Düþük kapasiteli mesanelerin cerrahi tedavisi 19. yüzyýlýn sonlarýnda tanýmlanmýþ, ancak 1950’li yýllarda tüberküloz nedeniyle popüler olmuþtur. Schistosomiazis, interstisyel sistitde, nörojenik mesanede, detrüsor instabilitesinde, undiversiyonda ve renal transplantasyon öncesi alt üriner trakt disfonksiyonunun düzeltilmesinde endikedir. Mide, ileýým, kolon gibi doða! greftlerin yanýnda sentetik greflerde kullanýlabilir. Saðladýðý yararlarýn yanýnda neden olduðu metabolik bozukluklar, divertikülarizasyon, mukus oluþumu, bakteriiiri, taþ oluþumu, perforasyon ve karsinom geliþimi gibi komplikasyonlarý vardýr. Augmentasyon sistoplastisi konservatif tedavinin baþarýsýz olduðu durumlarda alternatif bir tedavi yöntemidir.

Augmentation cystoplasty was first described at the end of the 19th century, but it was popular for the small contacted tuberculous bladder, indications to this procedure are schistosomiasis, interstitial cystitis, neurogenic bladder dysfunction, detrusor instability, undiversions, various congenital conditions and correction of the lower urinary tract dysfunction before renal transplantation. Stomach, ileum and colon can he used as natural grafts. There are also synthetic grafts for bladder augmentation. Complications of this procedure are metabolic disturbance, diverticularization, mucus production, bacteriuria, stone formation, perforation and increased risk for carcinoma development. Augmentation cystoplasty is an attractive alternative for the minority failing conservative management.

Amaç: Bu çalýþmada Mikrobiyoloji ve Klinik Mikrobiyoloji Laboratuvarýna gönderilen yara ve apse örneklerinin kliniklere göre daðýlýmý ile örneklerden izole edilen bakterilerin antibiyotik duyarlýlýklarýný araþtýrmak amaçlanmýþtýr.
Gereç ve Yöntem: Þiþli Etfal Eðitim Ve Araþtýrma Hastanesi Mikro-biyoloji ve Klinik Mikrobiyoloji Lahoratuvanna gönderilen 388 yara ve apse örneði, %5 kanlý a gar, çýýkýýlatamsý agar ve Eozin-Methylen Bine agar besiyerleriýýe ekilmiþtir. Besiyerlerinde üreyen bakteriler tanýmlanmýþ ve disk difüzyoýý yöntemi ile antibiyotik duyarlýlýklarý saptanmýþtýr.
Bulgular: Gönderilen 388 yara ve apse örneðinin çoðunluðu cerrahi bölümlerden olýýp en fazla Ortopedi Kliniðine (%29.8) aittir. Örneklerin 239’unda (%61.5) iireme olurken 149’unda (%38.4) üreme olmamýþtýr. Üreme olanlarýn 122’sinde (%5I) gram pozitif bakteriler, 117’sinde (%48.9) gram negatif bakteriler saptanmýþtýr. Ýzole edilen gram pozitif bakterilerden metis il in dirençli Stafilokok aureus ile metisilin dirençli koagülaz negatif stafilokoklar vankomisin ve teikoplanine %100 duyarlý bulunurken diðer antibiyotiklere düþük oranlarda (%17-%65) duyarlýlýk bulunmuþtur. Metisilin duyarlý Stafilokok aureus ile metisiliýý duyarlý koagülaz negatif stafilokoklar, penisilin G ve ampisiline %l2-%38 duyarlý bulunurken diðer antibiyotiklere %70-%I00 duyarlý bulunmuþtur. Alfa hemolitik streptokoklar penisilin G‘ye %75, beta hemolitik streptokoklar %I00 duyarlý olarak saptanmýþtýr. Gram negatif bakterilerden Pseudomonas spp. imipeneme %89, amikasine %75 duyarlý, acinetobacter spp. imipeneme %90, siprofloksasiýýe %76, amikasine %75 duyarlý, Klebsiella spp. imipeneme %I00, siprofloksasin ve ofloksasine %90, seftriaksona %80, sefoksitine %76 duyarlý bulunurken, suþlar diðer antibiyotiklere %20-%70 duyarlý bulunmuþtur. E.coli ve Proteus spp. ampisiline %35-%55 duyarlý bulunurken diðer antibiyotiklere c/o65-%IOO duyarlý bulunmuþtur.
Sonuç: Yara enfeksiyonu ve apselere cerrahi bölümlerde daha sýk karþýlaþýlmaktadýr. Oluþan enfeksiyonlarda etkenler kliniklere göre farklýlýklar gösterebilmektedir. Etkili tedavi için klinisyenlerin, gerekli durumlarda buna göre ampirik tedavi baþlamalarý ve etken bakterilerin antibiyotik duyarlýlýðýný bilmeleri yararlý olacaktýr.

Objective: In this study, the distribution of wound and abscess samples according to clinics and isolated bacteria antibiotic susceptibility were examined which were sent to Microbiology and Clinical Microbiology Laboratory.
Study Design: 388 wound and abscess samples which were sent to Þiþli Etfal Training and Research Hospital were inoculated 5% blood agar, chocolate agar and Eozin-Methylen Blue agar. In these media, reproduced bacteria were defined and antibiotic susceptibility was determined by using disc diffusion test.
Result: The samples were usually from Surgical departments, mostly belong to Ortopedics Clinics. Although 239 (61.5%) of samples were reproduced, 149 (38.4%) of them were not reproduced. Among the 239 of samples, 122 (51%) were Gram positive bacteria, 117 (48.9%) were Gram negative bacteria. Although methicillin resistant Staphylococcus aureus and methicillin resistant coagulase negative staphylococcus which were isolated from Gram positive bacteria were found to be 100% sensitive to vancomycin and teicoplain, they found less sensitive (17%- 65%) to other antibiotics. Methicillin sensitive Staphylococcus aureus and methicillin sensitive coagulase negative staphylococcus were found I2%-38% sensitive to other antibiotics. Alfa hemolytic streptococcus were determined 75% sensitive to penicillin G and beta hemolytic streptococcus were ¡00% sensitive to penicillin G. From Gram negative bacteria, Pseudomonas spp. were found to be 89% susceptible to imipenem and 75% susceptible to amikacin, Acinetobacter spp. 90% susceptible to imipenem, 76% susceptible to ciprofloxacin and 75% susceptible to amikacin, Klebsiella spp. 100% susceptible to imipenem, 90% susceptible to ciprofloxacin and ofloxacin, 80% susceptible to ceftriaxone, 76% susceptible to cefoxitin but they found to be 20%-70% susceptible to other antibiotics. E.coli and Proteus spp. were found to be 35%-55% susceptible to ampicillin but 65%-100% susceptible to other antibiotics.
Conclusions: Wound infections and abscess were encountered mostly at Surgical departments. The factors that were occured in infections showed difference to clinics. For an effective treatment, clinicians have to start empirical treatment on the necessary situations and it is useful for them to know the antibiotic susceptibility of agent bacteria.

Amaç: Hipofiz tümörlü hastalarda parasellar yayýlýmý göstermede pateni visuel evoked potansiyellerin yararý incelenmiþtir.
Materyal ve Metod: 27 hastada P-VEP incelemeleri nöroftalmolojik ve hipofiz manyetik resonans görüntüleme ile karþýlaþtýr ýlmýþtýr.
Bulgular: Hipofiz tümörlü hastalarda PI00 amplitüdlerinde düþme saptanmýþtýr. 25 hastada incelemede P-VEP patolojik bulunmuþtur.
Sonuç: P-VEP incelemesinin suprasellar yayýlýmý göstermede çabuk bir tarama aracý olarak kullanýlabileceði ve optik yollarýn tutulumunu gösterebileceði gözlemlenmiþtir.

Objective: Patients who had pituitary tumors were investigated using patern visuel evoked, potentials to show the tumors invasion to paracellar region.
Study Design: In 27 patients P-VEP examinations were compared with neuropthalmologic findings and magnetic resonance imaging.
Results: In patients who had pituitary tumor we found that PI00 amplitudes were decreased. In 25 patients P-VEP examinations were pathologic.
Conclusion: The results showed that it was a quick way of searching supracellar invasion and testing of optic pathways.

Amaç: TNF-alfa‘nýn akut myokard infarktüsü (AMl)’ndeki taný deðeri ve trombolitik tedavinin TNF-alfa düzeyine etkisi incelenmiþtir.
Gereç ve Yöntem: Çalýþmaya Þiþli Etfal Eðitim ve Araþtýrma Hastanesi acil polikiniðine AMl klinik ve laboratuvar bulgularý ile ilk S saat içinde baþvurup koroner yoðun bakým ünitesine yatýrýlan S kadýn, 22 erkek hasta alýndý. Yaþlarý 24 ile 69 arasýnda deðiþen ve trombolitik tedavi endikasyonu bulunan hastalarda, trombolitik tedavi öncesi ve tedavinin 48. saati TNF-alfa düzeyleri bakýldý; elde edilen deðerler birbirleri ile karþýlaþtýrýldý.
Bulgular: Tüm AMTlü hastalarda 0 ile 8. saat arasýnda bakýlan TNF-alfa deðerleri yüksek bulundu. Anterior ve inferior AMl gruplarý arasýnda anlamlý fark bulunmadý. Trombolitik tedavi sonrasý 48. saatte TNF-alfa düzeyleri, ilk 8 saatteki düzeylere göre anlamlý düþüþ kaydetti (Anterior AMl‘de p=O.OI6, inferior AMÝ‘ tide p-0.03). 48. saat TNF-alfa düzeyleri anterior AMÝ grubunda 48. saat CRP deðerleri ile (p=0.003), inferior AMÝ grubunda ise ilk 8 saatlik CRP dü¬zeyleri ile anlamlý derecede (p-0.028) paralellik gösterdi.
Sonuç: Serum TNF-alfa düzeyi, miyokard nekrozunun deðerli bir diagnostik göstergesi olduðu gibi, trombolitik tedaviyle saðlanan repeýfiizyonun da non-invaziv bir göstergesi olarak kabul edilebilir.

Objective: In this study, the diagnostic value of TNF-alpha in myocardial infarction and the effect of thrombolytic therapy on TNF-alpha is assessed.
Study Design: Eight female and 22 male patients were enrolled in this study, who had attended to Sisli Etfal Hastanesi emergency service within the first eight hours of initiation of chest pain, in whom AMI was diagnosed with clinical evaluation and laboratory workup. The patients were, then, referred to coronary care unit. TNF-alpha concentrations, before thrombolytic therapy and in the 48th hour of thrombolytic therapy, were evaluated in the patients with ages ranging between 24 and 69, who had the indication of thrombolytic therapy.
Results: TNF-alpha concentration within the hours of 0 and 8, was high in all patents who had the diagnosis of AMI. No significant difference was found between the anterior and inferior AMI subgroups. TNF-alpha concentrations in the 48th hour of the thrombolytic therapy was apparently lower when compared with the concentrations in the first eight hours (p=O.OI6 in anterior AMI, p=0.03 in inferior AMI). There was a significant parallel correlation between the 48th hour of TNF-alpha and CRP concentrations of anterior AMI group (p=0,003), and the first eight hours of CRP concentrations in the inferior AMI group (p=0,028)
Conclusions: Plasma TNF-alpha concentrations can be accepted as both a valuable diagnostic indicator of myocardial necrosis and an indicator of reperfusion provided by thrombolytic therapy, as well.

Amaç: Görme yollarýnýn lezyonlarýnýn saptanmasýnda, nörooftalmolojik muayene ve testlerin yaný sýra P-VEP incelemesinin yararlýlýðý incelenmiþtir.
Materyal Metod: Çalýþmanýn yapýldýðý kliniklerde toplam 23 olgu deðerlendilmiþtir. P-VEP incelemeleri yapýlmýþ, klinikle karþýlaþtýrýlmýþtýr.
Bulgular: 23 hastadan 14 olguda oftalmolojik muayenede, 16 olguda P-VEP de patoloji saptanmýþtýr.
Sonuç: Kompresif optik nöropatilerde P-VEP latanslarýnda uzama, daha belirgin olarak PI00 amplitudünde düþme saptanmýþtýr. Klinik olarak nörooftalmolojik inceleme tamamen normal saptanan hastalarda P-VEP patolojiyi gösterebilir.

Objective: We investigated the usage of P-Vep examinations to detect the lesions on the visual pathways comparing them with, neuroophtalmologic tests
Study Design: 23 patients were included. Their P-VEP study was made and compared with clinical evidence.
Results: In 23 patients, 14 has ophtalmologie evidence and 16 has P-VEP pathology.
Conclusion: In the optic neuropathies P-VEP latencies were longer but essentially, P100 amplitudes were more lower than normals. Neuroophtalmologic examination can appear as normal while P-VEP reveal pathology.

Amaç: Ýntrauterin geliþme geriliðinin (IUGR) tanýsýnda 3. trimesterde uygulanan uterin arter, orta serebral arter (MCA), umblikal arter (EA) doppler incelemelerinin prediktivite deðerinin olup olmadýðýný ortaya koymayý amaçladýk.
Gereç ve Yöntem: 26. haftadan sonra IUGR þüphesi olan 45 vakanýn uterin arter analizlerini ve MCA/UA rezistif indeks (Rl) deðerlerinin oranlarýný renkli doppler ultrasonografi (RDU) ile deðerlendirdik.
Bulgular: 45 gebenin 5 tanesinde IUGR ile uyumlu uterin arterlerde çift taraflý diastolik çentik ve MCA/UA RI oraný I’in altýnda saptanmýþtýr.
Sonuç: Çalýþmaya 45 hasta alýndý, 5 olgu IUGR ile sonuçlandý. Uterin arterde çift taraflý çentiðin varlýðýnda IUGR saptanmasýnýn sensitivitesi %60, spesitifitesi %95 ve kesinlik deðeri %91.1 bulunmuþtur. MCA / UA RI deðerleri oranlandýðýnda, IUGR’n‘ýn saptanmasýnda sensitivitesi %80, spesitifitesi %97.5 ve kesinlik deðeri %97.5 olarak tespit edilmiþtir.

Objective: We aimed to bring up the predictive value of uterin artery, middle cerebral (MCA) and umbilical arteries (UA) doppler measurements to diagnosis of intrauterin growth retardation (IUGR) of the third trimestr.
Study Design: To evaluate the analysis of uterin artery and MCAIUA resistance index (RI) measurements using by color wave doppler ultrasound in 45 cases of third trimestr pregnancies who are at high risk of IUGR
Results: We estabilished in 5 cases that resulted with IUGR have bilateral diastolic notch of uterin arteries and MCA/UA<1 resistance index values.
Conclusions: We found that bilateral diastolic notch of uterin arteries in IUGR; sensitivity 60%, spesificity 95%, accuracy 91.1% and MCAIUA RI<1; sensitivity 80%, spesificity 97.5%, accuracy 97.5%.

Amaç: Serum kreatinin fosfokinazMB (CPK-MB) deðerlerinin efor testi esnasýnda arttýðý birçok çalýþmada bildirilmektedir. Biz de bu çalýþmada, efor testi uygulanan hastalarda egzersiz öncesi ve egzersizden iki saat sonraki CPK-MB deðerlerini kýyaslayýp, efor testi müspet çýkan hastalarda CPK- MB’ nin seyri ve ayný hastalarda uygulanan anjiografi neticelerinin diagnostik önemini incelemeyi amaçladýk.
Materyal ve Metod: Çalýþmamýz Ocak 2001-Haziran 2001 tarihleri arasýnda hastanemiz 1. Dahiliye kliniðine müracaat eden ve koroner arter hastalýðý düþünülen 40 hastaya tatbik edilmiþ, bunlardan 10’nuna koroner anjiografi yapýlmýþtýr. Bu çalýþma grubundaki hastalardan 24’ü erkek, 16’sý kadýn olup yaþ ortalamasý 56,23±IO,5’dir. Vakalara standart Bruce protokolü uygulanarak Treadmill testi yapýlmýþtýr. Testin uygulandýðý 40 hastadan efor uygulanmadan önce kan alýnarak CPK-MB tayini yapýlmýþ, efordan sonra da ilk iki saatin sonunda CPK-MB’leri alýnarak karþýlaþtýrýlmýþtýr.
Bulgular: Elde edilen verileri deðerlendirdiðimizde, efor testi pozitif olan vakalarda test öncesi ve sonrasý bakýlan CPK- MB deðerlerinde anlamlý bir farklýlýk var iken, efor testi negatif çýkan vakalarda anlamlý bir fark bulunmamýþtýr. Efor testi pozitif çýkan 10 vakaya yapýlan koroner anjio ve ventrikülografi tetkikinde iki hastanýn koroner anjiolarý normal bulunmuþ olup kalan sekiz hastanýn dört tanesi üç damar hastasý, üç tanesi iki damar hastasý, bir tanesi de tek damar hastasý olarak tespit edilmiþtir.
Sonuç: Literatürdeki çalýþmalarda deðiþik derecelerdeki iskemilerde CPK-MB seviyeleri farklý bulunmuþtur: bizim çalýþmamýzda da efor testi pozitif hastalarda test sonrasý CPK-MB deðerlerinin yükseldiði görülmektedir Sonuç olarak, bu verilerin CPK-MB‘ nin iskeminin aðýrlýðýnýn bir göstergesi olabileceði yönündeki görüþleri desteklediðini düþünmekteyiz.

Objectives: Many studies state that the serum creatinine phosphokinase-MB (CPK-MB) values increase during cardiac stress test. We aimed to determine the diagnostic importance of CPK-MB values and the results of coronary angiography in patients who have positive cardiac stress test, by comparing CPK-MB results before and after the exercise during the cardiac stress test.
Study design: Our study contained 40 patients who were admitted first Internal Medicine department between January and June 2001; that were thought to have coronary arterial disease. 10 of these had coronary angiography. 24 of these patients were male and 16 were female. The mean age was 56,23±10,5 years. The patients were performed Treadmill test using the standart Bruce protocole. Blood samples for CPK- MB were obtained from these patients before and after the first two hours of the test and the results were compared.
Results: When we evaluated the datas, there was a significant difference between CPK-MB values before and after the stress test in the patients who had positive stress test; but there wasn’t in those who had negative stress test. Coronary angiography and ventriculography results of 10 patients, who had positive cardiac stress test, were found normal in two patients, three vessel diseased in four of the remaining eight patients, two vessel diseased in three and one vessel diseassed in one of them.
Conclusions: CPK-MB values in various degrees of ischemia were found different at studies in literature; also increased after the stress test in patients who had positive test results. As a conclusion, we think that these results support the ideas indicating that CPK-MB could be a predictor for the degree of ischemia.

Amaç: Koroner kalp hastalýðýnda risk faktörlerinin tanýmlanmasý gerek primer koruma, gerekse sekonder korumada büyük önem taþýmaktadýr. Akut miyokard infaýktüsü sýrasýnda mikroalbuminiiride artýþ olduðu bilinmekle beraber mekanizmasý tam olarak saptanamamýþtýr. Çalýþmamýzda akut miyokard infarktiisü sýrasýnda mikroalbuminüri düzeylerindeki deðiþimi ve trombolitik tedavinin bu deðiþime etkisini araþtýrdýk.
Materyal ve Metod: Dr. Lütfi Kýrdar Kartal Eðitim ve Araþtýrma Hastanesi Ýç Hastalýklarý Kliniði Koroner Yoðun Bakým Ünitesinde Ocak 2000 - Aralýk 2000 tarihleri arasýnda myokard infarktiisü nedeni ile trombolitik tedavi uygulanan 40 hasta ve akut miyokard infarktiisü tanýsý alan fakat endikasyonu olmamasý nedeni ile trombolitik tedavi uygulanmayan diðer 40 hasta çalýþmaya alýndý. Hastalarýn yatýþlarýnýn ilk saatinde ve 7. günde biyokimyasal para-metrelerinin saptanmasý için kan örnekleri alýndý. Ayrýca hastalarýn spot idrarlarý alýndýktan sonra ilk 24 saatlik idrarlarý toplandý. 24 saatlik idrarda kantitatif mikroalbuminüri ölçümleri yapýldý.
Bulgular: Ýzlenen tüm hastalarda I. gün 24 saatlik idrarda albuminüri düzeyleri ortalama 423.21±276.3 mg/gün, 7. günde ise 238.78±154.2 mglgiin olarak bulunmuþtur. Hastalardaki 1. ve 7. gün 24 saatlik idrardaki albuminüri düzeyleri arasýndaki deðiþim istatistiksel olarak ileri derecede anlamlý bulunmuþtur(p<0. 0001). Ayrýca I. gün ölçülen 24 saatlik idrardaki albümin düzeyleri tromboli-tik tedavi uygulanan ve uygulanmayan grup arasýnda istatistiksel ola-rak anlamlý farklýlýk göstermektedir (p<0.00l). 7. gündeki albuminüri deðerleri ise iki grup arasýnda anlamlý farklýlýk göstermemektedir (p>0.05).
Sonuç: AMI‘nü takiben üriner protein ekstraksiyon artýþýn varlýðý, is- kemiýýin sistemik vaskiýler permeabilitedeki artýþ hipotezini desteklemektedir. Oluþan proteiýýüriniýý reninanjiotensin sistemindeki aktivasyon gibi glomeruler hemodinamik deðiþikliklere, vasküler endotelyal duvarda oluþan hasara ve sonuçta vasküler permeabilitedeki artýþa baðlý olduðu düþünülmektedir.

Objectives: It is important to define rise factors for both primary and secondary prevention of coronary heart disease. An increase on microalbuminuria during acute myocardial infarction is known but mechanism of this isn’t determined. In our study, we studied variation in microalbuminuria levels and efficacy of thrombolytic treatment on it during acute myocardial infarction.
Study design: 40 patients who were put on thrombolytic treatment because of acute myocardial infarction and other 40 patients who were also diagnosed as acute myocardial infarction but were not thought to have an indication for thrombolytic treatment, were included into the study. Blood samples for biochemical parameters were obtained in the first hour and 7th day after hospitalization of the patients. Also, total urine in the first 24 hours were collected after obtaining a spot urine. Quantitative microalbuminuria measurements was made in 24 hours urine samples.
Results: Albuminuria levels were 423.21 ±276. 3 mg!day in 24 hours urine of the first day and 238.78±154.2 mg/day of 7th day. There was a statistically significant difference between albuminuria levels of the first and 7th day urine samples (p<0. 0001). Also, there was a statistically significant difference between patients who were put on thrombolytic treatment and not, according to 24 hours urine albuminuria levels of the first day (p<0.00l). But there was no statistically significant difference between these groups according to albuminuria levels of 7th day (p<0.05).
Conclusions: The presence of an increase in urinary protein extraction rate is supporting hypothesis which suggets that an increase in systemic vascular permeability is caused by ischemia. It is thougt that increase of proteinuria is depending on hemodynamic changes like activation in reninangiotensin system, damage on vascular endotelial wall and increase of vascular permeability.

Amaç: Bu çalýþmada hastane enfeksiyonu etkeni olarak izole edilen Gram negatif enterik basillerin çeþitli antibiyotiklere duyarlýlýklarýnýn saptanmasý amaçlanmýþtýr.
Gereç ve Yöntem: Bu çalýþmada Þiþli Etfal Eðitim ve Araþtýrma Hastanesi’ nde 1998 Haziran-1999 Haziran tarihleri arasýnda hastane infeksiyonuna neden olan Gram negatif enterik basiller incelendi. Basillerin antibiyotik duyarlýlýklarý disk diffüzyon yöntemi ile saptandý.
Bulgular: Çalýþmaya alman Gram negatif basillerin daðýlýmlarý; K. pneumoniae 26 (%32.5), E. coli 23 (%28.7), E. aero- genes 9 (Toll.2), E cloacea 7 (%8.7), K oxytoca 4 (%5.0), Enterobacter spp 2 (%2.5), P. mirabilis 2 (%2.5), P vulgaris 2 (%2.5), C diversus 1 (%J.2), C. freundii 1 (%1.2), H. alvei 1 (%1.2), M. morganii 1 (%l.2), E. sakazakü 1 (%1.2)’dir. Etkenlerin 57’si (%71.2) idrar, 15’i (%18.7) yaraabse, 5’i (%6.2) trakeal aspirat, 2’si (%2.5) kan, l’i (%1.2) beyin omirilik sývýsý örneklerinden izole edilmiþtir. Suþlarýn antibiyotiklere duyarlýlýklarý; amoksisilinklavulanik asit %20, sefazolin %28, sefodizim %53, seftriakson %60, sefotaksim %60, sefepim %68, gentamisin %6l, tobramisin %63, iletilmiþin %64, amikasin %76, ofloksasin %76, siprofloksasin %82, imipenem %98, meropenem %97 oranlarýnda saptanmýþtýr.
Sonuç: Çalýþmamýzda en etkili antibiyotiklerin karbapenemler olduðu, bunlarý kinolon ve aminoglikozidlerin izlediði gö¬rülmüþtür.

Objective: This study aimed to determine the antibiotic susceptibility of Gram-negative enteric bacilli isolated from nosocomial infections.
Study Design: Gram-negative enteric bacilli that caused nosocomial infections between June 1998-June 1999 in The Sisli Etfal Training and Research Hospital were taken in to the study. The anitibiotic susceptibility of these bacilli were determined by disc diffusion method.
Results: The distribution of Gram-negative bacilli were; K. pneumoniae 26 (32.5%), E. coli 23 (28.7%), E. aerogenes 9 (11.2%), E. cloacea 7 (8.7%), K. oxytoca 4 (5.0%), enterobacter spp 2 (2.5%), P. mirabilis 2 (2.5%), P. vulgaris 2 (2.5%), C. diversus 1 (1.2%), C. freundii 1 (1.2%), H. alvei I (1.2%), M. morganü 1 (1.2%), E. sakazakii 1 (1.2%). The nosocomial agents were isolated from the specimens as follows; 57 (71.2%), from urine 15 (18.7%) from wound-abscess, 5 (6.2%) from trakeal aspirate, 2 (2.5%) from blood, 1 (1.2%) from cerebrospinal fluid. The susceptibilities of the strains against the antibiotics were as follows; amoxicillin clavulanic acid 20%, cefazolin 28%, cefodizim 53%, ceftriaxone 60%, cefotaxime 60%, cefepim 68%, gentamicin 61%, tob¬ramycin 63%, netilmicin 64%, amikacin 76%, ofloxacin 76%, ciprofloxacin 82%, imipenem 98%, meropenem 97%.
Conclusions: In our study we determined that the most effective antibiotics were carbapenems, followed by quinolones and aminoglycosides.

Bu olgu sunumunda, transverse kolonda mideye invazyon gösteren kitlesi olan 55 yaþýndaki kadýn hasta irdelendi. Hastanýn, 3 yýldan heri karýn aðrýsý ve kusma, 2 aydan heri 5 kilo kaybetme þikayeti mevcuttu. Endoskopide midede fýstül aðzý ve fekaloid, kolonda kitle tespit edildi. Operasyonda mideye invazyon yapan kolonik kitle saptandý ve transverse kolon rezeksiyonu, hemigastrektomi uygulandý ve gastroduodenostomi, kolon anastomozu ile operasyon tamamlandý. Olgu kolon tümörüne haðlý gastrokolik fistüliin nadir bir durum olmasý sebebiyle irdelendi.

In this case report, 55 years old woman with a mass in transverse colon that invades stomach was evaluated. Patient complains abdominal pain and vomiting for three years and 5 kg weight loss for two months. A fistula in stomach with faeces and a mass in transverse colon was determined with endoscopic studies. During the operation a colonic mass that invades the stomach was found out and transverse colon resection, hemigastrectomy was carried out and operation was finished with gastroduodenostomy, colonic anastomosis. The case was evaluated because of gastrocolic fistula of colonic carsinoma is a rare situation.

Meme kanseri; tüm kadýn neopiazmlarýnýn yaklaþýk %25’ini oluþturan, insidansý yaþ ile artan, beyaz ve Musevi ýrkta daha fazla görülen, uzun süreli seyreden bir hastalýktýr. Aile anamnezi, erken menarþ, geç menapoz, ilk hamileliðin geç yaþta olmasý veya hiç hamilelik olmamasý, eksojen östrojen alýmý, radyasyon, diet ve alkol gibi epidemiyolojik risk faktörlerinin oluþumda suçlandýðý, ölümcül sonuçlara neden olabilen bir hastalýktýr. Klinik olarak memede aðrýsýz kitle, ciltte ödem ve portakal kabuðu görünümü, ülserasyon ve aksiller lenfadenopati gibi semptomlar verir. Bazen de meme baþýnda kanlý akýntý, meme baþýnda çekinti oluþabilir. Direkt, lenfatik ve hematojen yollarla vücudun çeþitli bölgelerine metastazlar yapabilmektedir. Cerrahi, kemoterapi, hormonoterapi (Östrojen ve Progesteron Reseptörüne baðlý olarak) ve radyoterapi gibi yöntemlerle tedavi edilmeye çalýþýlýr. Bu gibi yöntemlerle yapýlan tedavi çalýþmalarý esnasýnda metastazlar yapabilmektedir. Metastazlar genellikle tipik bölgelere olmakla birlikte bazen de atipik bölgelere de olabilmektedir. Bizde kliniðimizde atipik bölgeye metastaz yapmýþ bir meme kanseri vakasýný literatür ýþýðýnda yayýnlamayý amaçladýk.

Breast cancer is mostly seem in white and juwish race, consisting nearly 25 % at the female neoplasms, whichs incidance is increasing by age and has a long survival, it is a disease in which epidemiological rise factors are blamed in forming it such as family anamneses, early menarch, late menapouse, being the first pregnancy at late ages or never been pregnant uptake of exogen estorogen, radiation, diet and alcohol and may cause death, it can cause to some symptoms like: Clinically painless mass in breast, oedema in skin and prange-like apperence, iilsertaion, aksillary lymphadenophaty. sometimes it can cause to bloody discharge the nipllse or skin retraction, it can spreads directly, lymphatically and hematologically to several parts of the body. It is tried to cure by surgery, chemotherapy, hormonal therapy(related to estrogen, progesterone receptors), radiotherapy. Metastases can occur also under the treatment. Metastases are generally to bone, liver but sometimes also to atypical parts. We aimed to publish a breast cancer, with metastazes in our clinical in the path of current literature.

Mandibulaya metastaz nadir bir fenomendir. Tüm oral kavite tümörlerinin sadece %1’ini oluþturur. Bu makalede 62 yaþýnda rektum adenokarsinomu olan bir hastada mandibulaya olan metastaz ve palyatif tedavisi sunulmuþtur.

Métastasés to the mandibula is a rare phenomenon. It accounts only 1% of all malignant tumors of the oral cavity. In this article, presented is a case of adenocarcinom of the rectum metastatic to the mandible of a woman aged 62 aud¬its palyatif treatment.

Pasini ve Pierini’ nin idyopatik Atrofodermasý (PP/A), yuvarlak-oval, mavi-kahverengi deprese atrofik plaklar ve tipik olarak “uçurum yamacý" borderla karakterizedir. Lezyonlar simetrik olarak gövdede lokal izedir. Hastalarýn çoðu kadýndýr ve genellikle 2. -3. dekadlarda görülür. PPÝA nadir görülen bir hastalýk olduðundan PPÝA teþhisi alan bir hastayý sunuyoruz.

Idiopathic Atrophoderma of Pasini and Pierini (IAPP) is characterized by round or ovoid, blue-brown depressed atrophic plaques with typical cliff- borders. The lesions are lokalized on trunk symmetrically. Many patients are women and is seen usually in second-third decades. Because of IAPP is a very rare disease, we decided to present a patient who was diagnosed as IAPP.