Objective: Acarbose primarily inhibits the post prandial blo¬od sugar surge, so that the toxic effects of glucose on insulin resistance and the beta-cell function is reduced or prevented. We tried to evaluate the short term effects of additional acar¬bose treatment on metabolic control.
Study Design: Patients with poor metabolic control (HbAlc values between 7-10 nmol/L) under therapy were includucd in the study. An acarbose 3x100mg/day fgroup 1, n=!00) or placebo (group 2, n=30) therapy was added to their previous therapies. Patients were followed up for 12 weeks. Baseline to week 6 and week 12 in HbAlc, c-Pepticle, immunoreactive insuline, body mass index (BMI) and serum lipids were me¬asured.
Results: In group 1, additional acarbose therapy reduced HbAlc from baseline by 1.54 percentage points (p<().()()I ). C- Peptide and insulin levels signifantly reduced at week 6 (p<0.05). This reduction maintained at week 12. In group 2 this reduction was not observed
Conclusion: The data from this study show that additional acarbose therapy provides a good metabolic control and beneficial effects on insulin resistance even in short term in type 2 diabetic patients who previously received oral antidiabetic drugs.

Objective: Epidemiological and clinical aspects of tuberculosis patients who were hospitalised and treated in Yedikule Research and Education Hospital for Chest Disease and Thorasic Surgery 3. Clinic between years 1994-1998.
Study Design: 1965 tuberculosis patients were included in study group. Clinical and laboratory data of all subjects were evaluated retrospectively.
Results: The study group consisted of 1965 subjects with the diagnosis of tuberculosis. 268 (% 13.63) subjects were female and 1697 (%86.37) were male. The mean age of the study group was 30.4 ± 6.28. Active tuberculosis was diagnosed in % 90.63 of the subjects. The mean hospitalization period was 21.6 ± 4 days. In 1630 cases (%82.95) PPD was found to be positive; while BCG scar was observed in 1004 (%51.09) cases. Acid - fast bacilli were detected in %45.03 of the patients hence the diagnoses was made bacteriological!): In %9.36 of cases the diagnosis was possible with cytopatological methods and in the remaining cases (%45.6I) diagnosis was made with clinical and radiological observation. In %5.49 of subjects an additional disease was also found to be present. Diabetes Mellitus was the most common disease accompaning tuberculosis.
Conclusion: Our findings correlated with the results presented in the literature. Further large scale epidemiological studies are needed for an effective and a sophisticated struggle against tuberculosis.

Objective: Traumatic diaphragm rupture is an easily missed complication following blunt or penetrating thoracoabdominal injury. Missing of diaphragm ruptures, increases the related complications, morbidity and mortality.
Study Design: Between January 1998 - January 2003, 10 patients whom were operated due to traumatic diaphragm rupture were evaluated according to age, gender, occurrence of trauma, clinical symptoms, diagnostic assays, accompanying pathologies, operative findings, repair technique, morbidity and mortality.
Results: Nine cases were male and one was female, with a median age of32 (25-44) years. Occurence of the trauma and accompanying organ injuries are; 6 cases were penetrating injury (3 cases of gunshot wounds with liver and spleen injury, 2 cases of stab wounds with liver and 1 case of stab wound with spleen, small bowel injury), 4 cases were blunt trauma due to traffic accident (2 cases with spleen injury and 2 cases with spleen, small bowel injury). The accurate diagnosis was made in the first attendance in 9 cases and 48 hours after in one case. Laparotomy was performed in all cases without necessity for thoracotomy and diaphragm was primarily repaired in all cases. Two cases had pleural effusion after the operation. All patients have discharged from hospital without complication. Median hospital stay is 9.2 days, mean follow- up period is 10 months.
Conclusions: The traumatic rupture of the diaphragm, can easily be missed during the acute period of the trauma. The main and valuable diagnostic tool is PA chest X-ray.Diagnostic laparoscopy could be performed for evaluation and treatment. The main point for its diagnosis is the consideration of its existence.

Objective: The use of thrombolytic therapy in early stages of myocardial infarction is very crutial for the reduction of the mortality rate. However, in these early stages, in certain cases, the expected ECG changes, can not be shown, so the reciprocal changes in other leads become more significant. In this study, uv examined the diagnostic importance of the reciprocal ST segment depression in aVL in early diagnosis of acute inferior myocardial infarction.
Material and Methods: We have done our study among 58 patients who were admitted to our emergency service within ten hours of the onset of chest pain and were treated for acute inferior myocardial infarction in our coronary intensive care unit, in the first ECG recordings, 30 of these patients showed I mm of ST segment elevation at least two of the classical inferior myocardial infarction leads (Dll, III or aVF) these are compared with 28 patients whose ECG recordings showed abnormal q wave and inverted T wave without ST segment elevation. The recordings of ST segment depressions in Dl, aVL and V 1-6 leads are compared within both groups.
Results: In the first group who had more than I mm of ST segment elevation in inferior leads (Dll, III or aVF) demonsrated the highest percentage (%86.5) of ST segment depression in aVL. On the other side, the second group who had no ST seğmeni elevation showed the highest percentage (%57.I) of ST segment depression in aVL. Although first and second group patients showed the highest percentage of ST segment depression in leads of VS. V4 and V4, V5 respectively, when these findings were compared with those of in aVL it was seen that the findings ofaVL were more valuable.
Conclusion: In the early stages of acute inferior myocardial infarction, the reciprocal changes in aVL are diagnostic as well as ST segment elevations in inferior leads. We came the conclusion that these findings are especially helpful in the early thrombolytic therapy of the patients who display no classical ECG findings.

Objective: To evaluate the etiology, associated problems, fre¬quency of epilepsy and the factors which affect antiepileptic therapy in children with spastic tetraplegia.
Methods: A total of 270 consecutive patients (60%males) aged 41-190 months (mean 68) with spastic tetraplegia were retrospectively studied. Type and frequency of epilepsy, EEG finding, cranial MRI finding and etiology of spastic tetraple¬gia were analysed.
Results: Follow up period ranged 15 and 35 months (mean 24 months). The % 54.5 of cerebral palsy were evaluated as spastic tetraplegia, hi the etiology the reasons were found as follow: prenatal in 33 patients, postnatal in 39 patients, peri¬natal ini47 patients. The most, frequent cranial MRI finding was cortical lesions (45.5 %). The frequency of epilepsy was 38 % in spastic tetraplegia. In 65 % of the epileptic patients, the onset age of epilepsy was under I year of age, and generalized convulsions were the most common type. Neona¬tal seizures and cranial cortical lesions associated with a hig¬her incidence of epilepsy. Regarding response to antiepileptic therapy there was not apparently any relationship between control of the seizure and the onset age of the epilepsy and the gender of the patients.
Conclusion: Epilepsy in spastic tetraplegia can be predicted if seizures occur in the neonatal period and if there is cort ical lesion in cranial MRI

Objective: To investigate the risk factors associated with ROP development.
Methods: 280 premature infants were followed according to ROP development between May 2001 and April 2003 in our clinic. Risk factors were recorded.
Results: Among 280 premature babies 105 (%37.5) were developed ROP. The stages of ROP were as follows: 41(%39.04) stage I, 39(%37.14) stage 11, 23(%21.90) stage III and 2(%0.19) stage IV and V.Among 105 ROP developed infants 21(%20) were referred for further treatment to ophthalmological departments of university hospitals.in these 21 infants 19(%18.09) were threshold disease, 1 was (%0.09) stage IV A and 1 was (%0.09) stage V. Associations between 8 potential risk factors and ROP were assesed using univariate tests. Multivariate logistic regression analysis of the significant findings from univariate tests was then performed. Using logistic regression analysis tests we found that birth weight of 1250 gr and below, and gestational age below 32 week were the most important risk factors.
Conclusion: We determined that the most important risk factors in the pathogenesis of ROP were low birth weight and low gestational week.

The etiology of hypertension should be carefully searched in chronic hypertensive pregnant women. In patients with diagnosis of seconder hypertension, precise examinations for identifying the etiology must be throughfully made, patients should be grouped as ‘low‘ or ‘high risk’ before pregnancy and then appropriate therapy and follow-up must be planned.

Tuberculosis in Turkey is a common infectious disease but esophageal tuberculosis is a rare form of extrapulmonary tuberculosis. It usually occurs when tuberculous bacilli infected mediastinal lymph nodes enlarge and with perinodal inflammation invade esophagus wall. Here we present a case of esophageal tuberculosis secondary to mediastinal tuberculous lymphadenitis with endobronchial involvement.

Cavernous angiomas are the second most common intracra¬nial vascular malformation after arteriovenous malformation and represent 15 % of all cerebral vascular malformations. They are congenital malformations and usually present with symptomatic hemorrhages or seizures. In our case report, we have presented a 11 year old female patient who had complex partial seizures. Magnetic resonance imaging revealed a left amygdala lesion which demonstrated typical signal intensity characteristics of a cavernous angioma. The most common location for intracranial cavernous angiomas is within the cerebral hemisphers followed by pons.

Hepatic métastasés due to carcinoid tumors cire highly vascular because they derive blood supply predominantly from the hepatic artery; thus occlusion of the arterial vasculature nourishing the cancer has been used for palliation for many ye¬ars. Noninvasive imaging modalities especially magnetic resonance imaging has a distinguished role in the evaluation of the effectiveness of chemoembolization treatment by demonstrating various degree of necrosis in the lesions as a result of that treatment. In our case, we presented a 14 year old female who had been diagnosed as having a carcinoid tumor with multiple métastasés in the liver. Having applied intraarterial chemoembolization therapy, we performed magnetic resonance imaging of the liver which demonstrated multiple métastasés of varying sizes in the liver They showed either minimal or no enhancement due to necrosis. Thus we can agree that magnetic resonance imaging can he used to check the results of chemoembolization treatment as a reliable and noninvasive modality.

Neurofibromatosis is classified into two different inherited disorders that are known as type 1 and type 2 forms. Type I consists of the peripheric form and is also known as von Recklinghausen disease. It is far more common than type 2 disease and is characterised by benign peripheral nerve sheath tumors and cafe an lait spots on the skin. Other than neurofibromas or schwannomas, neurofibromatosis type I patients have a predilection for developing central nervous system abnormalities which include such as optic nerve gliomas and dysplastic as well as hamartomatous lesions. In our case, we demonstrated a 29 year old female patient with known history of neurofibromatosis type I. Patient had multiple neurofibromas in the pelvis, at the sacral nerve roots and scattered throughout the subcutaneous region. Magnetic resonance imaging revealed characteristic signal intensity features of these lesions and provided useful information about the relationship of these lesions with adjacent structures. Thus we can conclude that it is a very useful modality both in terms of diagnosis and follow-up of patients with neurofibromatosis type 1.