two groups: Twenty four patients in the first group, siproteron acetate 100 mg/day during the first ten days of the menstruel cycle and siproteron acetate 2 mg/ay and ethynl estradiol 0,035 mglday on the 5th to 25th days of the mensýruel cycle were administered. The remaining 19 patients
spinolactone 100 mglday and a triphasic oral contraceptive were administered. Both treatment groups were evaluted clinically, biochemically and adverse drug reactions were evaluted.
RESULTS: There were significant decrease in Ferriman-Gallway scores after 6 months treatment with both siproteron acetate and spironoclactoýýe (p<0.001, p<0.001, respectively). Free testosteron, androstenedion and DHEA -S levels were decreased in patients who were administered siproteron acetate but FSH and LH levels were unchanged. SHGB levels were increased (p<0.01, p<0.001, p<0.001, p>0.05, p>0.05, p<0.01). in those cases who were administered spinoloactone, free testosteron levels were decreased, androstenedion, DHEA-S, FSH and LH levels were unchanged, SHGB levels were increased (p<0.01, p>0.05, p>0.05, p>0.05, p>0.05, p<0.01).There were no adverse reactions in both treatment protocols.
CONCLUSION: We concluded that both siproteron acetate and spironolactone are stili effective and reliable drugs in the treatment of hirsutism.

Doğum esnasýnda kullanýlan bazý aneljezik ve anestezikler, doğumdan sonra tekrarlayan ve gözden kaçabilen bazý nörolojik etkilere sahiptir. Bu etkilerin ortaya konmasýnda en sýk kullanýlan testler, Scanlon'un Early Neonatal Neurobehavirol Skalasý (ENNS) ile Amiel-Tison ve ark. tarafýndan belirlenen Neuologic and Adaptive Capacity Scor(NACS)'dir.
Biz de çalýşmamýzda, propofol ve tiopental indüksiyonu ile anestezi alan gebelerin yenidoğanlarýnda, ENNS ve NACS bulgularýný değerlendirdik. Yenidoğanlarýn spontan solunum başlama zamanlarý, indüksiyon-doğum aralýğý, 1. ve 5. dakika Apgar skorlarý, doğum ağrýlarý ve gebelik haftalarý kaydedildi. NACS skalasý 15. dk., 2. ve 24. saatte değerlendirildi. 35 ve üzerinde ise yenidoğan aktif, altýnda ise depresyonda kabul edildi. ENNS skorlamasý 2. ve 4. saatlerde yapýldý ve her grupta yüksek puan alan yenidoğan yüzdesi belirlendi. Ýstatiksel değerlendirme ANOVA ve X2 testi ile yapýldý. p<0.05 anlamlý kabul edildi.
Bütün yenidoğanlarýn 5. dk. Apgar skorlarý 8 veya daha yüksekti. Propofol grubunda 1. dk. Apgar skorlarý anlamlý olarak düşüktü (p<0.05). Spontan solunum başlama zamanlarý propofol grubunda anlamlý olarak uzundu (p<0.05). NACS ve ENNS skorlarý her üç grupta benzerdi.
Sonuç olarak, propofol yüksek riskli vakalar hariç alternatif bir indüksiyon ajaný olabilir kanýsýndayýz.

Some analgesic and anesthesic use in labor may cause repetitive neurologic effects.
Scanlon 's Early Neonatal Neurobehavioral Scala (ENNS) and Amiel-Tison's Neurologic and Adaptive Capacity Scoring (NACS) are the most used tests to show these effects.
in our study, we used ENNS and NACS to evaluate the effects of propofol and thiopenthal in neonates who have mothers induced with these agents before general anesthesia.
The onset of spontanous respiration of the newborns, the period between induction of anesthesia and the delivery time, Apgar scores at 1 sý. and 5th. minutes, delivery weights and gestational age were recorded. The scale of NASC was established at the 15th min, 2nd. and 24th. hours, scores more than 35 showed ýhat the newborns was active, while less ýhan 35 was accepted as depression. ENNS scoring was applied at 2nd. and 24th. hours and percentage of the high scored newborns in each group were evaluated. Statistical evaluation was done by using ANOVA and X2 tests and p<0.05 was accepted as significant.
The Apgar scores of all the newborns were more than 8 at the 5th. min. Apgar scores were significantly low and induction of spontaneous respiration time was significantly long in the propofol group. Scores of NASC and ENNS were similar in ali of ýhe three groups.
We suggest that propofol may be an altenýative induction agent except high risk cases.

Değişik sürelerdir kronik hemodializ tedavisinde olan 39 hastada, ulnar, peroneal ve surat sinirlerde nöroelektrofizyolojik sinir iletimi çalýşmalarý yapýldý. Yalnýzca 12 olguda Carpal Tunnel Sendromu (CTS) saptandý, bu olgularda eşlik eden polinöropati bulgusuna rastlanmadý. 6 olguda periferik polinöropati (SMN, erken dönem CTS), 5 olguda yalnýzca periferik polinöropati (PPN), 5 olguda periferik polinöropatiye eşlik eden CTS saptandý. 11 olgu ise elektrofizyolojik değerlendirmede normal bulundu.
Hemodializ olgularýnda sinir iletimi bozukluklarý ve özellikle CTS bulgularýna uygun olarak rastlanmaktadýr. Bu nedenle bu hastalarda dializ tedavisine başlanmasý ile birlikte sýk aralýklarla sinir iletimlerinin kontrolü gerekmektedir. Buna özellikle CTS'nin erken tanýsý, geri dönüşümsüz sinir hasarlarýnýn önüne geçebilmesi için gerek vardýr.

Ulnar, median, peronal and sural nerves neuro-electrophysiological studies were applied in 39 patients who have been on chronic hemodialysis far varying periods of time. Only twelve patients had Carpal Tunnel Syndrome (CTS) (without poyneuropathy), 6 had sub clinical median neuropathy (SMN), 5 had peripheral polyneuropathy (PPN), 5 had CTS (without polyneuropathy) and il patients had normal electrophysiological findings.
Nerve conduction velocity abnormalites and especially CTS findings were common in hemodialysis patients. They need frequent nerve conduction conýrol studies from the onset of dialysis, in order to identify CTS early and to avoid irreversibl nerve damages and appropriate surgical management.

Şişli Etfal Hastanesi 3. Genel Cerrahi kliniğinde Şubat 1992 - Temmuz 1994 tarihleri arasýnda 66 noduler guatrlý hasta preoperatif dönemde ince iğne aspirasyon biopsisi (11AB) yapýlarak değerlendirildi. 16 hasta ameliyat edilmeyip, izlendi. Opere edilen 50 hasta preoperatif uygulanan tiroidoktemi materyalinin histopatolojik sonuçlarýyla karşýlaştýrýldý.
Bu çalýşma IIAB'de yanlýş negatiflik % 4, yanlýş pozitiflik % 0 olarak bulundu. Duyarlýlýk % 50, spesifiklik % 100, kesinlik o/o69 olarak bulundu.
Sonuç olarak: Tiroid nodülllerinin preoperatif değerlendirilmesinde, IIAB yönteminin kullanýlma­sýyla, gereksiz cerrahi girişimlerin azalacağý, buna karşýn malign nodüllerin daha erken tanýnýp, etkili olarak tedavi edileceği kanýsýna varýldý.

66 Patients who were admitted to Şişli Etfal Hospital 3. General Surgery Department with a diagnosis of noduler goitre between February 1992 and July 1994, underwent fine needle aspiration biopsy (FNAB) preoperatively. 16 patients were followed without being operated, in the 50 patients who had an operation cytological findings from FNAB were compared to the histopathological findings from postoperative thyroidectomy material.
it was found FNAB had false positive results in % 4 of the patients while false negativity was %0. Therefore spesificity of FNAB was found to be % 100 whereas sensitivity was % 50 that malignant nodules, which can be recognized earlier treated more efficiently.

60 metastatik ve nonmetastatik kanserli hastada serum transferrin (TRF) düzeyleri tayin edildi. Serum TRF düzeylerini kanserli hasta grubunda 2,22±0,61 g/L, metastatik kanserli grupta 1,81±0,30 g/L, nonmetastatik kanserli grupta 2,63±0,58 g/L bulduk. Kontrol grubunda ise serum TRF düzeyi 3,00±0,57 g/L idi. Kontrol grubu ve kanserli hasta grubu arasýnda anlamlý fark bulundu (p: 0,0001 ). Ayrýca nonmetastik ve metastatik kanserli hasta grubu arasýnda (p: 0,0000) ve kontrol grubu ile metastatik kanserli grup arasýnda anlamlý fark vardý (p: 0,0000). Ama kontrol grubu ve nonmetastatik kanserli hasta grubu arasýnda anlamlý fark yoktu (p: 0,2466). Bu sonuçlara göre malign hastalýklarda metastaz varlýğýnýn gösterilmesinde serum TRF tayininin kolaylýkla uygulanabilir ve yararlý bir test olduğu görüldü.

We analyzed the serum levels of transferrin (TRF) in 60 patients with cancer having metastasis and without metastatis. We observed the mean value of the serum TRF as 2,22±0,62 g/L in cancer patients and 1,81±030 g/L in metastatic patients and 2,63±0,58 gr/L in non-metastatic patients. The mean value of the serum TRF was 3,00±0,57 gr/L in control group. We found a significant difference between the control group and patients have non-metastasis and also between control group and patients have metastasis (p: 0,0001 and p: 0,0000, respectively). But there was not a significant difference between control group and nonmetastatic group (p: 0,2466). According to our results, we can suggest that in terms of the determining metastasis in patients with cancer, the serum levels of the TRF is readily appliable and useful test.

Metastik meme kanserlerinde tedavi planlamasý yapýlýrken seçilecek Kemoterapi ajanlarýnýn tedavideki başarýlarý kadar yan etkileri de önemlidir. Enkürabl olan bu hastalýkta, çeşitli kemoterapi kombinasyonlarý yada tek ajanlý kemoterapiler kullanýlagelmektedir. Mitoxanýrone metastatik meme kanserlerinde etkin bir antiýýeoplastik ajandýr. Yine 5Fluorouracil ve Calcium Folinate kombinasyonu da tedavi edilmemiş meme kanserli hastalarda yaklaşýk % 20 cevap oluşturmaktadýr.

Metastatic breast cancer remains incurable today. Therefore the toxicity and efficacy of systemic chemotherapy has critical importance. 5-Fluorouracil and high dose calcium foliuate (Leucovorin) produced response rates of approximetely 20 % in heavily pretreated patieýýts. Mitoxantrone is effective in the treatment of metastatic breast cancer and less adverse effects. We observed that this combination.

Çalýşmamýzýn amacý MSS enfeksiyon hastalýklarýnýn tanýsýnda meningeal ve diğer fiziksel bulgularýn önemini araştýrmaktý.
MSS enfeksiyonu şüphesi ile başvuran 224 hastada bazý klinik indikatörleri kullanarak, bunlarýn en az birine sahip olan her hastaya lomber ponksiyon (LP) uyguladýk. Kullanýlan klinik indikatörler, konvülsiyon, nörolojik bulgular, fontanelin bombe ve/veya pulsatil olmasý, meningeal irritasyon bulgularý (MiB), nedeni
bulunamayan ateş, baş ağrýsý-kusma, şüpheli döküntü ve irritabilite idi.
224 hastanýn 135'ine MSS enfeksiyonu tanýsý kondu ve yaş gruplarýna göre herbir indikatörün görülme sýklýğý incelendi.
2 yaþýýn altýndaki çocuklarda en sýk nörolojik bulgular, nedeni bulunamayan ateş ve fontanel bulgularý saptandý.
Konvülsiyonda bu yaş grubunda daha büyük çocuklara oranla daha sýk görüldü. 2 yaşýndan büyük çocuklarda ise en önemli bulgular baş ağrýsý, kusma, MIB ve nedeni bulunamayan ateş idi. MiB ve fontanel bulgularý olmasa
dahi 2 yaşýndan küçük çocukta tek başýna nedeni bulunamayan ateş, konvülsiyon veya nörolojik bulgu varlýðýnda ve 2 yaþýndan büyük çocukta tek baþýna baþağrýsý, kusma veya ateş varlýğýnda ve tüm çocuklarda tek baþýna þüpheli döküntü veya irritabilite varlýðýnda LP uygulamak gerektiği kanýsýna varýldý.

The purpose of our study was to assess the reliability of meningeal signs and other physical findings in predicting central nervous system (CNS) infectious diseases.
Using some clinical indicators we performed lumbar puncture in 224 patients who were suspected to have CNS infections, and had at least one these indicators. These signs, bulging and/or pulsating fontanel, meningeal irritation signs (MIB) fever of unknown origin (FUO) hedache-vomiting, suspicious rash and irritability.
135 of 224 lumbar punctures were positive for pleocytosis. The indidence of each clinical indicator for LP according to age groups of 135 patients were evaluated.
The signs and symptoms mostly present in patients less than 2 yrs of age were neurological signs, fontanel signs and fever of unkown origin and over 2 yrs of age were headache-vomiting meningeal irritation sign and FUO. Convulsion were present more in the under 2 yrs of age group.
We would suggest that a patient less than 2 yrs of age presenting with only FUO, convulsions or neurological signs, and a child over 2 yrs of age presenting only headache-vomiting or FUO and all children presenting with only suspicious rash or irritability although not having the classical signs of CNS infections such as MIB but only have bulging fontanel must be performed a lumber puncture.

Çalýşmamýzda, 1990-1994 yýllarý arasýnda Şişli Etfal
Hastanesi I. Çocuk Kliniği'ne yatan 75 Henoch-Schön-
lein Purpurasý (HSP) hastasý incelemiş olup, hastalar böbrek bulgularýnýn şiddetine göre gruplandýrýlmýş, böbrek bulgularýnýn ciddiyetinin yaş ve diğer sistemik bulgular ile ilişkisi araştýrýlmýştýr. Hastalarýn 31'inde (% 41.3) böbrek tutulumu saptanmýştýr. Böbrek bulgusu saptanan hastalarýn yaş ortalamasý 7.9 ± 2.7 yaş olarak bulunmuştur. Böbrek tutulumu kýz çocuklarýnda %51.7 erkeklerde %34. 78 oranýnda saptanmýş olup, kýzlarda erkeklerden daha fazla izlenmiştir. Hastalarýmýzda en sýk görülen böbrek bulgusu mikroskopik hematüri olup, böbrek bulgusu olanlarýn %96.7'sinde izlenmiştir. Böbrek tutulumu olan hematuria, hastalarýmýzýn %38.7'sinde makroskopik hematüri, %41.9'unda bir veya iki pozitif albüminuri gürülmüştür. Hastalarýmýzýn % 8'inde hipertansiyon saptanmýştýr. Böbrek bulgusu olan hastalarýn o/o77.41 'inde "Minimal idrar Bulgusu", o/o16.14'ünde "Beligin idrar Bulgusu", o/o6.45'inde "Nefritik -Nefrotik Sendrom" gözlenmiştir. Hastalarýmýzda böbrek tutulumunun ciddiyeti yaş büyüdükçe artmýştýr. Çalýşmamýzda böbrek dýşý bulgularýn sayýsý arttýkça böbrek tutulumunun ciddiyetinin arttýğý saptanmýþtýr.

Between 1990-1994 75 henoch-Schoenlein purpura cases have been examined and they were classifien according to their nefrotic involvement which is 41.3%. The mean age of the patients with renal involvement was 7.9 ± 2. 7 years, and it was most frequently encountered in girls. The most frequent renal öamifestation is, misroscopic hematuria, which occured 96.7% of the patients. We detected macroscopic hematuria in 33.7% of the patients. We concluded that, the severity of the renal involvement increases with respect to age and the number of external symptoms.

0-1 yaş grubu çocuklarda intrakranial patolojilerin saptanmasýnda kranial USG önemli bir taný yöntemidir. Bu çalýşmada Şubat 94 -Ocak 95 tarihleri arasýnda kliniğimize intrakranial patoloji şüphesi ile gelen 112 olguda kranial USG'nin taný değerini ortaya koymaya çalýştýk. 22 hastada hidrosefali, 20 hastada menenjit, 17 hastada serebral ödem, 9 hastada intrakranial hemoraji, 4 hastada ventrikülit, 6 hastada subdural kolleksiyon saptadýk. Bazý hastalarda birden fazla patoloji bir aradaydý. 45 hasta normal olarak değerlendirildi.

Cranial sonography is an important diagnostic method of demonstration of intracranial pathologies in neonatal age group (0-1). In this report we intended to determine the diagnostic ability of ultrasonography in cranial pathologies in 112 cases who were suspected with intracranial pathology (from February 1994 to January 1995). We observed hydrocephalus in 22 patients, meningitis in 20 patients, cerebral edema in 17 patients, imracranial hemorrhage in 9 patients, ventriculitis in 4 patients, subdural collection in 6 patients. Some of these patients had more ýhan one pathology. 45 patients were observed as normal.

Prematür infantlarýn intrakranial patolojilerinde, USG taşýnabilir olmasý, kolay uygulanabilmesi, iyonizan radyasyon içermemesi ve sedasyon gerektirmemesi gibi nedenlerden dolayý sýk kullanýlan bir görüntüleme yöntemidir. Bu çalýşmada 27 prematür bebek kranial USG ile incelendi ve kranial USG'nin etkinliği araştýrýldý.

Ultrasonography is a common using modality in the intracranial pathology of premature infants, because of some advantages, such as portability, easy applicability, lack of ionizing radiation and no need of sedation. In this study 27 premature babies were screened with cranial sonography and accuracy of cranial sonography was evaluated.