Amaç: Çalýþmanýn aman serviks kanserli hastalarda, Cerrahi ve Radyoterapi sonrasý genel saðkalým ve pelvik kontrol oranlarýný etkileyen prognostik faktörlerin geriye dönük olarak incelenmesidir.
Gereç ve Yöntem: 1992-2002 tarihleri arasýnda Þiþli Etfal Eðitim ve Araþtýrma Hastanesi. Radyasyon Onkolojisi Kliniði Serviks kanseri tedavi protokolüne göre tedavi edilmiþ 166 hastadan 6 ay ve daha uzun takip edilen 108’i çalýþmaya alýnmýþtýr. Medyan yaþ 52(22-80)‘din Histopatolojik taný. 96 olguda skuamoz hücreli. 10 olguda adenoakrsinom. 2 olguda küçük hücreli karsinom þeklindedir. 13 olgu evre IB. 14 olgu, evre HA. 25 olgu evre 1IB. 6 olgu evre IIIA. 31 olgu evre IIIB, 12 olgu evre IVA-IVB, 7 olgu da baþvuru sýrasýnda niiks hastalýklýdýr. Evre IB-IIA hastalara cerrahi sonrasý adjuvant olarak. evre IIB-IVA hastalar ise inop olarak deðerlendirilerek Co 60 cihazý ile, 50 Gy (t.8-2 Gy/fr) eksternal radyoterapi yapýlmýþ, ÝCRT dozu (20 Gy) Bý akiterapi Ünitesi bulunan bir merkeze yönlendirilerek tamamlanmýþtýr. Parametrium tutulumu olan olgularda (n=37) tutulu tarafa boost okýrak 10 Gy uygulanmýþtýr. Seçilmiþ vakalarda (n-26) konkomitan kemo- terapi (haftalýk cisplatin 35 nýg/nû) uygulanmýþtýr.
Sonuç: Evrelere göre genel saðladým: evrelB’de 47.3 ay, evre HA, 31.5 ay. evrellB 26.5 ay. evrelllA 23.9 ay, evrellIB 22.3 ay, evre IVA / 9 ay, evrelVB 9 ay dýr (p-().00l). 39 olguda takip sýrasýnda pelvik niiks geliþmiþtir. Taný sýrasýnda pelvik lenf nodu tutulumu olan 33 olgunun, 15’inde (%45) takip sýrasýnda nüks geliþmiþtir. Nükslerin %4I‘I lenf ýýodu tutulumu (+) olan hastalarda geliþmiþtir. Taýýý sýrasýnda paraaortik lenf nodu tutulumu olan 9 hastanýn tamamýnda tedavi sonrasý takipte nüks gözlenmiþtir. 6 olguda kemik, 4 olguda karaciðer, 3 olguda akciðer ve 1 olguda kolonda metastaz saptanmýþtýr.
Tartýþma: Baþlangýçta lenf nodýý tutulum olmasý pelvik nüks riskini artýran önemli bir prognostic faktördür (p-O.OJ). Paraaortik lenf ýýodu tutulumu kötii prognoz ile iliþkilidir. Yaþ ve histopatolojik tipin prognoz üzerine etkileri anlamlý deðidir. Yüksek riskli hastalarda radyoterapiye cisplatin bazlý kemoterapi eklenmesi, tek baþýna radyoterapi ile kýyaslandýðýnda prognozu olumlu etkilemektedir (p-0.05).

Purpose: Our aim was to study, in Cervix cancer patients, retrorespectively, the prognostic factors in relation with the ratio between survival and local-recurrence. Material & Method: Some 108 pateients were chosen, from among 166 who were treated at Si§li Etfal Hospital between 1992- 2002 and had been followed-up at our clinic for 6 or more months.Median Age: 52 (22-88).Histological Diagnosis: 96 patients were squamous cell ca, 20 patients were adenocarcinoma and 2 patients were small cell Ca. Stages: 13 patients were stage IB, 14 were stage HA, 25 were IIB, 6 were IIIA, 31 were IIIB, 12 were IVA-IVB. All patients were received radiotherapy with Co60. Stage IB and HA patients were received radiotherapy as adjuvant after radical hysterectomy. Stage IIB-IV patients were received radiotherapy alone or concomitant with chemotherapy.External radiotherapy was given to 50 Gy (1.8-2 Gy/fr), parametria! boost 10 Gy was given to patients with parametriaI invasion (n=37).ICRT (Intracav.it.er. radiotherapy) 20-25 Gy was given after external radiotherapy. Results: General Survival Rate in relation with stages are: 47.3 months for stage IB, 31.5 months for stage 11 A. 26.5 months for stage IIB, 23.9 months for stage HI A, 22.3 months for stage IIIB, 19 months for stage IVA and 9 months for stage IVB. 39 patients had recurrence at their follow-ups. 41 % of the recurences happened with patients (+) lymph node. All of 9 patients with pataaortic lymph node métastasés at diagnosis had recurrence. 6 patients had bone, 4 patients had liver, 3 patients had lung and / patients had colon métastasés during follow-up. Discussion: Pelvic lymph node métastasés at diagnosis is the major prognostic factor (p=().()l). Patients with paraaortic lymph node métastasés prognosis is worse. Age and hystopcithologic type are less important in prognosis. Radiotherapy with concomitant chemotherapy have positive effect on prognosis with high risk patients (p=0.05).

Amaç: Rektal kanserin preoperatif evrelendirilmesinde transrektal ultrasonografi ve rektal kontrastlý manyetik rezonans görüntülemenin taývsa! sonuçlarýný karþýlaþtýrmak.

Gereç ve Yöntem: 16 hastaya (6 kadýn ve 10 erkek, ortalama yaþ 56: yaþ daðýlýmý 23-80 arasý) 10 Mhz eýýdoanal prob ile transrektal ultrasonografi ve body coil kullanýlarak MR görüntüleme (1.5 T) yapýldý. 1500-2000 ml su ve 20 ml superparamanyetik demiroksit MR kontrastý karýþýmýnýn rektal yoldan uygulanmasýnýn ardýndan koronaI ve aksiyal planlarda Tl gradient recall imajlar atýndý. Deðerlendirmelerin sonuçlarý histopatolojik sonuçlarla karþýlaþtýrýldý.

Sonuçlar: TNM sistemine göre, histopatolojik inceleme ile, 6 hastada T2, 6 hastada T3 ve 4 hastada T4 tümör gösterildi. Evre I hasta yoktu. Tüm hastalarda, T evrelemesi için transrektal sonografinin doðruluðu % 87.5, rektal kontrastlý MR görüntülemenin doðruluðu % 81 olarak belirlendi. Rektal duvar tutulumunuýý deðerlendirilmesinde (Duke’s sýnýflandýrmasý) traýýsrektal sonografinin sensitivitesi % 100, spesifitesi %67 ve doðruluðu % 87.5: MR görüntülemenin sensitivitesi % 100, spesifitesi % 50 ve doðruluðu % 81 olarak bulundu.

Tartýþma: Rektal kanserin preoperatif evrelemesinde transrektal ultrasonografi ve MR görüntüleme yakýn doðruluk oranýna sahipti. T evrelemesinin deðerlendirilmesinde, düþük maliyet, kolay uygulama ve yüksek doðruluk oraný nedeniyle transrektal sonografi ilk tercih olabilir. Endoanal probýýn ulaþamayacaðý yüksek yerleþimli rektal tümörlerde ve yaygýn hastalýktan þüphelenilen olgitIpýrla, MR görüntüleme, transrektal sonografiye tercih edilmelidir.

bjective: We aimed to compare the diagnostic yield of transrectal sonography and magnetic resonance imaging with rectal contrast for preoperative staging of rectal cancer.

Study Design: Sixteen patients (6 women and 10 men, mean age 56 years: range 23-80 years) underwent transrectal ultrasonography performed with 10 Mhz endoanal probe and MR imaging (1.5 T) using a body coil. After application of a mixture of 1500-2000 ml superparamagnctic iron oxide MR contrast.; Tl gradient, recall echo images in the coronal and axial planes were obtained. The results of the examinations were compared with histopathologic results.

Results: According to TNM system, histopathology showed 6 stage T2, 6 stage T3 and. 4 stage T4 tumors. There weren’t any patient with stage /. In all patients, transrectal sonography had an accuracy 87.5% for T staging, and the accu¬racy of MR imaging with rectal contrast in predicting T stage was 81%. The assesment of rectal wall penetration (Duke’s classification A versus B) reveald a sensitivity, spesificity and accuracy of 100%, 67% and 87.5%, respectively for transrectal sonography and 100%, 50% and 81% for MR imaging.

Conclusion: Transrectal ultrasonography and MR imaging had very similar accuracy rate in preoperative staging of rectal cancer. In a highly experienced radiologist, transrectal sonography should be the first choice in prediction of T staging: due to lower cost, easy to perform and high accuracy rate. MR imaging should be prefer to transrectal sonography in highly located tumors of rectum where endoanal probe could not reach and in case of suspected of advanced disease.

Giriþ: Endoskopik retrograd kolanjiopankreatografi (ERCP) bilier sistem ve pankreas hastalýklarýnýn taný rcj tedavisinde çok önemli bir yöntemdir. Cerrahiye alternatif yada cerrahi¬nin bütünleyicisidir. Kliniðimizde ERCP Haziran 2002‘de baþladý. Bu çalýþmanýn amacý kliniðimizde yapýlan ERCP olgularýnýn retrospektif olarak deðerlendirilmesidir.

Sonuçlar: Haziran 2002-M ay t s 2005 tarilý/eri arasýnda kliniðimizde SS hastaya 104 seans ERCP uygulandý. Hastalarýn ortalama yaþý 54 (18-90) 51‘i kadýndý. 88 hastanýn 74’ünde (%84) selektif koledok kaniilasyonýý saðlanmýþtýr. 54 hastada (%6I,4) ise tedavi edici iþlemler baþarýyla uygulanmýþtýr. Hastalarýn 51‘inde (%57.9) koledok lasý. 19‘ýnýda (%21.5) malignite,8 hastada (%9) normal bulgular.1 hastada kist hidatik operasyonuna baðlý kaçak. 2 hastada sklerozun kolanjit, / hastada Camii hastalýðý saplanmýþtýr. 12 hastada (% 13,6) 2. seans, bir hastaya 3. bir hastaya ise 5 seans uygulandý. On iþlemde komplikasyon geliþti (%9,6). Yedi hastada karýn aðrýsý ve hiperamilazemi, 2 hastada hafif sýzýntý tarzýnda kanama ve bir hastada kolesistit geliþti.

Yorum: Yeni ERCP yapmaya baþlayan bir klinik olarak selektif kanalizasyon oranýmýz %84, terapötik iþlemlerde baþarý oranýmýz %61,4’dir. 2.seans iþlemi tekrar denemek baþarýyý arttýrmaktadýr

Endoscopic retrograd cholangiopancreatography (ERCP) is the most important method for the diagnosis and treatment of bilier and pancreatic disease. It is alternative or complamentary to surgery. We have began to perform ERCP at our clinic at June 2002. At this study, a retrospective evaluation of 88 ERCP subjects (104 ERCP procedures) were done. Patient’s mean age was 54 years (18-90 years) and 51 of patients were women. ive cannulation was succesfully done at 74 patients (84%). Also, therapeutic procedures were succesfully done at 54 patients (61,4%). The diagnosis of ERCP were choledocholithiasis in 51 patients (57,9%), malignancy in 19 patients (21,5%), normal findings in 8 patients (9%), biliary leak after cyst hydatic operation in I patients, primary sclerosing cho¬langitis in two patients and Caroli‘s disease in one patient. Second procedure was required for 12 patients (13,6%), three and five procedures were required to one patient eac h. Seven abdominal pain and hyperamylasemia, two mild, self-limited bleeding and one acute cholecystitis were seen as ERCP complication (%9,6). ive cannulation rate was 84% and succes at therapeutic procedures was 61,4%. At temping second procedure was increased succes rate.

Amaç: Henoch-Schönlein Purpurasý (I1SP), çocukluk çaðýnda sýk görülen lökositoklastik bir vaskülittir. Sýklýkla palpabl purpura, artralji-artrit, gastrointestinal ve renal bulgular ile karakterize sistemik bir hastalýktýr. Bu çalýþmada HSP‘li hastalarýmýzýn klinik özelliklerinin deðerlendirilmesi amaçlandý.
Yöntem: Ocak 2002 - Nisan 2005 tarihleri arasýnda I. Çocuk Kliniðinde MSP tanýsý alarak yatýrýlan 75 hastanýn dosyalarý retrospektif olarak Ýncelendi.
Bulgular: Olgularýn yaþ ortalamasý 9.3 ± 3.1 yýldý. Hastalarýmýzýn %55’i erkek, %45‘i kýz idi. Yaz aylarýnda baþvuru oldukça nadirdi. Hastalarýn tamamýnda palpabl purpura, %78’inde GÝS tutulumu, %72’sinde artrit ya da artralji, %33’ünde renal tutulum mevcuttu. %49 hastada dýþkýda gizli kan pozitifliði vardý. Akut batýn tablosunda baþvuran %6.7 hasta mevcuttu. Saçlý deride ödem %5.3 hastada, skrotal ödem %I2 hastada saptandý. Böbrek tutulumu olan hastalarda ortalama izlem süresi-,22.-3 ± 15 aydý. Aðýr böbrek tutulumu olan toplam 13 hastaya böbrek biyopsisi yapýldý. Yorum: HSP’ nm en sýk görülen bulgusu cilt döküntüsü olmakla beraber, daha önce veya takipte eklem tutulumu, renal ve gastrointestinal bulgularýn ortaya çýkabileceði, diðer vas- kiilit tablolarýna eþlik edebileceði akýlda tutulmalý ve ayýrýcý tanýda dikkatli olunmalýdýr.

Objective: Henoch-Schonlein purpura (HSP) is a common leukocytoclastic vasculitis of childhood characterized by purpuric skin lesions, arthritis, gastrointestinal and renal involvement, Our aim was to evaluate the clinical findings of our patients with HSP.
Study Design: 75 patients diagnosed as HSP who were hospitalized in our clinic between January 2002 and April 2005 were retrospectively evaluated.
Results: Mean age of the patients (55% boys and 45% girls) were 9.3 ± 3.1. Hospitalization rates were lowest during summer seasons. All patients had palpable purpura, 78% had GIS findings, 72% had arthritis or arthralgia and 33% had renal involvement. Occult blood was present in 49%, 6.7% had acute abdominal symptoms, scalp edema was present in 5.3% and scrotal edema in 12%. Mean follow-up period for patients with renal involvement was 22.3 ± 15 months. Renal biopsy was performed in 13 patients with serios renal involvement.
Conclusion: Although the most common finding in PISP is the purpura; arthritis, renal or gastrointestinal findings may be present previously or during the, follow-up. Other, causes of vasculitis should also be included in the differential diagnosis.

Amaç: Bu çalýþmada tolamik enfarktlý hastalarda saptanan kognitif bozulduklarýn enfarkt lokalizasyonu ile iliþkisini ve bu bozukluklarýn hastalarýn günlük yaþamýna etkisini araþtýrmayý amaçladýk.
Gereç ve Yöntem: Bu amaçla talamik enfarkt tanýsý akýn 21 hasta beyin bilgisayarlý tomografi ya da manyetik rezonans görüntüleme ile paramedian arter enfarktý, polar arter enfarktý ve inferolateral arter enfarktý olarak 3 gruba ayrýldý. Hastalara kýsa mental durum muayenesi. sayý menzili testi, kelime listesi türetme testi (semantik), kelime menzili ezberleme prosedürü, küp kopyalama ve saat çizme testi uygulanarak kogýýitif deðerlendirme yapýldý.
Bulgular: Kognitif bozukluk paramedian ve polar arter enfarktlarmda daha sýktý.inferolateral arter enfarktlarinda kognitif bozukluk nadirdi ve bu grupta kognitif bozukluk saptanan hastalarýn hiçbirinin okýuna yazmasý yoktu. Kognitif bozukluk ayný zamanda bilateral talamik enfarkth olgularda da belirgindi.
Sonuçlar: Tolamik enfarktlarda kognitif bozulma en fazla paramedian ve polar arter enfarktlarýnda iken en az inferolateral enfarktlarda teshil ediimiþtir.Diiþiik eðitim düzeyi kognitif durumu etkilemektedir. Ayrýca bilateral talamik enfarktlar enfarkt lokalizdsyonundan baðýmsýz olarak kognitif bozulma için bir risk oluþturabilir.

Objective: In our study we aimed to investigate the cognitive dysfunction in thalamic infarctions and its relation with the localization of the infarction and its effect to activities of the daily living.
Study Design: 2 / patients with the diagnosis of thalamic infarction were grouped as paramediafi artery infarction, polar artery. infarction and inferolateral artery infarction using brain cranial tomography or magnetic resonance imaging. All patients had cognitive evaluation with minimental state examination, digit span, word generation procedure (semantic), drilled word span procedure, drawing a clock and copying a cube.
Results: Cognitive dysfunction was more common in patients with paramedian and‘polar artery infarctions. In inferolateral artery infarctions cognitive dysfunction was seldom and none of the patients with cognitive dysfunction were educated in this group. Cognitive dysfunction was also prominent in patients with bilateral thalamic infarctions.
Conclusions: Cognitive dysfunction in thalamic infarctions were more common in paramedian and polar artery infarctions where as it is less common in inferolateral infarctions. Education can affect cognitive status. We decided that bilateral thalamic infarctions may. be a risk factor for cognitive dysfunction free of the localization of the lesion.

Amaç: Travmatik epidural hematomlarýn tedavi kriterleri ve prognostik faktörlerinin saplanmasý

Gereç ve Yöntem: Bu çalýþmada. 1996-2000 yýllarý arasýnda, travmatik epidýýral hematimi nedeniyle öpere edilen 69 hasta, yaþ. cinsiyet, travma etiolojisi, baþvuru Gtaskow koma skoru (GKS). yerleþim yeri, eþlik eden intrakranial lezyonlar ve Glasgow koma skoru (GGS) yönünden incelenmiþtir.

Bulgular: Vakalarýn %R5.5’i erkek, % 14.5‘i kadýndý: eri sýk %37.7 ile 21-40 yaþ grubundaydý. Vakalar %95.7‘si supratentorial yerleþimli idi. Travma etiolojisinde en sýk trafik kazalarý yer almaktaydý (% 33.6). Mortal ile oraný %l 0.1‘ idi.

Sonuç: Epidural hematomlarda erken cerrahi önemlidir, endikasyon için bilgisayarlý beyin tomografisi ve bilinç düzeyi birlikte deðerlendirilmesinin yaný sýra özellikle yoðun bakýmda hastalarýn ICP (Intracranial pressuretintra kranial basýnç) takibi mortaliteyi düþürmeye yönelik tedavi zamanlamasý ve biçimi açýsýndan çok önemlidir.

-brbr-Conclusion- Early surgical treatment is important in epidural hematomas. Surgical management of crania! epidural hematomas require a thorough evolution of cranial computerized tomography and level of consciousness. Furthermore, ICP is essential to decide on the timing and the method of treatment for being able to decrease mortality-

Amaç: Anestezi indiiksiyonunda birden fazla ilacýn birlikte kullanýmý “koindüksiyon” olarak tanýmlanmýþtýr. Çalýþmamýzda. propofolün anestezi indüksiyonunda tek baþýna kullanýmý ile midazolamla kombine olarak koindüksiyonda kullanýmýný karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Hastane Etik Kurulunun izniyle, ASA l-ll grubundan 40 olgu randomize olarak propofol (Grup P) ve koindüksiyon (Grup K) gruplarýna ayrýldý. Indüksiyon fenta- nili takiben kirpik refleksi kaybolana kadar verilen propofol ve atraküryumla gerçekleþtirildi. Grup K’da Grup P‘den farktý olarak propofol öncesi 0.03 mg / kg midazolam verildi. Ýdame propofol infüzyonu, 02 içinde %33 N20 ile saðlandý. Hemodinamik parametreler indüksiyoýý öncesi ve sonrasýnda 3., 5., 10. ve 15. dklarda, peroperatuar ve postoperatuar 15 dk aralýklarla takip edildi. Indüksiyon propofol dozu, propofol e baðlý aðrý, derlenme, yan etkiler kaydedildi. Bulgular varyans analizi ve kikare testleriyle deðerlendirilerek, p<0.05 anlamlý kabul edildi.
Bulgular: Indüksiyon propofol dozu ile propofol e baðlý aðrý insidansý Grup K‘da anlamlý olarak düþüktü (p<0.05). Grup P‘de Grup K’ye göre derlenme daha uzun ve yan etki sýklýðý daha yüksek bulundu (p<0.05). Hemodinamik parametreler Grup P‘de Grup K’ya göre indüksiyonda anlamlý düþiik (p<0.05) olmakla birlikte, gruplar arsýnda peroperatuar ve postoperatuar anlamlý fark saptanmadý.
Sonuç: Propofol ile midazolamm koindüksiyon için kombine kullanýmý indüksiyonda propofolün tek baþýna kullanýmý ile karþýlaþtýrýldýðýnda: propofolün indüksiyon dozunu azaltmýþ, derlenmeyi bir miktar uzatmýþ, yan etkilerin sýklýðýnda azalma saðlamýþtýr.

Objective: Anaesthesia induction with two or more drugs is defined as “coinduction". In our study we aimed to compare propofol administration for anaesthesia induction and combination with midazolam for coinduction.
Study Design: After the approval by the Medical Ethics Committee of our hospital, 40 patients in ASA I-II physical status randomized into two groups as propofol (Group P) and coinduction (Group C) groups. Anaesthesia was induced with fen- tanyl followed by propofol which was given till the loss of eyelash reflex and atracurium. In Group C 0.03 mg/kg midazolam was given before propofol different than Group P. Anaesthesia was maintained with propofol infusion and %33 N20 in 02. Haemodynamic parameters were recorded before induction and at 3., 5., 10. and 15. after induction and 15 mill intervals per and postoperatively. Propofol dose at induction, propofol injection pain, recovery, side effects were also recorded. Results were analysed with analyses of variance and ki kare tests, p<().()5 was considered as significant.
Results: Propofol dose at induction and incidence of propofol injection pain were lower in Group C. Recovery and side effects were similar between groups. Although the haemodynamic parameters were lower in Group P than Group C at induction, these parameters were similar between the groups per and postoperatively.
Conclusion: Combination of propofolmidazolam for coinduction reduced dose of propofol for induction, prolonged recovery shortly and decreased the incidence of side effects compared to propofol administration for anaesthesia induction.

Fibrolamellär tip hepatosellüler karsinoma nadir görülen bir tiimör olup, koýývansiyonel hepatosellüler karsinomaya kýyasla ayýrt ettirici klinik, radyolojik, histolojik ve prognostik özelliklere sahiptir. Biz olgu bildirimizde özgeçmiþinde siroz hikayesi olmayan 28 yaþýndaki bir erkek hastayý tanýmladýk. Hastanýn rutin laboratuvar muayenesinde karaciðer enzimleri yüksekti ve yapýlan ultrasonografide büyük bir karaciðer kitlesi tespit edildi. Manyetik rezonans görüntüleme ile bu tümörler için tipik olan büyük lobiile þekilli kitle lezyonu, erken fazda yoðun heterojen kontrast tutulumu., santral skar dokusu ve ekstrahepatik malign lenf nodlarý ortaya kondu. Core biopsisini takiben yapýlan histopatolojik inceleme ile fibrolamellar tip hepatosellüler karsinoma tanýsý doðrulandý. Hasta karaciðer dýþý hastalýk yayýlýmý nedeniyle rezeksiyona uygun bulunmadý ve kemoterapiye gönderildi.

Fibrolamellar type hepatocellular carcinoma is a rare malignant tumor that has distinctive clinical, radiological, histological and prognostic features in comparison to conventional hepatocellular carcinoma. In our case report, we describe a 28 year old male who has no history of chirrhosis. In a routine laboratory examination, liver enzymes were found abnormal and ultrasonographic examination revealed a huge liver mass. Magnetic resonance imaging demonstrated typical features of these tumors which include large lobulated mass, early heterogenous dense enhancement, santral scar tissue and extrahepatic malignant lymph nodes. Following core biopsy, histopathologic examination confirmed the diagnosis. The patient was regarded as unresectable due to extrahepatic disease and underwent to chemotherapy.

10 yýl önce geçirilmiþ pnömoni öyküsü olan 54 yaþýnda ev hanýmý hasta, kliniðimize Uç ayckýn heri eforla nefes darlýðý, kuru öksürük, halsizlik, kilo kaybý ve yaygýn eklem aðrýlarý þikayetleriyle baþvurdu. 20 yýldýr muhabbet kuþu ve papaðan besleyen hastanýn solunum sistemi oskültasyonunda öksürük ve pozisyonla deðiþmeyen inspiryum sonu railer duyuldu.PA akciðer grafisinde bilateral alt zonlarda bronkovaskuler izlerde belirginleþme, toraks yüksek rezolüsyonlu bilgisayarlý tomografide hýýzlýý cam görünümü saptandý. Yapýlan bronkoskopide sað ve sol bronþ sistemi mukozasýnda frajilite artýþý dýþýnda patolojik bulguya rastlanmadý. Balgam ve bronkoalveolar Ictvaj sývýsý gram boyamasý ve kültürde bakteri görülmedi. BAL immünolojik tetkikinde lenfosit hakimiyeti, CD4ICDB oranýn¬da azalma mevcuttu. Hastanýn ileri yaþta olmasý ve olasý mal ignite þüphesi nedeniyle, mini torakotomiyle elde edilen acýk akciðer biyopsi piyesinde perihronþiyoler lenfosit topluluklarý ve orta derecede fibrozis saptandý. Mevcut anamýýez ve bakteri kültürü negatifliði nedeniyle yapýlarý serolojik testlerde chlamydia IgM negatif, IgG pozitif bulundu. Tür ayrýmý için yapan MIF tekniði ile C. pneumoniae‘ya karþý IgM negatif, IgG yüksek fitrede pozitif C. trachomatis ve C. psittaci’ye karþý IgM ve IgG negatif bulundu. Olgu. IgM negatif ancak yüksek litrede IgG pozitif saptandýðý içiýý subakýýt seyirli C. pneumoniae pnömonisi olarak deðerlendirildi. Tetrasiklin 2grigiiýý þeklinde haþlanan tedaviye 10 gün sonra in tolerans olmasý nedeniyle klaritromisin Igr.l giiýý verildi. 3 aydan beri izlenen hastada klinik ve radyolojik olarak parsiyel regresyorý gözlendi.

Our case was referred to our clinic with effort dyspnea, dry cough, malaise, and weight loss and joint pain lasting for three months. In the respiratory auscultation of the patient who had a history of avion pet for 20 years (parakeet and parrot), eougli and rales at terminal inspirium not altering with position were heard. In his chest roentgenogram marked appearance in hronchovaseular traces in bilateral lower zones and an appearance of ground glass in high resolution computerized tomography of thorax were determined. In the bronchoscopy performed, no pathological finding was encountered except increased fragility in the mucosae of the right and left bronchial systems. No bacteria were found in sputum and gram staining of BAL fluid, neither in the culture. There was a preponderance of lymphocytes and a decrease at the ratio of CD4ICDH in the immunological examination carried out. Due to the fact that the ease was an old woman and that malignancy was suspected, peribronchiolar lymphocyte populations and moderate degree of fibrosis were detected at the open lung biopsy piece obtained by mini thoracotomy and malignancy has been ruled out. As the bacterial culture was negative, serological tests have been performed and Chlamydia IgM was found to be negative, and IgG positive. By MIF technique performed for the differentiation of species, IgM was found negative, IgG positive at high titration against C. pneumoniae and IgM and IgG negative against C. trachomatis and C. psittaci. The case was evaluated as C. pneumoniae (possible reinfection) with a subacute course, since IgM was detected to be negative, but IgG positive only at high titration. Treatment with tetracycline at a dose of 2 grand day was intolerated 10 days later: therefore tetracycline treatment has been substituted with Chlarytromycine / gram/day. The patient was followed-up for three months and both clinical and radiological partial regression has been observed.

Gastrointestinal stromal tümörler (GÝST) normalde harsak duvarýnda bulunan intestinal pacemaker hücreleri olan Cajal‘ýn interstisyel hücreleri veya onlarýn prekürssörlerinin malign transformasyonundan kaynaklandýðýna inanýlan mezenkimal tümörlerdir. GÝST en çok mideden geliþirken, ince karsaklardan geliþenler nadir olup daha malign potansiyele sahiptir. En sýk semptomlar belirsiz karýn aðrýsý, gastrointestinal kanama ve batýnda kitledir. Esas tedavisi tam cerrahi rezeksiyondur. Cerrahi tedavi sonrasý rekürrens veya rýüks olasýlýðý yüksektir. Bu nedenle hastalarýn cerrahiden sonra özelikle ilk 2 yýl 6 ayda bir, daha sonra yýlda bir muayene ve BT ile takibi uygundur. Bizim olgumuz 83 yaþýnda olup, akut karýn bulgularý ile baþvurdu. BT‘de batýn sol alt kadranda kitle saptandý. Laparatomide jejenumda 5 cýrý çaplý patolojide yüksek gradeli gastrointestinal stronýa tiimör olduðu belirlenen kitle saptandý. Rezeksiyon yapýldý. Hastanýn 2. yýl takibinde nüks görülmedi.

Gastrointestinal stromal tumors are mesenchymal tumors of the gastrointestinal tract that are believed to originate from neoplastic transformation of the intestinal pacemaker cells (interstitial cells of Cajal) normally found in the bowel! wall, or their precursors. The majority gastrointestinal stromal tumors occurs in the stomach, stromal tumors involving the small intestine are far less common but seem to have greater malignant potential. The most common symptoms are vague abdominal pain, gastrointestinal bleeding, and abdominal mass. The mainstay of treatment continues to be complet surgical resection. GIST surgical patients subsequently have an increased risk of postoperati ve recurrence or metastasis. The refore, we recommend systematic follow-up after surgical resection of a malignant GIST including physical examination and CT scan at 6-month intervals for up to 2 years after surgery with following annual CT scan and physical examinati¬on. Our case was 83 years old and applied to our hospital with symptoms of acute abdominal pain. CT scan demonstrated a mass lesion at left lower quadrant. Laparotomy revealed a 5 cm mass which was diagnosed as a high-grade gastrointestinal stromal tumor by pathological examination. Finally, resection was done and no recurrence or metastasis was detected in following postoperative 2 years.