-

-

Amaç: Kanser baþlýca ölüm nedeni olmasý ve medikososyal problemleri açýsýndan; kanser istatistiðinin üzerinde önemle durulmasýna yol açmýþtýr.
Gereç ve Yöntem: Bu çalýþma ile Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Radyasyon Onkolojisi Kliniði‘ne baþvuran hastalarý ikamet yerleri, cins, yaþ, tanýlarý ve sosyal güvencelerine göre retrospektif inceleyerek hastanemizin çekim alanýný (catchment area) belirleyip; ülkemizin kanser istatistiklerine katkýda bulunmayý amaçladýk.
Bulgular: Kliniðimize 17.09.1984-24.10.2001 tarihleri arasýnda 20.467 hasta baþvurmuþtur. Kadýn/erkek oraný: 0.59’dur. En sýk görülen yaþ grubu 61-70’dir. En fazla hastanýn geldiði ilk 3 il Ýstanbul (n=2307,%15.7), Kastamonu (n=670,%4.5) ve Sivas (n=654,%4.4)’týr.
Sonuçlar: 1984 yýlýndan itibaren imkanlarýn artýþý, kliniðin tanýnmasý, radyoterapi ekipmanlarý, cihaz niteliklerinde ve sayýsýnda artýþ, multidisipliner çalýþmanýn artmasý nedeniyle hasta sayýsýnda artýþ meydana gelmiþtir. Hastanemizin devlet hastanesi olmasý, tüm sosyal güvence kurumlarýna baðlý kanser hastalarýna cerrahi, radyoterapi ve kemoterapi tedavilerinin tümünü ücretsiz uygulayabilmesi diðer en büyük etkenlerdir.

Objective: Being the main death cause and medico-social problems of the disease makes statistics of cancer have become more important.
Study Design: We aimed to participate with this study to the cancer statistics of our country by doing a retrospective research of the patients who applied to The Department of Radiation Oncology of Þiþli Etfal Training and Research Hospital to determine catchment area by sorting them to their dwelling, sex, age, diagnosis and social guarantee.
Results: 20.467 patients have applied to our clinic between 17.09.1984 and 24.10.2001. Ratio of women/men was 0.59. Frequently seen age group was between 61 and 70. The first 3 countries of which the most the patients came from: Istanbul (n=2307,15,7%), Kastamonu (n=670,4,5%) and Sivas (n=654, 4,4%).
Conclusions: After 1984 the increase of clinics reputation, using new radiation instruments, increase in the quality of equipment and number, multidiciplinary work rised the patient numbers. Being a goverment hospital and applying surgery, radiotheraphy and chemotherapy without a fee to all social security associations patients who have cancer is an important factor.

Amaç: Lomber ponksiyon (LP) Beyin içindeki boþluklarda ve omurilik çevresinde dolaþan sývýnýn incelenebilmesi için uygulanan bir yöntemdir. Çeþitli hastalýklarýn (enfeksiyon, kanama, tümör... vb) belirtilerini görebilmek, kafa içi basýncýný ölçebilmek veya tedavi uygulayabilmek amacýyla LP yapýlmasý gerekebilir. Ýnvazifbir iþlem olduðu için ebeveynlerin iþlem hakkýnda bir takým çekinceleri vardýr. Ebeveynlerin LP hakkýndaki þüphe ve endiþelerini deðerlendirmek, bunlarýn sebeplerini araþtýrmak ve çözüm üretmek amaçlý bir çalýþma yürüttük.
Gereç ve Yöntem: Ailelerin iþlem hakkýndaki bilgi ve çekincelerini deðerlendirmeyi amaçlayan bir soru formu hazýrlanmýþ ve çeþitli sebeplerle LP endikasyonu konulan 90 hastanýn ebeveynlerine, doktor tarafýndan uygulanmýþtýr. Form LP endikasyonunu, ebeveynlerin sosyokültürel ve demografik verilerini, iþleme ilk tepkilerini ve doktorla yapýlan görüþmeden sonraki düþüncelerini içermektedir. Toplanan verilerle ilgili tablolar oluþturulmuþ ve sonuçlar SPSS 11.0 istatistik programý ile deðerlendirilmiþtir.
Bulgular: LP endikasyonlarýnýn çoðu merkezi sinir sistemi enfeksiyonu (%54.4) ve sebebi bilinmeyen ateþti (%22.2). Ebeveynlerin %51.1’i LP iþlemini hemen onayladýlar. %46.6’sý ilk baþta reddetmesine raðmen doktor görüþmesi sonrasý ikna oldular. Felç en sýk korku nedeni idi.
Sonuçlar: Ebeveynler LP iþlemini ilk bakýþta reddetmektedirler; bu da merkezi sinir sistemi enfeksiyonu, intrakraniyal kanama gibi hayatý tehdit eden enfeksiyonlarýn tanýsýný güçleþtiren ciddi bir durumdur. Ciddi hastalýklarýn tanýsýnýn gecikmemesi için toplum ve aileler iþlem konusunda bilinçlendirilmelidir.

Objective: Lumbar puncture (LP) is a method which applied to examine the cerebrospinal fluid. LP is used in diagnose of variable diseases (infections, tumors, intracranial bleeding...i. e.) and to measure the intracranial pressure. As it’s an invasive procedure parents have doubts and anxiety towards LP.
Study Design: A study was carried out to evaluate parents’ attitude and doubts about the lumbar puncture procedure; causes and solutions to these doubts. Parents of 90 children ever applied LP before was enlisted to the study in April 2006-October 2006. A questionnaire was filled by doctor after interview with one of the parents (usually mother). The questionnaire was consist of child’s indication for LP, sociocultural and demographic data about the parents, their initial reaction to the procedure, doubts about LP and thoughts after doctors talk to persuade. Charts were formed about the data we collected and the results evaluated with the SPSS 11. 0 statistical program.
Results: Most of the children’s indication for LP was CNS infections (%54.4), and some of them was fever of unknown origin (%22.2). %51.1 of the parents approved LP in the first hand, %46.6 of them were first denied but persuaded after the interview with the doctor. Paralysis was the most common (%60) doubt.
Conclusions: Parents tend to deny LP in the first hand; this situation is a problem preventing the diagnosis of diseases like CNS infections and intracranial bleeding which are life threatening. We have to acquaint the families and the community about the procedure by media, not to delay the diagnosis of serious diseases.

Amaç: Bu çalýþmada kolesistektomi operasyonu uygulanan hastalarda remifentanil ile fentanilin cerrahi stres yanýt üzerine etkilerinin karþýlaþtýrýlmasý amaçlandý.
Gereç ve Yöntem: Çalýþma, kolesistektomi operasyonu planlanan ASA I-II grubundan 35 olgu üzerinde yapýlmýþtýr. Randomize ve körleme olarak iki gruba ayrýlan olgulara ayný genel anestezi verildi. Grup F’ye (n-18) lmcg/kg fentanil verildi ve tahmini cerrahi bitiþ süresinden 20 dakika önceye kadar Ýmcglkglh infüzyon yapýldý. Grup R’ye (n=17) Ýmcglkg remifentanil verildi ve cilt sütürüne kadar 0,25Ýmeg/kg/min infüzyon yapýldý. 4 ölçüm zamanýnda (1.anestezi indüksiyonundan hemen önce, 2. cerrahi insizyondan önce, 3. insizyondan 10 dakika sonra, 4. ekstübasyondan 20 dakika sonra), OAB, KTA, kortizol, insülin, glikoz, ACTH ve GH deðerleri kaydedildi.
Bulgular: Grup R’de 2. ve 3. ölçüm zamanlarýnda OAB, KTA grup F’ye göre anlamlý düþük bulundu (p<0.05). Kortizol deðeri Grup R’de 2. ve 3. ölçüm zamanlarýnda baþlangýç deðerlerine göre ileri derecede anlamlý düþük bulundu (p<0.001). Her iki grup arasýnda insülin, glikoz, ACTH ve GH deðerleri açýsýndan anlamlý fark bulunmadý.

Sonuç: Remifentanil, cerrahi sýrasýnda fentanilden daha iyi hemodinamik stabilité saðlamýþtýr. Her iki grupta da cerrahiye stres yanýtta benzer etkiler görülmüþ, stres cevap köreltilememiþtir.

Objective: In this study, the effects of fentanyl and remifentanyl on the surgical stress response in patients undergoing cholecystectomy operation were compared.
Study design: 35 patients with ASA I-II physical status undergoing cholecystectomy were included in this study. The same general anaesthesia was given to patients which were double blind randomly divided into two groups. Group F (n=18) had Imcglkg fentanyl and until 20 seconds before the end of surgery lmcg/kg/h fentanyl was infused. Group R (n=17) had lmcg/kg remifentanil and until the end of surgery 0. 25mcg/kglmin remifentanyl was infused. MABP, HR values and blood cortisol, insuline, glucose, ACTH and GH levels were measured in four periods: 1. before the induction of anaesthesia, 2. before the surgical incision, 3. 10 minutes after the incision and 4. 20 minutes after extubation.
Results: During 2. and 3. period MABP, HR values were lower in Group R compared with Group F (p<0.05) and blood cortisol level was lower during 2. and 3. period in comparison with the first period. (p<0.001) There was no difference in the other stress parameters between the 2 groups
Conclusion: During cholecystectomy, remifentanyl provided more stable hemodynamics compared with fentanyl. There was no difference in stress response between the 2 groups and neither remifentanyl nor fentanyl was able to abolish stress response.

Amaç: Çalýþmamýzda, postoperatuar aðrý kontrolünde tramadolün hasta kontrollü analjezide (HKA) kullanýmýnda bolus doza eklenen bazal infüzyonun etkinliðini araþtýrmak amaçlandý.
Gereç ve yöntem: Genel anestezi altýnda abdominal histerektomi geçirecek 36 olgu standart anestezi uygulamasý sonrasý randomize olarak 3 gruba ayrýldý. HKA Grup 1’de bolus doz, Grup 11’ de bolus doz + düþük doz, Grup III’de bolus doz + yüksek doz bazal infüzyon uygulamalarýyla saðlandý. Postoperatuar aðrý (Verbal Rating Scale-VRS- ile), solunum hýzý, sedasyon skorlarý operasyon sonrasý 1., 2., 4., 8., 12. ve 24. saatlerde kaydedildi. 24 saatlik toplam analjezik tüketimi hesaplandý. Yan etkiler takip edildi.
Bulgular: VRS; Grup I’de, Grup II ve Grup IIP e göre yüksek, solunum hýzý; Grup II ve Grup III’de, Grup Ve göre düþük ol¬makla birlikte, aradaki fark anlamlý deðildi (p>0.05) Sedas¬yon skoru ve toplam analjezik tüketimi; Grup III’de, Grup I’e göre daha yüksek bulundu (p<0.05). Yan etkiler olarak gast¬rointestinal sisteme ait olanlar Grup II ve Grup III’de Grup I’e göre daha sýk görüldü.
Sonuç: Tranýadolün postoperatuar aðrý tedavisi saðlamak amacýyla HKA’de kullanýmýnda, bolus doza eklenen bazal infüzyon uygulamasýnýn, aðrýyý kontrol etmede bolus doza göre anlamlý bir üstünlük saðlamadýðý, yanýsýra total analjezik tüketiminde artýþa neden olduðundan, baþta solunum depresyonu olmak üzere yan etkileri artýracak bir faktör olduðu sonucuna varýldý.

Objective: In our study we aimed to investigate the effectiveness of basal infusion added to bolus dose for patient controlled analgesia (PCA) for postoperative pain management.
Study design: 36 patients undergoing abdominal hysterectomy under general anaesthesia were randomized to three groups after standart anaesthetic procedure. In Group I bolus dose regimen, in Group II bolus dose+low basal infusion rate, in Group III bolus dose+high basal infusion rate were used for PC A. Postoperative pain evaluation(with Verbal Rating Scale-VRS-), respiration rate, sedation score were recorded at I., 2., 4., 8., 12. and 24. hours postoperatively. Total analgesic consumption for 24 hours was calculated. Side effects were observed.
Results: VRS was higher in Group I than Group II and Group III and respiration rate was lower in Group II and Group III than Group I. But these differences were not statistically significant (p>0.05). Sedation score and total analgesic consumption were significantly higher in Group III than Group I (p<0.05). Gastrointestinal side effects were more frequent in Group II and Group III than Group I.
Conclusion: We concluded that basal infusion added to bolus dose has not provide a significant superiority to bolus dose alone when used with PCA for postoperative pain management. Also side effects, mainly respiratory depression, can be associated with the increased total analgesic consumption caused by basal infusion.

Çift J üreter stentler uzun süredir rutin üroloji pratiðinde kullanýlmakla beraber son dönemde kullaným endikasyonlarýnýn geniþlemesine paralel olarak komplikasyon oranlarý da artmaktadýr. Bu komplikasyonlar içerisinde en ciddi olanlarýndan biri stentlerin kalsifiye olmasý, kireçlenmesidir (enkrustasyon). Bu makalede sað lomber aðrý, disüri, pollaküri ve makroskopik hematüri þikayeti ile polikliniðimize baþvuran 37 yaþýndaki erkek hastanýn anamnez, fizik muayene ve tetkikler sonucu uzun süre kalmýþ çift J üreter stentin enkrustasyonuna baðlý sað afonksiyone böbrek ve mesane taþý olgusu sunulmaktadýr.

Although double-J ureteral stents have been used routinely in urological practice for a long time, more recently, in parallel with the spread of indications the rate of complications has been on the rise. One of the most serious complications is stent encrustation. In this paper, the case of a 37 year -old patient who has flank pain, dysuria, frequency and macroscopic hematuria is evaluated. Following anemnesis, physical examination and screening test, evidence is presented with respect to right a functional kidney and bladder stone arising from long-standing double-J ureteral stent.

Türkiye’de halk arasýnda delihal olarak bilinen; Brezilya, Japonya, Nepal ve Türkiye’de de Karadeniz Bölgesi’nde üretilen balda bulunan, Rhododendron Ponticum isimli nektarýn, þiddetli bradikardi ve hipotansiyon yaptýðý bilinmektedir. Grayanatoxin I, diðer adýyla andromedotoxin yalnýzca Ericaceae bitkileri tarafýndan oluþturulup toksikasyondan sorumlu içerik olarak kabul edilmektedir. Tipik zehirlenme semptomlarý genellikle gastrointestinal sisteme ait olup bazen yaþamý tehdit eden þiddetli bradikardi ve hipotansiyon geliþebilmektedir. Biz de acil polikliniðimize Karadeniz balý yedikten sonra zehirlenme semptomlarý göstererek baþvuran bir hasta sunduk.

Honey which is produced in Brazil, Japan, Nepal and The Black Sea Region of Turkey is also known as the ‘mad honey’ by Turkish people and contains Rhododendron ponticum nectar, which is known to cause severe bradycardia and hypotansion. Grayanotoxin I, also known as andrometoxin, is only produced by Ericaceae plants and thought to be the compound which is responsible for the poisoning. Typical toxicat ion symptoms are assosieted with gastrointestinal system and sometimes may cause life-treatening severe bradycardia and hypotension. Here we present a patient who admitted to our emergency department with the symptoms of poisoning after the with the black sea honey.

Amaç: Prostat lenfomasý nadir görülen malign hastalýktýr.
Metod/Sonuçlar: 60 yaþýnda erkek hasta prostatizm semptomlarý ile üroloji kliniðine müracaat etmiþti. TUR- biopsi sonucu primer prostat lenfoma tanýsý konuldu. Radyasyon Onkolojisi Kliniðine yönlendirilen hastaya 6 kür CHOP kemoterapisi ardýndan eksternal Radyoterapi primer bögeye uygulandý. 1 yýl sonra inguinal lenf nodu metastazý saptandý. Ve kür 2. seri kemoterapi olarak VEBEP rejimi uygulandý. Hasta halen kliniðimizde takip edilmektedir.
Tartýþma: Primer prostat lenfoma görülme yaþý literatürde 57 olarak bildirilmiþtir. Klinik olarak; prostatizm semptomlarý, renal yetmezlik bulgularý, obstrüktif üropati, astenia, kilo kaybý, anoreksi görülebilir. PSA düzeyinintaný ve takipte önemi yoktur. Histolojik taný prostat biopsisi ile konulmaktadýr. Ultrasonografý ve CT taný ve takipte çok önemlidir. Tedavide, TUR veya retropubik prostatektomi sonrasý, kemoterapi ve radyoterapi kullanýlýr.

Objective: Lymphoma of prostate is an uncommon disease. We report a case of prostate lymphoma.
Methods/Results: A 60 year-old male patient was referred to the Urology department with a clinical picture of prostatism. Biopsy was performed, and pathology revealed a primary prostate lymphoma. The patient was referred to Radiation Oncology Clinic. He received 6 cycle CHOP chemotherapy and external pelvic radiotherapy. I year later inguinal lymph node metastases was detected. He received 6 cycle second line VEBEP chemotherapy. The patient is currently followed by regular visits to Radiation Oncology Clinic.
Conclusions: Of the cases reviewed, mean age at diagnosis was 57 years. Clinical behavior was with prostate symptoms, with or without acute urinary symptoms and sometimes manifestations of renal failure due to obstructive uropathy, as well as general symptoms (astenia, anorexia, weight loss). PSA values remain unaltered in prostate lymphoma patients. Histologic diagnosis may be made by transrectal prostate biopsy Ultrasound and CT scan are of great utility for diagnosis of both local and distant tumors. From a therapeutic point of view, surgery for the obstruction of the lower urinary tract (TUR or retropubic prostatectomy) may be necessary, as well as the chemotherapy and radiotherapy.