Amaç: Bu çalýþmanýn amacý dijital muayene ile vajinal mik-roorganizmalarýn servikse penetrasyonunu tanýmlamaktý.
Gereç ve Yöntem: Dijital servikal muayeneden önce ve sonra steril spekulum ile muayene edilip standardize edilen semika- litatif ve semikantitatif endoservikal kültür alman, membran¬larý rüptüre 34 haftalýk veya daha geç gebelik haftasýna sahip 35 hasta çalýþmaya dahil edildi.
Bulgular: Digital muayeneden önce alman kültürlerde 2.8±1.7 deðiþik tipte organizma tanýmlanmýþtýr. Buna karþýlýk dijital muayenedn sonra 4.4±1.5 deðiþik mikroorganizma ta¬nýmlanmýþtýr (p<0.0001). Muayeneden sonra alýnan kültür¬lerde 28 hastada (%80) daha yüksek miktarda ve deðiþik tipte mikroorganizmaya rastlanmýþtýr. Fetal membranlarýn durumunun (rüptüre veya intakt) bu iliþkiye etkisi yoktur.
Sonuç: Vajinadan servikal kanala mikroorganizma giriþine dijital muayenenin ani bir etkisi vardýr.

Objective: The purpose of this study was to determine whet¬her digital examination introduces vaginal organisms into the cervix.
Study Design: Thirty-five women with reported ruptured membranes at >34 week gestation underwent a sterile specu¬lum examination and a standardized, semiqualitative, semi- quantitative endocervical culture before and immediately af¬ter digital examination.
Results: Cultures taken before digital examination demonst¬rated a mean of 2.8+1.7 different types of organisms, whereas cultures taken after digital examination demonstrated a mean of 4.4±1.5 different types of organisms (p<0.0001). Twenty eight patients (80%) had heavier growth or a greater number of different organisms in the post examination culture than in the pre examination culture. The state of the fetal membranes (ruptured as opposed to intact) did not alter these relations. Conclusion: An immediate effect of digital examination is the introduction of vaginal organisms into the cervical canal.

Amaç: Selim safrcý yolýý darlýðý bulunan hastalarda, güncel cerrahi tedavi yaklaþým ve literatür gözden geçirilmiþtir.
Gereç ve Yöntem: Kliniðimize sevk edilen üç selim safra yolu darlýðý olgusu etyolojik neden, darlýk seviyesi, biyokimyasal tetkikler, cerrahi tedavi ve komplikasyonlar bakýmýndan de¬ðerlendirildi. Tiim hastalara preoperatif batýn ultrasonografi¬si, bilgisayarlý tomografi ve magnetik rezonans kolanjio-pankreatografi yapýldý.
Bulgular: Her üç hastada da Bismuth Tip-ll safra yolu darlý¬ðý. saptandý ve transanastomotik stent üstünden Roux en Y he- patikojejunostomi uygulandý. Hastalarýn kontrollerinde her¬hangi bir problem ile karþýlaþýlmadý.
Sonuç: Selim safra yolu darlýklarýnýn tedavisinde, altýn stan¬dart halen cerrahi yaklaþým ve yapýlan Roux en Y tipi hepati- kojejunostomidir.

Objective: Current surgical therapy and literature for the patients with benign biliary stricture were looked over.
Study Design: Three patients with benign biliary stricture, whom sended to our clinic were evaluated due to etiology, stricture level, biochemical findings, surgical treatment and complications. Preoperatively, abdominal ultrasonography, computed tomography, magnetic rezonans cholangiopancreaticografi were applied to all patients.
Results: Bismuth Type-ll bilier stricture were determined in every patients and Roux en Y hepaticojejunostomy with transanastomotic stent were performed. There wasn’t any problem in their controls.
Conclusions: For the treatment of benign biliary stricture, surgical treatment and Roux en Y type hepaticojejunostomy have still gold standard.

Amaç: NSCLC‘de cerrahi, RT ve KT’ye raðmen median sað- kalým siiresi 8 ile 10 ay arasýnda deðiþmektedir. Bu nedenle klasik kemoterapi rejimlerine alternatif rejimler denenmekte¬dir. Bu çalýþmamýzda Cisplatin+Etoposide; Cisplatin+Gem- citahin + Vinorelhine; Ifosfamide + Cisplatiýý + Etoposide kombinasyonlarýnýn etkinlik ve tolerabilite açýsýndan karþý¬laþtýrýlmasý amaçlandý.
Gereç ve Yöntem: ÞEH Radyasyon Onkolojisi Kliniðine NSCLC tanýsýyla baþvuran 800 hastadan 6 ay ve daha uzun süreli takibi yapýlan 235 hasta deðerlendirmeye alýndý, istatis¬tiksel anlamlýlýðý deðerlendirmede Ki-Kare testini kullandýk.
Bulgular: Hastalar progresyona dek geçen süre, toplam sað- kalým süresi ve yan etkileri yönünden karþýlaþtýrýldý. Kemote¬rapi toplam 6 kür yapýldý. 62 hastaya ÝCE, 67 hastaya Cispla¬tin+Etoposide, 98 hastaya Cisplatin+Vinorelbine+ Gemcita- bin, 8 hastaya oral etoposide uygulandý. Hastalara RT ve/ve¬ya cerrahi sonrasý kemoterapi uygulandý. Gruplar arasýnda yaþ, cinsiyet, uygulanan kür sayýsý, ve performans durumu açýsýndan anlamlý fark yoktu. Takip sýrasýnda ICE kolunda 13 hastada; Cisplatin+Etoposide kolunda 15 hastada; Cispla- tin+Gemcitabin+Vinorelbine kolunda 21 hastada metastaz gözlendi. ÝCE kolunda 41 hasta; Cisplatin+Etoposide kolun¬da 36 hasta; Cisplatin+Gemcitabin+Vinorelbine kolunda 64 hasta; oral Etoposide kolunda 4 hasta ex olmuþtur. Progres¬yona kadar geçen þiire ICE kolunda 4.5 ay; Cisplatin+Etopo¬side kolunda 4.1 ay; Cisplatin+Gemcitabin+Vinorelbine ko¬lunda 4 ay olarak bulunmuþtur. Ortalama saðkalým ICE ko¬lunda 11.1 ay; Cisplatin+Etoposide kolunda 12.2 ay; Cispla- tin+Gemcitabin + Vinorelhine kolunda 13.6 ay þeklidedir. Gruplar arasýnda progresyona kadar geçen þiire ve toplam yaþam süresi açýsýndan anlamlý bir fark yoktu (p: 0.11). Tok- sisite deðerlendirmesi WHO kriterlerine göre yapýldý. Her 3 gurupta da tedaviyi sonlandýrmayý gerektirecek düzeyde (WHO grade3-4) yan etki gözlenmedi. Kemoterapiye baðlý olarak ölen hasta olmadý.
Sonuç: NSCLC’li hastalarda 3’lü kombinasyonun standart kemoterapi rejimlerine eþit etkinlikte ve iyi. tolere edilebilen bir tedavi seçeneði olduðu görülmüþtür.

Objective: In spite of surgery, chemotherapy and radiotherapy, median survival in NSCLC is about 8 to 10 months. Thus alternative regimens are heeing tried. In this study we aimed to evaluated different chemotherapy regimens to their effectivies and tolerability.
Study design: The years of 1996-1999, 235 NSCLC patients who we are treated and followed up more than 6 months in Sisli Etfal Hospital, Radiation Oncology clinic are evaluated.
Results: The patients are compared, for the time to progression, Survival and side effects. 62 patients were received ICE, 67 patients were received cisplatinum and etoposide, 98 patients were received cisplatinum+vinorelbine+gemcitabine and 8 patients were received oral etoposide in 6 cycles. Chemotherapy was given after surgery and/or radiotheray. The time during the followed up métastasés were seen; 13 patients in ICE arm, 15 patients in cisplatinum+etoposide arm and. 21 patients in cisplatinum+vinorelbine+gemcitabine arm. Exitus was seen 41 patients in ICE arm, 36 patients in Cisplatinum+etoposide arm, 64 patients in cisplatinum+vinorelhine+gemcitabine arm and 4 patients in oral etoposide arm. The time to progression was 4.5 months in ICE arm, 4.1 months in cisplatinum+etoposide arm, 4 months in cisplatinum+vinorelbine+gemcitabine arm. Median survival was 11.1 months in ICE are, 12.2 months in cisplatinum+etoposide arm, 13.6 months in cisplatinum+vinorelbine+gemcitabine arm. (p: 0.11) There was not seen any toxicides WHO grade 3-4. There was no any patients who died during the chemotherapy arm, 36 patients in ci.splat.inum+etoposide arm, 64 patients in cisplatinum+vinorelbine+gemcitabine arm and 4 patients in oral etoposide. The time to progression was 4.5 months in ICE arm, 4.1 months in cisp- latinum+etoposide arm, 4 months in cisplatinum+vinorelbine+gemcitabine arm. Median survival was 11.1 months in ICE are, 12.2 months in cisplatinum+etoposide arm, 13.6 months in cisplatinum+vinorelbine+gemcitahine arm. (p: O.llJThere was not seen any toxicides WHO grade 3-4. There was no any patients who died during the chemotherapy.

Amaç: Heri dönem böbrek yetersizliðinde trombotik kompli- kasyonlar ve kanamaya eðilim bir arada görülür. Hemodiya- liz esnasýnda karým suni yüzeylerle temasý sonucunda trombo- sitlerin ve pýhtýlaþma faktörlerinin aktivasyonuyla ekstrakor- poral pýhtýlaþmanýn meydana gelmesi güçlü bir sorun olarak karþýmýza çýkmaktadýr. Regüler hemodiyalize giren iiremik hastalar tromhoz komplikasyonlarý açýsýndan büyük risk al- týndadýr. Bu komplikasyonlarýn oluþmasýnda düþük antitrom- bin III (AT III) seviyeleri de rol oynaý: Kan pýhtýlaþmasýnýn majör doðal inhibitörü olan AT III’iin kalýtsal eksikliði venoz trombotik hastalýklarla birliktelik gösterir. Biz düzenli olarak hemodiyalize giren kronik böbrek yetersizliði hastalarýnda (koagiilasyon aktivasyonunu incelemek için) diyalize girme- den hemen önce ve diyalizden hemen sonra fibrinojen, aPTT, protrombin zamaný ve ÂT III aktivitelerini tayin ettik.
Gereç ve Yöntem: Hasta grubu düzenli diyalize giren 50 kiþi, kontrol grubu ise saðlýklý 20 kiþiydi. AT III tayinleri kromoje- nik substrat yöntemi kullanýlarak Boehringer Mannheim- Hi- tachi 717 otoanalizoründe çalýþýldý.
Bulgular: Kontrol grubunda AT III aktivitesini ortalama %I03,8±8,85 bulduk. Hasta grubunda; diyaliz öncesi AT III aktivitesini ortalama %84,56±I3,0, diyalizden sonra %99± 14,12 olarak bulduk.

Sonuç: Hasta grubunda diyaliz öncesi AT III aktivitesi kont- rol grubuna kýyasla anlamlý bir þekilde düþüktür p: 0.000 Di- yaliz sonrasý AT III aktivitesinde anlamlý bir artýþ kaydedil- miþtir (p: 0.000).

Objective: Both bleeding tendency and thrombotic complica¬tions are seen together in advance renal failure. Because oj the blood contacts on artificial surface during hemodialysis the activation of platelets and clotting factors lead to clot for¬mation in the extracorporeal circuit and this still remains as a potential problem. Patients undergoing regular hemodialysis are subject to height risk of thrombotic complications. The low levels of antithrombin III play a role with the genesis oj these complications. AT III is a major inhibitor of blood co¬agulation and hereditary deficiency is associated with venous thrombotic disease. We measured plasma AT III, fibrinojen, active partial thromhoplastine time (aPTT) and protrombin time (PTT) in order to investigate the activation of coagulati¬on before and after dialysis in patients with chronic renal fa¬ilure undergoing regular hemodialysis.
Study Design: Patient group was 50 people and control gro¬up was 20 people. We determined AT III via cromogenic substrat method, by using Hitachi-717 otoanalyzer produced by Boehringer Mannheim.
Results: We found the mean value for AT III activity 103,8%±8,85 in healthy controls. The mean values for AT III before dialysis and after dialysis were respectively 84,56%±I3,0 and 99%±J4,12 in patients with chronic renal failure. Conclusions: As compared with the healthy controls, the pa¬tients with chronic renal failure had significantly lower (p: 0.000) AT III activity before dialysis and significantly inc¬reased AT III activity after dialysis, (p: 0.000)

Preeklampsi fizyopatolojisi ve etyolojisi hala tümüyle açýklanmamýþ bir endotel bozukluðudur. Günümüzde fetal geliþme geriliði, prematüre doðum ve maternal ölümlerin baþta gelen nedenlerinden biridir. Preeklampside görülen; endotel hasarý, düþük prostasiklin kan düzeyleri, trombositlerin agregasyonu, düþük trombosit sayýsý ve vazospazm, hipertansiyon, proteinüri ve ödem gibi fizyolojik ve metabolik deðiþikliklerde artmýþ lipid peroksidasyonunun ve kandaki antioksidanlarýn koruyucu kapasitelerinin aþýlmasýnýn, rol oynadýðý gösterilmiþtir. Biz bu çalýþmada, plazma lipit peroksit düzeyi ile preeklampsi pa- togenezi arasýndaki iliþkiyi araþtýrdýk. 40 preeklamptik gebe ile 20 saðlýklý gebenin plazma lipit peroksit düzeyi ile serum kolesterol, trigliserit, ürik asit, total protein, albümin, tam kan trombosit sayýsý, hematokrit ve fibrinojen düzeylerini ölçtük. Plazma lipit peroksit tayininde, lipid peroksidasyonunun son ürünü olan MDA (malodialdehite)’ in, TBA (thiobarbitürik asit) ile oluþturduðu pembe rengin ölçümüne dayanan TBA yöntemi kullanýlmýþtýr. Plazma lipit peroksit düzeyi ile diastolik ve sistolik kan ba¬sýnçlarý arasýnda pozitif korelasyon bulunduðunu saptadýk (p<0.001, rl=0.79, r2=0.83). Preeklamptik olgularda lipit peroksit düzeyinin kontrol grubuna göre anlamlý derecede arttýðýný gözledik (p<0.0001). Hastalarýmýzý sistolik ve dias¬tolik kan basýnçlarým dikkate alarak gruplandýrdýðýmýzda, en yüksek artýþýn aðýr grupta olduðunu gördük. Preeklampsi olgularýnda lipit peroksitlerin dolaylý olarak prostaglandin metabolizmasýný bozarak endotel hasarý ve trombosit membran hasarý ile vazokonstrüksiyona yol açabileceði bilgisi ýþýðýnda, lipit peroksitlerin hastalýðýn primer semptomu olan hipertansiyona katkýda bulunabileceði sonucuna vardýk.

Sisli Etfal Hospital, Biochemistry and Clinical Biochmistry Preeclampsia is an endothelial disease of which pathogenes and etiology is still an open question. Today, preeclampsia the major reason of fetal immaturity, premature births ar, maternal deaths. Reasons of the endothelial damage in preei lampsia are low blood protacycline levels, low plathelet ci unts, increased lipid peroxidation. This leads to exceed th capacity of the antioxidant systems of the body. The aim i the study was investigate the reletionship between plazma I pid peroxide level and pathogenesis of preeclampsia. Oi study groupconsisted of 40 preeclamptic preganacies and 2 healty pregnant women, whom we have primarily measure plasma lipid peroxide level and secondarily measured serui cholestrol, triglyceride, uric acid, total protein, albumin, bit od plathelet count, hematocrit, and fibrinogen levels. We use Thiobarbituric acid method. In this methon malodialdehidt end product of the lipid peroxidation, reacts with thiobarbut, ric acid and produces pink reaction end product. We have observed that plasma lipid peroxide level showed blood pressure dependent increase, where both diastolic an systolic blood pressures were highly correlated with lipid pe roxside levels (p<0.001, rl= 0.79, r2= 0.83). We have als. observed that lipid peroxide levels in preeclamptic prcgnanci es were significantly higher than that of the healty pregnar subjects (p<0.0001). When we clasified the peeclamptic pati ents according to the severity of the desease, as mild and se vere, the higher increased was found in the severe preeclamp tic group. Considering the information that in preeclamptic patients li pid peroxides indirectly caused endothelial damage by affec ting the prostaglandin metabolism, distrupt the platele membrane and lead to vasocontriction. We have conferrei that, lipid peroxides may make a contribution to the develop ment of disorders primary symptoms that is hipertention.

Amaç: Ýntracranial giriþimlerde, çok kýsa etkili bir opioicl olan, remifentanil infüzyonunun, orta etkili bir opioid olan fentanil infüzyonuna kýyasla anestezi süresince yeterli hemodinami ve daha kýsa bir post operatif derlenme saðlayýp saðlamayacaðýný araþtýrdýk.
Gereç ve Yöntem: Etik Kurul onayý alýndýktan sonra, intrakranyal giriþim planlanan ASA 1 ve 2 grubu 30 hasta çalýþma¬ya alýndý Gerekli monitörizasyonlar yapýldýktan sonra, 1. Gruba fentanil/propofol 2. Gruba, remifentanil / propofol ile TÝVA yapýldý. Hastalarýn hemodinamik ölçümleri baþlangýç¬tan itibaren post-op. ekstübasyonun 5. dakikasýna kadar kaydedildi. Derlenme Ramsey Skorlamasý ile deðerlendirildi, istatistiksel deðerlendirmede, student t ve eþlendirilmiþ dizilerde t testleri kullanýldý.
Bulgular: O AB indüksiyondan, cerrahi insizyona kadar olan dönemde remifentanil grubunda baþlangýca göre düþük seyrederken, fentanil grubunda anlamlý olarak yüksek bulundu. KAH’lan, remifentanil grubunda indüksiyondan itibaren an¬lamlý olarak düþtü ve operasyon boyunca düþük seyretti. KAH’da fentanil grubunda, baþlangýca göre, anlamlý bir deðiþme görülmedi. Ramsey skorlarý bakýmýndan, gruplar arasýnda fark yoktu. (p0,05) Fentanil grubunda kullanýlan propofol dozu, remifentanil grubuna göre anlamlý derecede daha yüksekti. (p(),05)
Sonuç: Aðrýlý uyaranlara, hipertansiyon, taþikardi gibi refleks yanýtlarý baskýlamasý, birikiri etkisinin olmamasý, oryantasyon zamanýnýn kýsa olmasý ve daha az hipnotik gereksini¬mine ihtiyaç göstererek maliyeti azaltmasý gibi özellikler gözönüne alýnarak, remifentanilin intrakranial giriþimlerde tercih edilebilecek bir ajan olduðu düþünüldü.

Objective: During anesthesia, we investigated the infusion e- mifentanyl a very short effective opioid promides or not, eno¬ugh hemodynamia and short postoperative recovery in intrac¬ranial procedures compared with fentanyl, a moderate opi¬oid.
Study Design: After the approval by the Medical Ethics Com¬mittee, 30 patients in ASA I-II were obtained in to study. TIVA was done with fentanyl / propofol and remifentanyl / propofol to Group I and II respectively after required monitorisations. The hemodynamic measurements of patients were recorded from beginning of anesthesia until fifth minutes postoperative extubation. Recovery was assessed with Ramsey Scores.
Results: Mean arterial pressure was found lower than begin¬ning in remifentanyl group during the period from induction until surgical incision, but it was significantly higher in fen¬tanyl group. Heart rate significantly decreased in induction and continued low during operation. No significant difference was seen on heart rate in fentayl group when compared to be¬ginning. There was not any difference in Ramsey Scores bet¬ween groups. (pO, 05) The dose of propofol was sign ificantly higher in fentanyl group when compared with remifentanyl group. (pO, 05)
Conclusion: Remifentanyl was thought as a preferable agent in intracranial procedures because of it. inhibits reflex. Responses as pain stimulus, hypertension, tachycardia and has no accumulative affect, and has short orientation period and is cost effective due to less hypnotic requirements.

Amaç: Bu çalýþmada, bir eðitim hastanesine baþvuran göðüs travmalý olgular deðerlendirildi ve yaralanmanýn morbidité ve mortalité oranlan belirlendi.
Gereç ve Yöntem: Ocak 1995 ve Haziran 2001 tarihleri ara¬sýnda, Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Acil Cerrahi Polikliniði‘ne baþvuran göðüs travmasý bulunan 146 hasta, retrospektif olarak, yaþ, cinsiyet, travma cinsi, klinik bulgular, tedavi, morbidité ve mortalité oranlarýna göre deðerlendiril¬di.
Bulgular: Göðüs travmasý 105 olguda (%72) penetre yara¬lanma ve 41 olguda (%28) künt mekanizma ile meydana gel¬miþtir. 29 olguda (%20) izole hemotoraks, 66 olguda (%45) izole pnömotoraks ve 51 olguda hemopnömotoraks saptandý. 133 olgu (%9I) tüp torakostomi ile tedavi edildi, 13 olguda (%9) torakotomi gerekli oldu. 14 olguda (%9.5) ek abdominal yaralanma saptandý. Post-operatif dönemde, 20 olguda komplikasyon geliþti. En sýk görülen komplikasyonlar pnömo- ni ve atelektazi idi. Mortalité 4 olguda gözlendi.
Sonuçlar: Sonuç olarak, göðüs travmalý olgular için ideal yaklaþým; ilk basamak tedavilerin travma merkezlerinde ya¬pýlmasý, ileri tetkik ve tedavilerin ise göðüs cerrahisi merke¬zinde yapýlmasý gerektiðini düþünmekteyiz.

Objective: In this study, the cases with thoracic trauma whom had applied to a training hospital were evaluted and morbi¬dity and mortality rates of the injury were def ined.
Study Design: Between January 1995 and June 2001, 146 patients with thoracic trauma whom applied to Sisli Etfal Training and Research Hospital Surgical Emergency Unit were evaluated retrospectively due to age, sex, type of injury, clinical symptoms, therapy, morbidity and mortality rates.
Results: Thoracic trauma occured in 105 cases (72%) by pe¬netrating injury and in 41 cases (28%) by blunt mechanisms. In 29 cases (20%) isolated haemothorax, in 66 cases (45%) isolated pneumothorax and in 51 cases (35%) haemopne- umothorax were established. 133 cases (91%) were treated with tube thoracostomy and thoracotomy required in 13 cases (9%). Additional abdominal injury was established in 14 ca¬ses (9,5%). In post-operative period, complications were oc¬cured in 20 patients. The most common complications were pneumonia and athelectazia. Morbidity were observed in 4 cases.
Conclusions: As a conclusion, we have considered that ideal approach to cases with thorax injuries; first step theraphies should made in trauma centers, advanced studies and theraphies should made in thorax surgery centers.

Amaç: Operasyon sonrasý aðrý tedavisinde tramadol infüzyo- ýýýý ilave edilen ve edilmeyen olgularda aralýklý intravenöz tramadol doz gereksinimini karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Major abdominal kanser cerrahisi alacak 45-82 yaþ arasý, ASA 3-4 risk grubunda 36 hasta çalýþmaya alýndý. Genel anestezi uygulandý ve p o stop eratif vakalar iki gruba ayrýldý. Grup I de yalnýzca PC A, grup 2 de PC A + 5 mg/h tramadol infiizyonu verildi. Tüm hastalar da PC A takip dozu 20 mg, kilitli kalma süresi 15 dakika idi ve yükleme dozu uygulanmadý. Her iki grupdaki hastalarýnda ekstübe edildiklerinde visual rating scale ve cerrahiden 24 saat sonra beþ puanlý skala deðerleri chi square ve unpaired t’-testi ile karþýlaþtýrýldý.
Bulgular: Grup I‘de tramadol tüketimi 401.25 mg, grup 2’de 413.33 mg idi. Gruplar arasýnda istatistiksel anlamlýlýk yoktu. Po stop er atif ilk 24 saat içinde 36 hastanýn 35’ inde zaman za¬man orta þiddetle aðrý, yalnýz 1 hastada zaman zaman þiddet¬te aðrý yakýnmasý vardý.
Sonuç: Major abdominal cerrahi sonrasý hem aralýklý PCA hemde tramadol infüzyon ilaveli PCA uygulamasý minimal yan etkilerle etkin analjezi saðladý.

Objective: The aim of the study was to compare interr, IV tramadol dose regimens with and without a mainte tramadol infusion in the treatment of postop eratifpain.
Study Design: Thirty six patients (aged between 45-82 ASA class 3,4) undergoing major abdominal cancer si were entered in to the trial. It was given general anaes and patients were divided into two group postoperativ group 1, only PCA was given and in group 2 both PC. IV infusion of 5 mg/h tramadol were given. ALL of the ents demand dose was 20 mg tramadol no loading dos used, lockout time was 15 min. The results of the two g when the patients extubated with VRS and 24 h after si with give point scale were compared by chi-square tes unpaired t-test.
Results: Consumption of tramadon in group 1 was 4012 and in group 2 was 413.33 mg. There was no statistical rence between groups. There were sometimes moderate in 35 of 36 patients, only one patient have sometimes si pain suffering in the first 24 hours of postoperative.
Conclusion: Both tramadol PCA and PCA plus tramad fusion produced sufficient analgesia with minimal side e in PCA after major abdominal surgery.

Amaç: Çalýþmamýzda, neostigminin preemptif olarak epidu¬ral kullanýmýnýn postoperatif analjezik etkinliðini araþtýrmayý amaçladýk.
Gereç ve Yöntem: Hastane Etik Kurulu onayýyla abdominal histerektomi geçirecek ASA l-ll grubunda, 40-65 yaþ arasýnda 45 olgu çalýþmaya alýndý. Indiiksiyondan 20 dk önce epidural yolla Grup l‘e 10 mi serum fizyolojik, Grup II‘ye 0.5 mg ne¬ostigmin, Grup IH’e 0.5 mg neostigmin+25 mg bupivakain verildi. Olgulara standart genel anestezi uygulandý. Peropc- ratýýar monitorizasyonda ortalama arter basýncý (OAB), kalp atým lýýzý (KAH), perifenl oksijen saturasyonu kaydedildi. Postoperatif aðrý tedavisi lýasta kontrollü epidural analjeziyle saðlandý. Postoperatif I., 2., 6., 12., 24. saatlerde OAB, KAH, Visiiel Analog Skala (VAS) ile aðrý takipleri yapýldý, 24 saatlik total analjezik tüketimi, yan etkiler kaydedildi. Ýstatistiksel deðerlendirmelerde student t, ANOVA testleri kullanýldý. P<0.05 anlamlý olarak deðerlendirildi.
Bulgular: Olgularýn per ve postoperatif OAB, KAH deðerleri arasýnda anlamlý farlc saptanmadý. VAS, 24 saatlik total anal¬jezik tüketimi, yarý etki sýklýðý Grup III’ de diðer iki gruba gö¬re anlamlý olarak düþiik bulundu.
Sonuç: Preemptif amaçla epidural yolla uygulanan neostig¬minin bir lokal anestezik olan bupivakain ile kombine kulla¬nýldýðýnda postoperatif aðrýyý ve analjezik tüketimini anlamlý ölçüde azalttýðýný saptadýk. Abdominal histerektomilerde pos¬toperatif analjezik etkinlik için neostigmin+lokal anestezik kombinasyonunun iyi bir tercih olabileceði kanýsýna vardýk.

Objective: In our study we aimed to evaluate the postopi ve analgesic efficacy of preemptive epidural neostigmine
Study Design: After the approval by the Medical Ethic < mittee, 45 patients in ASA I-II aged between 40-65 years included into the study. 10 ml 0.9% NaCI solution in Grc 0. 5 mg neostigmine in Group II, 0.5 mg neostigmi.ne+2. bupivacaine in Group III were administered epidurally 21 nut.es before induction. Standard general anaesthesia applied to the patients. Mean arterial pressure (MAP), i rate (HR), peripheral oxygen saturation were recorded / peratively. Patient controlled epidural analgesia was use postoperative pain management. MAP, HR, pain evciliu with Visual Analogue Scale (VAS), adverse effects at post rative I., 2., 6., 12., 24. hours, total analgesic consumj for 24 hours were recorded. Student’s t test and ANOVA used for the statistical analyses. P<0.05 was considered nificant.
Results: MAP, HR values were not significantly differen. and postoperatively. VAS, total analgesic consumption frequency of adverse effects were lower in Group III v compared with other two groups.
Conclusion: Preemptive epidural neostigmine decrease toperative pain and analgesic consumption when comb with bupivacaine. We suggest that, neostigmine and I anaesthetic combination can be a good choice (for post rative analgesia) after abdominal hysterectomies.

Elde parmak yokluðu fonksiyonel ve estetik açýdan ciddi bir kayýptýr. Elin tüm fonksiyonlarým saðlamada baþparmak %40 oranýnda öneme sahiptir. Baþparmak rekonstrüksiyonunun amacý ideal uzunluk ve görünümde, maksimum stabilité, ha¬reket kabiliyeti ve duyuya sahip orjinale yakýn baþparmak oluþturmaktýr. Ayak birinci ve ikinci parmaðý fonksiyon, duyu ve estetik açýdan bu özellikleri karþýlayan en uygun seçenek¬tir. Bu amaçla 26 yaþýnda, 7 ay önce iþ kazasý sonucu sað el baþparmakta avülziyon yaralanmasý oluþmuþ erkek hastaya, sol ayak 2. parmaðý el baþparmaðý yerine transplante edildi. Po stop eratif olarak, uzunluk, duyu ve örtü restorasyonu, kozmetik iyileþme yönünden orjinale yakýn bir sonuç elde edildi.

Loss of finger in a hand is a serious loss from point of functional and aesthetic problem. Forty percent of all function require a healty thumb. Aim of thumb reconstru is to constitute a thumb which has an ideal length and carance with maximum stability, motion ability and sense Great toe and second toe are the most appropriate alter ves which have these properties for achievement of the fuonal, sensational and aesthetic goals. Left second toe transplanted to right thumb stump of a male patient who 26 years old and whose right thumb was avulsed 7 month in an accident. A satisfying result regarding the oriy length, sensation and cover restoration and cosmetic het was obtained postoperatively.

Üç yaþýnda erkek olgu, ani þuur kaybý ve siyanoz ile getirildi¬ði acil ünitesinde trakeostomi açýldýktan sonra kliniðimize ge¬tirildi. Geliþme geriliði ve mikrognatisi olan olgunun ~1 mm aðýz açýklýðý mevcuttu. Kalp atým hýzý 150 vuru dk-l, arteriyel kan basýncý 80/50 mmllg, solunum sayýsý 40 dk-l, arteriyel kan gazý analizinde lýipoksi ve lýiperkarbisi olan olgu, aspi¬rasyon pnömonisi ve akut kalp yetmezliði ön tanýsý ile ventilatör, hronkodilatatör, antibiotik ve dijital tedavisine alýndý. Tedavisinin 15. gününde maksillopalatomandibuler füzyon nedeniyle osteotomi operasyonu uygulanan olguya ~1.5 cm aðýz açýklýðý saðlandý ve daha sonra trakeostomisi kapatýldý. Olgu, komplikasyonsuz bir yoðun bakým desteði ile tedavi edilmiþ nadir bir maksillopalatomandibuler füzyon ve dolayýsýyla güç entübasyon olgusu olmasý nedeniyle sunulmuþtur.

A there years old boy was admitted to our department after an emergency tracheotomy performed at Emergency Unite; because of alteration of his consciousness and cyanosis. At initial examination micrognatia and underdeveloped growth were observed. There was only ~1 mm of mouth opening. 150/min heart rate, 80/50 mmHg arterial blood pressure, tachypnea (40/min) were noted. The arterial blood gas analysis showed hipoxia and hipercapnia. Because of aspiration pneumonia and acute cardiac failure, the patient was ventilated and treated with antibiotherapy, bronchodilatators and digoxin. After 15 days of treatment the patient had an osteotomy because of maxillopalatomandibular fusion and ~1.5 cm mouth opening was obtained. Later, tracheotomy was decanulated. Maxillopalatomandibular fusion is rare anomaly which presents difficult intubation problem. Our case constitues an example of successful intensive care treatment in maxillopalatomandibular fusion anomaly.

Tip / nörofibromatosis, Nörofibromatosis’ in en sýk görülen formu olup, baþka tanýsal kriterlerin, varlýðýna da raðmen, en az iki nörofibroma ve altý veya daha fazla cafe au lait lekele¬rinin varlýðý, ile karakterizedir. Biz sað siatik sinir lojunda, sakral sinir köklerinde, her iki uyluk bölgesinde, semiýýal vezikülün posteriorunda ve subkutan yerleþimli mültipl nörofibromalarla seyreden tipik bir Nörofibromatosis tip 1 vakasýný sunduk. Biz kitle ile sinirlerin iliþkisini göstererek ve T2 aðýrlýklý görüntülerde tipik sinyal intensitelerini açýða çýkararak nörofibromalarýn gösterilmesinde ve karakterizasyonunda MR ince¬lemenin çok önem taþýdýðýný vurguladýk.

Neurofibromatosis type 1 is the most frequent form of neuro-fibromatosis and is characterized by the presence of at least two neurofibromas and 6 or more cafe au lait spots although it does have other diagnostic criteria. We showed a typical neurofibromatosis type 1 case which presented multipl neurofibromas in the right sciatic region, sacral nerve roots, both thigh regions, posteriorly localized to the seminal vesicle and scattered subcutaneously. We emphasized that magnetic resonance imaning is very important showing and characterizing for neurofibromas in terms of revealing their typical high signal intensity on T2 weighed images and demonstrating the relationship between the mass and nerves