Objective: In this study, the effects of administration of midazolam, morphine, mepheridine and fentanyl premedication on patients sedation levels, arterial blood gases and peripheral oxygene saturation were compared.
Study Design: Sixty patients from ASA I,II grade were "ed. Patients were randomly divided in to four groups. 0.1 mg/kg midazolam, 0.1 mg/kg morphine, 1 mg/kg mepheridine and 1 pgr/kg fentanyl were administered., IM to the groups I, II, III and IV consecutively. Before and 45 minutes after premedication, levels of sedation, arterial blood gases and peripheral oxygene saturation values were recorded. Results were evaluated statistically with Student-t test.
Results: In Group I, an increase in sedation score was observed (P<0.001). Sedation score of Group III was statistically significant (p<0.05).The increase in Pa CO, in Group I was statistically significant (p <0.0 5)
Conclusions: In our study, mepheridine and particularly midazalom provided sufficient sedaton during premedication. But midazolam, should be used care fully because.

Objective: We aimed to evaluate the antibiotic susceptibility pattern of non-fermantative gram negative bacteria isolated from different Intensive Care Units.
Study Design: In this study, Acinetobacter and Pseudomonas species isolated from samples sent by different Intensive Care Units of Şişli Etfal Training and Research Hospital were identified with conventional microbiological methods. The activity of the antibiotics to the species in vitro was perfoimed by using disc diffusion method according to NCCLS criteria and these intermediately susceptible were accepted as resistant.
Results: In our study totally 77 bacteria Acinetobacter spp and 32 Pseudomonas spp respectively isolated from different samples were evaluated. Carbapenems were the most active antibiotics for both Acinetobacter and Pseudomonas species whereas the activity of other antipseudomonal antibiotics was definitely diminished.
Conclusions: Intensive Care Units are hospital units where antibiotics are frequently used and the prognosis of infections caused by resistant organisms is worse. For optimal "empirical treatment and in order to prevent nosocomial infections any hospital should assume its own data for antibiotic susceptibility

Objective: In this study, our aim was to evaluate effectiveness and side effects of tramadol and fentanyl with patient control analgesia after lower abdominal surgery.
Study Design: Forty patient (ASA I-II) aged between 20-60 years who underwent elective lower abdominal surgery were enrolled. A standart general anesthesia was used. Fentanyl and tramadol were administered in group F ve T respectively with intravenous PCA (loading dose was 100p.gr and 100 mg, bolus dose was 5p.gr and 20 mg, lockout time was 10 and 15 minutes, respectively). Visuel analog score (VAS), sedation scores and siae effects were recorded at postoperative 6,12,24 hours. Total consumption of the both dmgs was also recorded.
Results: VAS Decreased continyously in 24 hours. VAS was significantly lower in the group T than group F at postoperative 6 th hour (p <0.05). Sedation scores were similar in both groups Urinary retention was obseived higher in group F (p<0.05). Total fentanyl and tramadol consumptions were 270.1 ±10.9 and 310.7 ± 18.9 respectively.
Conclusion: Fentanyl and tramadol are effective and safe analgesics for use in PCA. We concluded that the lower rate of respiratuar depression for tramadol makes it the ding of alternative to agonist opioids.

Objective: von Willebrand factor (vWf) is a useful indirect indicator of atherosclerosis. Numerous clinical and experimental reports suggest that high vWf levels reflect damage to the endothelium or endothelial dysfunction. Levels of vWf are increased in patients with hypertension. In our Study we evaluated vWf levels in hypertensive patients with and without retinopathy comparing with control group.
Study Design: The Subjects were divided into three groups. Group I was composed of hypertensive patients with retinopathy, ingroup IIwere hypertensive patients without retinopathy and group III was formed as the control group. Mean ages of the groups were similar. The results were assessed by Dunnet multiple comparison test and Tukey-Kramer multiple comparison test.
Results: Mean vWf level in group I was 2.41 ±1.49 U/ml, in group II 1.34 ± 0.41 U/ml and in group III 1.18 ± 0.25 U/ml. When groups were compared with control group and with each other, the difference was significant between group I and III (p>0.05).
Conclusion: As a result, vWfmay be a valuable indicator of retinopathy in hypertensive patients.

Objective: In our study, our goal was to define platelet profiles in ITP and endication of splenectomy in resistant cases.
Study Design: We observed 9 cases, who hadn‘t seconder thrombocytopenia, were between 18 - 48 ages. 7 of them were female and 2 of them were male. We evaluated, their platelet counts in mm? of blood, platelet counts and morphology in peripheral blood, megakaryocyte counts and morphology in bone marrow,quantitative measurements of antiplatelet antibody. We researched the answer to corticotheraphy of these patients and evaluated the results of elective splenectomy in resistant cases.
Results: In 3 of 9 cases, platelet counts were 4.000- 4 of them were10.000, 2 of them were 35.000- 40.000 mm’ there were %3 megakaryocytes in 1 case, %5 in 3 cases and %4 in the rest 5 cases. Antiplatelet antibody was high in 2 cases. In clinical progress we obseived, vaginal bleeding in 5 of women; Petechiaes, ecchymoses in the rest of patients and epistaxis in 1 of them.
Conclusion: We used corticotherapy in patients who had low platelet profile in ITP but there wasn‘t any improve in 3 of them. After elective splenectomy, they recovered in clinical and laboratory.

Objective: In our study, we aimed to emphasize that the young myocardial infarction (MI) cases had different clinical and laboratory features and their therapies were important due to these differences.
Material and Methods: 46 of 466 cases, which were followed by our Coronary intensive Care Unit in between January 1999-2000 and were diagnosed as MI considering the clinical and the laboratory results, were included the study as young MI cases. The ages,genders,jobs,risk factors,seasonal distributions, localization of the infarction, the therapy modality were evaluated. Results: in our study group the presence of, being male, being working in a stressful job, smoking as one of the risk factors for the coronary heart disease, hypertension and the family history at the higher rate than the other risk factors were correlated with the prior laige studies (GISSI-2,GISSI-3) which were carried out with theyoung MI cases. The different results were the intensity in spring at the seasonal distribution, the higher incidence of the inferior localization and the less usage of thrombolytic agents on therapy rather than the expected one.
Conclusions: Recently, the thrombolytic therapy is the essential and the basic element of the therapy of MI and its positive effect, on the mortality and the morbidity at young MI cases, is more prominent. It has been thought the managements on many fields aimly the education should have been carried out to make spread this therapy which has been used less than the expected one in our country.

Objective: To determine the changes of free and total PSA and to find a baseline for PSA value for next observations after open prostatectomy.
Material and Methods: In the last 3 years, thirty patients who undeiwent transvesical prostatectomy, detected BPH after pathology and complying the following criterias are included in this research. For the patients with acute retention, PSA has been measured after 3 weeks from the cystostomy procedure. Patients who are cured due to acute bacterial prostatites in the last 6 weeks, treated with firıasterid for diagnosis ofPBH applied prostate biopsy were excluded from the study. TRUS biopsy has been done to those of them whose PSA level is more than appropriate PSA level in respect of age. PSA level has been measured with monoclonal Tandem R method in all subjects. After open prostatectomy, the measurement of PSA has been done in 3 months later or more, chi-square test was used for statistical analyses.
Results: While it was found that the patients operated on avarage age is 67(49-88) years old, weight of average prostate adenom in the operations is 81.5 g., the average of preoperatif total PSA is 11.8(0.47-54.5) ng/ml, the average of peroperatif free PSA is 1.4 (9.5-0.33) ng/ml, average free /total PSA is 0.12 ng/ml; the average of postoperatif free PSA 0.18(0.05-0.92)ng/ml, average free/total PSA as 0.14 ng/m was found. 89% reduction in postoperatif average free PSA has been observed (p<0.05). Total PSA, 87 % reduction in post operative average free PSA has been observed (p<0,05). The level of baseline PSA after open prostatectomy was detected as 1,3 ±0,99 ng/ml.

Objective: The aim is to compare the effects of general and spinal anesthesia on hemodynamic and biochemical changes during transurethral resection.
Study Design: 30 patints aged 60-80 years old (ASA I- III) who underwent TUR were enrolled. 5 mg diazepame and 500 ml ringer laktate solution were administered as a premedication. All patients divided two groups. Group spinal received 3 ml 0.5 % bupivacaine heavy, group general received standart ¦anesthesia with 5-7 mg/kg tiopentale, 0.6 mg/kg rocuronium and 1.5mcg/kg fentanyl. Anasthesia maintained with 30/70% O2/N2O and 2%sevorane. Hemodynamic and biochemical parameters were evaluated during perioperative and 60 min after posoperatively.
Results: In the group general, MAP decreased before administered irrigation solution‘s time while compare with before induction‘s time (p<0.05). In spinal group, CVP showed a lower value before irrigation (p<0.05). In spinal group, CVP showed a lower value before irrigation than the general group (p<0.05). Conclusion: These findings suggest that spinal and general anesthesia can be considered depend on patient‘s age, amont of prostate.

Objective: To compare tlıe methods of "breakand leave" and in ureteroscopic lithotripsy. Material and Methods: The last 100 patients with urolithiasis were randomly treated with miniureteroscope using the method of ‘‘break and leave "or " break and clean". A pneumotic. lithotrite was used as the power source. URS procedure was done by 6,9 Fr. Ureteroscope and 3 Fr basket catheter or 3 Fr. grasping forceps was used for cleaning procedure. KUB and USG were performed for the patients at fifteenth day of spontaneous passage following the lithotripsy. All patients were treated with cephaperazone+sulbactam forprophylaxy.
Results: This procedure was achieved in 44 of 50 patients who underwent to lihotripsy and spontaneous passage. In 3 cases secondary ureteroscopic intervention was performed successfully following the primaiy procedure. The remaining 3 cases were subjected to an open ureterolithotomy due. to the hard, multiple and/or big stones. Therefore, the success rate of intervention was 94%, whereas the complication rate was %0. During the ureteroscopy, an open surgery was performed for one patient who was subjected to accessorial interventions in addition to the primary lithotripsy because the basket catheter was broke in two withip ureter. In. one patient, a severe narrowness of ureteral meatus was detected during the postoperative checks, and transurethral meatotomy was petfoimed. In one patient, a detachment in the form of mucosal flap occured during the extraction of stone, and was treated with peroperatiye cold section, In three patients, the basket catheter was affixed during the extraction. In two of our these patients, the basket catheter was removed together with the stone without traction during the 24-48 hours spontaneous passage period, while in one patient the basket catheter was removed together with the stone using the method of peroperative unroofing. Jn 20 out of 50 patients, a 24-hour ureteral catheter was placed to avoid any possible trauma. Our inteiventional success rate was 98%, and the complication rate was 12%, Although using the "break and leave” method combined with cm accessorial tool for cleaning the pieces of stone operation seems to reach a similar success rate, both the high possibility of complications and additional cost of 150$per case should be reconsideved.

Objective: Malignant mesenchymal tumors of the uterus are rare neoplasms. Uterine sarcomas comprises 3% of the whole uterine malignities. According to the architectural and cytopathological properties; these are malignant smooth muscle neoplasms (leiomyosarcomas), endometrial stromal sarcomas, malignant mixed müllerian tumors, undifferentiated uterine sarcomas and other malignant mesenchymal tumors. Leiomyosarcomas comprises 1 of 3 the whole uterine sarcomas. 10-15% of malignant mesenchmal tumors are endometrial stromal sarcomas. Malignant mixed müllerian tumors comprises less than 1,5% of the whole uterine malignities. This study evaluates retrospectively those patients diagnosed with malignant mesenchmal tumors of the uterus that came to our laboratory between 1996-2000.
Material and Method: In this report, 21 cases of uterine sarcomas, in evaluated Department of Pathology SSK Okmeydanı Hospital between 1996-2000, retrospectively evaluated with their histopathological properties. Cases were evaluated with paramétrés of the age, diametre of the tumor, degree of differentiation, mitosis, atypia, necrosis, cellularity, cell type, macroscopic properties of the cut surface, tumor borders, vascular invasion, endoservical invasion. Immunhistochemical study were applied for the chosen cases.
Results: Ten of these 21 cases were leiomyosarcomas (47%), 6 were malignant mixed müllerian, tumors (29%), 5 were endometrial stromal sarcomas(24%). With the aid of immunhistochemistry malignant mixed müllerian tumors are diagnosed more accurately, so incidence of them are getting increased. The incidence rate of our cases and the literature are concordant.

Objective: To find the frequency of gestational diabetes by searching the pregnants in 24-28 gestational week who come to our policlinic.
Material and Method: Ninety pregnant in 24-28. week are taken for the study. As the risk factors maternal age, parity, obesity, diabetes in study, glucosuri, mort fetus or fetal anomaly, 4000 gr or more fetal weight are taken obstetric USG applied. To every case 50 gr glucose gestational searching test, we apply 75 gr oral glucose tolerance test to the pregnants who have 130 or more blood glucose level.
Results: When the cases searched for the relation ofvthe age and risk factors we see that in the cases who carry the risk factors and more than 25 years old. GDM can be seen much more (p<0,01)in the cases whoose hungry blood glucose level>90 mg/dl we see that 50 gr glucose searching test is %100 positive. And the ones whoose hungiy blood glucose level >130 mg/dl searching vtest positivity is %24.5. When OGTT with 75 gr glucose is applied to the cases who havepositivityin searching test, in six cases take (%27.2) GDM diagnosis. When we search the relation between the HbAlc levels, searching test and GDM we see that in the cases with GDMHbAlc levelsare high.
Conclusion: 50 gr glucose searching test is in rutin tests that applied to the pregnants in 24-28. gestational week. The caseswhoose searching test is positive the diagnosis must be supported with HbAlc levels and pregnants must be followed well.

Objective: The effect of high ligation varicocelectomy in the color Doppler ultrasonography and spermiogram parameters in the clinically and radiologically diagnosed oligoasthenospeimic varicocele patients.
Patients and Methods: Clinically and radiologically diagnosed 34 adult patients (mean age 27) with oligoasthenospermia were included in the study. Total 54 varicocele units were operated and twenty of them were bilateral. The diagnosis of varicocele was made by clinical examination and with color doppler ultrasonography in all cases. Subclinic varicocele was found in 18(33%) cases. 26 of cases were classified as G2-3 varicoceles and 10 cases as G1 varicoceles. High ligation varicocelectomy was performed in all cases. All of the radiologic exams were made in the same department. Follow up was made after 6 months by examine of spermiogram and color doppler ultrasonography.
Results: The signs of reflux in the color Doppler ultrasonography were found postoperatively in twelve units out of 54 operated. In 18 subclinic varicocele units reflux were not found postoperatively. Spermogram parameters were not improved in patients whom Doppler ultrasonography findings were continued in postoperative period. In 12 out of 20 bilateral and 8 out of 14 unilateral varicocele patients (20 units out of 34 units, %59) spermiogram parameters were improved. In 6 (15%) out of 40 bilateral cases reflux was continued and in 34 cases was stopped. In 12 (60%) of these patients spermiogram parameters were improved. In 8 of them spermiogram parameters were not changed or worsened. In 6 (43%) out of 14 bilateral varicocele patients reflux was continued and in 8 (57%) of them was stopped. In 6 (43%) out of this group spermiogram parameters were similar or worsened in 8 patients spermiogram parameters were improved.

Objective: Rosai-Dorfmann Disease ( Sinus histiocytosis with massive Iymphadenopaty-SHML) is a rare, idiopathic, histiocytic proliferative disorder that most commonly involves the cervical lymph nodes. The typical clinical features of this disease include bilateral painless lymph node enlargement, fever, leucocytosis, elevated eiythrocyte sedimentation rate, policlonal hypergammaglobulinemia. Generally, this is a benign reactive disorder, have an indolent clinical course; but have a highly variable biological behaviour. Here we report a case of Rosai Dorfmann Disease affecting the subglottic area and submandibular lymph nodes and discussed in the view of the literature.