Amaç: Otoimmün büllü dermatozlar (OBD) genetik zeminde geliþen, vezikül ve büllerle seyreden, morbidite ve mortalitesi yüksek hastalýklardýr. Bu dermatozlar, demografik ve klinik özellikler açýsýndan farklýlýklar göstermekte, tanýsal ve tedavi zorluklarý yaratmaktadýr. Amacýmýz OBD’li hastalarda klinik, demografik özelliklerin araþtýrýlmasý ve bulgularýn belgelendirilmesidir.
Gereç ve Yöntem: Ocak 1997 -Ocak 2007 tarihleri arasýnda kliniðimizde yatarak tedavi gören OBD’li hastalarýn epikriz ve genel arþiv dosyalarý incelendi. Demografik özellikler, klinik bulgular kaydedilerek literatür gözden geçirildi.
Bulgular: Çalýþmaya toplam 79 OBD hastasý alýndý, (yaþ or¬talamasý 52.96, kadýn/erkek, 50/29).En sýk OBD Pemfigus Vulgaris (PV, %49,36), en nadir OBD. Pemfigus Herpetiformis ve Lineer IgA dermatozu (%1,26) idi. PV hastalarý orta-lama 34,2 günle en uzun yatýþ süresine sahipti. En sýk anatomik tutulum yeri gövde arka yüz lokalizasyonuydu. (% 60). Oral mukozal lezyonlar en sýk PV’ de görüldü.. Taný almadan önce ortalama yakýnma süresi en uzun olan hastalýk, 89,16 ay ile Pemfigus Vejetans idi.
Sonuçlar: Bulgularýmýz literatürle benzerlik göstermekteydi.

Objective: Autoimmune bullous disorders (ABD), which occur on the genetic background and characterized with vesicles and bullae, have high morbidity and mortality rates epidemiologically. They exhibit distinctive features in terms of demographic and clinical characteristics and display diagnostic and therapeutic difficulties. Our aim to evaluate and manifest the clinical and demographic features of the inpatients with ABD, between Jan 1997 and Jan 2007;to document data and review the literature.
Methods and Materials: The medical records of the patients with ABD admitting to our dermatology department between Jan 1997 and Jan 2007 were evaluated. Demographic and clinical features including anatomic localisation of the lesions, associated disorders, complications were recorded by microsoft access database software.
Results and Conclusion: 79 patients with ABD were enrolled to the study, (mean age: 52,96 and female/male ratio was 50/29.) The most frequently seen ABD was pemphigus vulgaris (PV %49,36) and bullous pemhigoid (BP, %32,9I) and pemphigus herpetiformis and linear IgA bullous disease were the least frequent OBD with a ratio of %1,26. The patients with PV had longest duration of hospitalization with a mean duration of 34,2 days The lesions were most frequently seen on the back region of trunk (%60). Oral mucosal lesions were most frequently seen on the patients with PV.The OBD with the longest period before the diagnosis was pemphigus vegetans. Our all data were compatible with the literature.

Amaç: Bu çalýþma, sigara kullanýmýnýn çeþitli gebelik komplikasyonlarý üzerindeki etkisini ortaya çýkarmak için yapýldý.
Gereç ve Yöntem: Sigara kullanýmýna göre dört gruba ayrýlan 1000 gebe kadýn (Sigara kullanmayanlar, günde 1-5 adet sigara içenler,günde 6-10 adet sigara içenler, günde 10’dan fazla sigara içenler) retrospektif olarak incelendi.
Bulgular: Çalýþma grubunun ortalama yaþý 28+-3A idi.Preeklampsi için odds oraný 0.64 preterm eylem için odds oraný 1.2 idi.
Yorum: Sigara kullanýmý, preterm eyleme ve fetusta büyüme geriliðine yol açmaktadýr; ancak preeklampsi insidansýný azaltmaktadýr.

Objective: This study was performed to characterize the effect of smoking on pregnancy complications.
Study Design: 1000 pregnant women were grouped into 4 categories: (Nonsmokers, 1+-5 cigarettes per day, 6+-10 cigarettes per day and more than 10 cigarettes per day) and they were retrospectively analyzed.
Results: The mean age of the study was 28+-3.4.The odds ra¬tio for preeclampsia was 0.64 and for preterm labour was 1.2.
Conclusion: Smoking increases the incidence of preterm labour and intrauterine growth restriction but by a dose related manner it decreases the incidence of preeclampsia.

Amaç: Çalýþmamýzda alt batýn cerrahisi olgularýnda bupivakain ve ropivakain ile oluþturulan epidural anestezide blok özellikleri, peroperatuar hemodinamik deðiþiklikler ve postoperatuar erken dönemde analjezik özeliklerin karþýlaþtýrýlmasý amaçlandý.
Gereç ve yöntem: Hastanemiz Etik Kurulu izniyle, yazýlý onaylarý alman, inguinal herni operasyonu geçirecek ASA I-Il grubundan 30 olgu çalýþmaya dahil edildi. Premedikasyon tüm olgularda ÝV sývý replasmaný sonrasý midazolam ile saðlandý. L seviyesinden direnç kaybý yöntemiyle epidural aralýða girildikten sonra randomize olarak iki gruba ayrýlmýþ olgulardan; Grup B’dekilere %0.5 bupivakain, Grup R’dekilere %0.5 ropivakain 15 ml verilerek epidural blok gerçekleþtirildi. Çalýþma parametreleri olarak hemodinamik parametreler (ortalama arter basýncý, kalp atým hýzý), duyusal ve motor blok seviyeleri, duyusal bloðun 2 segment gerileme zamaný, postoperatuar 2. ve 6. saatlerde aðrý düzeyleri (Vizüel analog skala-VAS- ile), ilk analjezik ihtiyacý zamaný kaydedildi.
Bulgular: Her iki grupta hemodinamik parametrelerde peroperatuar kontrol deðere göre anlamlý olmayan azalma saptandý (p>0.05). Grup B‘de Grup R’ye göre duyusal bloðun 2 segment gerileme zamaný anlamlý olarak uzun (p<0.05), motor blok seviyesi anlamlý olarak yüksek (p<0.05) bulundu. VAS deðerleri gruplar arasýnda benzerdi (p>0.05). ilk analjezik ihtiyacý Grup R‘de Grup B’ye göre daha erken dönemde ortaya çýktý (p<0.05).
Sonuç: Alt batýn cerrahisi geçirecek olgularda bupivakain ile oluþturulan epidural anestezide daha yüksek seviyede motor blok oluþumunun ve duyusal blokta daha geç oluþan gerilemenin, ropivakain ile oluþturulan epidural anesteziye oranla peroperatuar anestezi ve cerrahi ile postoperatuar analjezi kalitesine daha fazla katkýsý olacaðý düþünüldü. Bununla birlikte erken mobilizasyon istendiðinde ve kardiyotoksisite riski göz önüne alýndýðýnda ropivakain epidural yolla uygulamada bu tür giriþimlerde bupivakaine alternatif olabilir.

Objective: In our study we aimed to compare the characteristics of epidural block, peroperative haemodynamic changes and analgesia in early postoperative period in epidural anaesthesia produced by bupivacaine and ropivacaine for lower abdominal surgery.
Study design: After the approval of Medical Ethics Committe of our Hospital and written informed consent, 30 patients in ASA I-II undergoing inguinal hernia repair were included the study. Midazolam was used for premedication after IV fluid replacement. Epidural anaesthesia wps performed from L} 4 epidural space with loss of resistance method with 15 ml 0.5% bupivacaine in Group B and 15 ml 0.5% ropivacaine in Group R. Haemodynamic parameters (mean blood pressure, heart ra¬te), sensory and motor block levels, time to two segment regression of sensory block, postoperative analgesia at 2. and 6. hours (with Visuel Analogue Scale-VAS), time to first analgesic demand and adverse effects were recorded as study parameters.
Results: Haemodynamic parameters were lower peroperatively in two groups when compared with control values (p>0.05). Time to two segment reggression of sensory block was significantly longer and motor block degree was significantly higher in Group B than Group R (p<0.05). VAS values were comparable between the groups. Time to first analgesic demand was significantly shorter in Group R than Group B (p<0.05).
Conclusion: High degree of motor block and delay of regression of sensory block after epidural anaesthesia produced by bupivacaine in inguinal hernia repair was evaluated more effective on quality of anaesthesia and surgery peroperatively and analgesia postoperatively than produced by ropivacaine. On the other hand, epidural ropivacine can be an alternative to bupivacaine when less cardiotoxicity and early mobilization were aimed in such operations.

Amaç: Ýnsan boðaz florasý birçok bakteriyi barýndýrmaktadýr. Kalabalýk yaþam koþullarý, boðazda bulunan normal flora bakterileriyle beraber patojen mikroorganizmalarýn da kolonizasyonunu arttýrýr.
Gereç-Yöntem: Okul çocuklarýnda, patojen olabilen bakterilerin diðer bakteriler ile birliktelikleri ve ayný sýnýfta kümelenmenin varlýðý incelenmiþtir. Bu amaçla yaþlan 7 ile 10 arasýnda deðiþen saðlýklý 114 (67 erkek, 47 kýz) çocuktan, boðaz sürüntüsü alýndý ve üreyen mikroorganizmalar açýsýndan deðerlendirildi.
Bulgular: 11 farklý türden 290 bakteri izole edilmiþtir. Bu mikroorganizmalar içinde S. pneumoniae %7, S. pyogenes %13 ve N. meningitidis %4 oranýnda izole edilmiþtir.
Sonuçlar: Sonuç olarak patojen bakterilerin kýz çocuklarda erkeklere göre daha fazla olduðu, kardeþ sayýsý arttýkça bakterilerin kolonizasyonunun arttýðý gözlenmiþtir. Bu durum, bu tip patojenlerle geliþebilecek infeksiyonlar açýsýndan önemlidir. Patojen bakterilerde ayný sýnýfta kümelenme görülmemiþtir. Bakterilerin birlikte bulunuþlarý incelendiðinde bir özellik saptanmamýþtýr.

Objective: Human throat flora contains many bacteria. Crowded living environments increase colonization of pathogen microorganisms along with the normal flora bacteria that could be in the throat.
Materials-Methods: The co-existence of potential pathogen bacteria with the other ones and the existence of one class of microorganisms were also considered on the school children. Therefore, we took throat cultures from 114 healthy children aged 7 to 10 (67 male, 47 female) and evaluated them in terms of grown microorganisms.
Results: We isolated 290 bacteria from 11 different genus. Among these bacteria, isolation rates of S. pneumoniae, S. pyogenes and N. meningitidis are 7,13, 4 % respectively.
Conclusions: Finally, the bacteria which have the potential to induce a disease was found to be higher in the females than males and by the increased number of siblings, the colonization of the bacteria was also increased. This condition is very important as for the infections which may develop with such pathogens. No same class accumulation of the pathogen bacteria was observed. No specialty was found when the coexistence of the bacteria was observed.

Giriþ: p53 hücre siklus düzenleme mekanizmalarýnýn merkezinde bulunan önemli bir transkripsiyon faktörüdür. Ki67’nin dokuda gösterilmesi ise proliferasyon aktivitesinin ölçümünü saðlar. Bu çalýþmada, normal tiroid, fetal tiroid, hiperplastik nodül, folliküler adenom ve papiller karsinomda p53 ve Ki67 nin immünhistokimyasal boyanma profilleri araþtýrýlmýþtýr.
Gereç ve yöntem: Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Patoloji Laboratuarýnda hiperplastik nodül, folliküler adenom ve papiller karsinom tanýsý verilen 53 tiroid operasyon materyali yantsýra, 5 fetal tiroid ve 5 normal tiroid dokusu çalýþma kapsamýna alýndý. Bu vakalara KÝ67 ve p53 immünohistokimyasal boya çalýþmalarý uygulandý. Her iki immün belirteç için nükleer boyanma deðerlendirmeye alýnarak sayým iþlemi yapýldý.
Bulgular: Fetal tiroid, normal tiroid, hiperplastik nodül olgu¬larýnda Ki67 ve p53 için boyanma saptanmadý. Yirmi folliküler adenom olgusunun 3’ünde Ki67 için olumlu boyanma elde edilirken, p53 için boyanma saptanmadý. Yirmi iiç papiller karsinom olgusunun ise 19’unda KÝ67 ile, 6’sýnda da p53 ile olumlu boyanma saptandý. Bu bulgulara göre, papiller karsinomda p53 ve Ki67 boyanma oranlarý, folliküler adenom, hiperplastik nodül, fetal tiroid dokusu ve normal tiroid dokusuna göre anlamlý ölçüde yüksek bulundu (KÝ67 için p<0,0001 ve p53 için p< 0,05).
Sonuç: Papiller karsinomlarýn, genel olarak düþük proliferasyona sahip tümörler olmakla birlikte, benign tiroid tümörleri ve normal tiroid dokusuna göre daha proliferatif olduðu ve p53 gen ekspresyonunun varlýðý gösterilmiþtir.

Objective: p53 is an important transcription factor in the centre of cell cyclus coordination mechanisms. The staining of Ki67 in the tissue helps to evaluate the proliferation activity. The immunohistochemistry staining profiles in normal thyroid, fetal thyroid, hyperplastic nodule, follicular adenoma and papillary carcinoma have been investigated using p53 and KÝ67 in this study.
Study design: Fifty three thyroid operation materials diagnosed in the Pathology Laboratory of Þiþli Etfal Tranining and Research Hospital, as hyperplastic nodule, follicular adenoma and papillary carcinoma were studied. Five fetal thyroid and 5 normal thyroid tissues were also included in the study. KÝ67 and p53 immunohistochemistry stains were applied. Nuclear staining was evaluated for both of the immune indicators and the number of stained cells were calculated.
Results: Immunostaining was not observed for KÝ67 or p53 stains in fetal thyroid, normal thyroid and hyperplastic nodules. Positive staining was established for Ki67 in 3 of 20 follicular adenomas, but staining was not observed for p53. In 19 of 23 papillary carcinomas, there was staining for KÝ67. In 6 of 23 papillary carcinomas, there was staining for p53. The staining rates of p53 and KÝ67 staining for the papillary carcinoma were significantly high, when compared with follicular adenoma, hyperplastic nodule, fetal thyroid and normal thyroid tissues. (p< 0,0001 for KÝ67 and p< 0,05 for p53).
Conclusions: Although papillary carcinoma are tumors with low proliferation activity, they were found to be more proliferative and have p53 gene expression when compared with benign thyroid tumors and normal thyroid tissue

Primer hiperaldosteronizm nedenleri arasýnda aldosteron salgýlayan adenom, aldosteron salgýlayan karsinom ile bilateral adrenokortikal hiperplazi yer almaktadýr. Adrenokortikal hiperplazi vakalarýnýn %25-35’ini teþkil eden idiopatik hiperaldosteronizmde adrenal kortekslerin makroskopik olarak normal, veya mikro ve makronodüllü, ya da mikroskopi ile hiperplazik olduklarý gösterilmiþtir. Biz hu olgu sunumumuzda 2 yaþýndan itibaren dirençli hipopotasemi tablosuyla seyreden ve bunun neden olduðu metabolik alkaloza baðlý iyonize kalsiyum düþüklüðü sonucu oluþan sekonder hiperparatiroidi ve yine hipopotasemiye baðlý nefrojenik diabetes insipiduslu vakayý irdeledik.

Causes of primary hyperaldosteronism are aldosteron secreting adenoma, aldosteron secreting carcinoma and bilateral adrenocortical hyperplasia. %25-%35 of adrenocortical hyperplasia patients have idiopathic hyperaldosteronism. In these cases adrenal cortex may be normal, macronodular or micronodular macroscopically, or may be hyperplasic, microscopically. In our case report. we described a patient who had resistant hypokalemia since he was 2 years old. In this patient hypokalemia caused metabolic alchalosis which resulted a decrease in ionized calcium levels causing secondary hyperparathyroidism and patient also had hypokalemia releated nephrogenic diabetes insipidus.

Amaç: Bu çalýþmada ventriküloperitoneal þant enfeksiyonu tanýsýyla izlenen olgulara ait bulgularýn sunulmasý amaçlandý.
Gereç ve Yöntem: 1 Ocak 2005-1 Nisan 2007 tarihleri arasýnda ventriküloperitoneal þant enfeksiyonu tanýsý ile yatýrýlan 16 hastanýn týbbi kayýtlarý geriye dönük olarak deðerlendirildi.
Bulgular: Hastalarýn 6’sý erkek (% 38), 10’u kýzdý (% 62); yaþ ortalamasý 6.2 aydý (0.5-26 ay). 13 olguda doðumsal, 3 olguda edinsel nedenlerle hidrosefali geliþmiþti. Enfeksiyonun ortaya çýkma zamaný ortalama 132.5 gündü (7-720 gün). 15 olguda (% 94) ateþ ve huzursuzluk, 6 olguda (% 38) beslenme bozukluðu, 4 olguda (% 25) konvülziyon, 3 olguda (% 19) baþ çevresinde büyüme ve 1 olguda (% 6) ciltten BOS sýzýntýsý mevcuttu. 2 hastanýn (% 13) kan kültüründe, 6 hastanýn (% 38) BOS kültüründe metisiline dirençli koagülaz negatif stafilokok üremiþti. Hastanede yatýþ süresi ortalama 77.4±72.9 gün, ölüm oraný % 25 idi.
Sonuç: Ventriküloperitoneal þant enfeksiyonu mortalité ve sekel riski yüksek olan; uzun sürede ve güç tedavi edilebilen bir durumdur. Risk faktörlerinin varlýðýnda erken taný ve uygun tedavi ile sonuç yüz güldürücü olabilir.

Study Design: Medical records of 16 patients with ventriculoperitoneal shunt infection admitted between January 1 2005- April 1 2007, were evaluated retrospectively.
Results: The mean age of the patients was 6.2 months (0.5-26 months). 10 of them (% 62) were female and 6 (% 38) were girls. Hydrocephalus has developed congenitally in 13 cases and it was acquired in 3 cases. Mean age at onset of infection was 132.5 days (7-720 gün). At admission 15 cases (% 94) had fever and discomfort, 6 cases (% 38) had feeding problems, 4 cases had (% 25) convulsion, 3 cases had (% 19) increased head circumference and one case (%6) had cerebrospinal fluid leakage to skin. Methicillin resistant coagulase negative staphylococcus was isolated from the cerebrospinal fluid in 6 patients (% 38) and in the blood cultures of 2 patients. Mean time of hospitalisation was 77.4±72.9 days. Mortality rate was % 25.
Conclusion: Ventriculoperitoneal shunt infections are associated with high mortality and morbidity. Its treatment is time consuming and diffucult. Outcome may be pleasant with early diagnosis, prompt and appropriate therapy.