Amaç: Adolesan gebeler, ileri yafltaki gebeler ileri maternal ve fetal sonuçlar açýsýndan karþýlaþtýrýldý.
Gereç ve Yöntemler: 2002-2007 yýllarý arasýnda Þiþli Etfal Hastanesi 1.Kadýn Hastalýklarý ve Doðum Kliniði’ne baflvuran adolesan gebeler ileileri yafl gebeler retrospektif vaka kontrol çalýþlmasý ile karþýlafltýrýldý.
Sonuçlar: Büyük çoðunluðu nullipar olan adolesanlarda düflük doðum aðýrlýklý yenidoðan, preterm eylem ve prematürite oraný ileri yaþ hastalara göre yüksek saptanýrken, fetal distress, fetal hasar, yeni doðan yoðun bakým gereksinimi açýsýndan fark saptanmadý. Adolesanlar ile diðer gebeler arasýnda doðumdaki gebelik haftasý açýsýndan fark saptanmaz iken, daha az makrosomik infant ve daha düflük sezaryen oranlarý izlendi. Perinatal mortalite maternal yaþtan etkilenmedi. Adolesanlarda sezaryen endikasyonu ön planda baþ pelvis uygunsuzluðu (CPD) ve primigravid makat gelifl (PMG) iken, ileri yaþ gebelerde en sýk endikasyon eski sezaryendi. Fetal distress endikasyonu ile sezaryen üç grupta da benzerdi. Özellikle adolesan ve 35 yafl üstü gebelerde prenatal takip oraný düþük saptandý. Adolesanlarda nikahsýz birliktelik oraný diðer gebelere göre yüksek iken, eðitim durumu yetersiz saptandý.
Tartýþma: Bu çalýþma göstermiþtir ki; adolesan ve 35 yafl üstü gebeler yüksek riskli grubu oluþturmakta, her iki gruba da gebelik sonuçlarýnýn düzeltilmesi için sosyal destek, eðitim ve düzenli takip ortamý saðlanmalýdýr. Bu hastalarda oluþabilecek komplikasyonlar ve gebeliðin takibi konusunda özen gösterilmelidir.

Objective: Adolescent pregnants are compared with old age pregnants in terms of maternal and fetal outcomes.
Material and Methods: Adolescent and old age pregnants admitted to Þiþli Etfal Training and Resource Hospital 1. Gynecology and obstetric clinic between 2002-2007 are compared in a retrospective case-control study.
Results: Although the rate of low birth weight infant,premature labour and prematurity are found to be higher in adolescents of whom majority‘r nulliparous than older patients; there is no difference in terms of fetal distress, fetal injury and the need for newborn intensive care unit. There is no difference in terms of gestational week at birth between adolescent and other pregnants; however,there is lower rate of macrosomic infant and caeserian section(C/S). Perinatal mortality is not influenced by the maternal age. The indication for C/S in adolescents are mostly CPD and primigravida breech presentation whereas in older ones the indications mostly are previous C/S. The rate of fetal distress is similar in both groups. The rate of prenatal follow-up is low especially in adolescent pregnants and pregnants above 35 years old. Cohabitation rate is higher in adolescents than other pregnants whereas educational status in adolescents is inadequate.
Discussion: This study has shown that adolescent pregnants and pregnants above 35 years old constitude high risk group, we should provide social support, education and regular follow-ups in order to have better pregnancy outcomes for both groups. We should take care about the possible complications and follow-up issues in those patients.

Amaç: Çalýþmamýzda yetersiz glisemik kontrollü tip 2 diyabetik hastalarýn, var olan OAD tedavilerine günde bir, iki ya da üç doz premiks insülin lispro %25 veya üç doz premiks insülin lispro %50 eklendiðinde, HbA1c düzeyini düþürmedeki etkinliðini amaçladýk.
Gereç ve Yöntem: Tip 2 Diabetes Mellitus tanýsý almýþ, bir ya da daha fazla OAD kullanan, ancak HbA1c düzeyleri >%7 olan 112 hasta ile günde 2 kez premiks insülin lispro %25 ve %75 insülin lispro protamin süspansiyonu ve/veya bir ya da daha fazla OAD kullanýp, HbA1c düzeyleri >%7 olan 29 hasta alýndý. Mevcut OAD tedavisine günde tek doz premiks insülin lispro %25 eklenmesiyle 3. ayýn sonunda regüle olmayan hastalara günde iki enjeksiyon olarak premiks insülin lispro %25 verildi. 6. ayýn sonunda yine regüle olmayan hastalara günde üç defa premiks insülin lispro %25 veya premiks insülin lispro %50 verildi. Hastalarda 3.,6. ve 9. ay sonunda HbA1c deðerleri deðerlendirildi ve baþlangýç düzeyleri ile karþýlaþtýrýldý.
Bulgular: Çalýþmamýzda günde bir kez premiks insülin lispro %25 ile hastalarýn %24’ü, günde iki enjeksiyon ile %47,5’u, günde üç defa premiks insülin lispro %25 ile hastalarýn %77’si Amerikan Diabet Birliði’nin glisemik kontrolü saðlamak için HbA1c<%7’lik hedefine ulaþmýþtýr. Günde üç kez premiks insülin lispro %25 ile hastalarýn %53,6’sý, premiks insülin lispro %50 kullanan hastalarýn %71,4’ü HbA1c <%7 hedefine ulaþtý.
Sonuç: Çalýþmamýz, premiks insülin lispro %25 in günde tek doz baþlanýp, glisemik hedeflere ulaþana dek dozun titre edildiði ve tedavi yoðunluðunun arttýrýldýðý bir örnek model olabilir. Ayrýca postprandial kan þekeri deðerlerinde büyük dalgalanmalarý olan hastalarda, aðýr kronik hiperglisemi ve yüksek HbA1c deðerlerine neden olan daha ileri insülin eksikliði olan hastalarda,günde üç defa premiks premiks insülin lispro %50 ile glisemik hedeflere ulaþýlabileceði sonucuna varmýþ bulunmaktayýz.

Objective: We aimed to evaluate the effectiveness of single, two or three additive doses of premixed insulin lispro %25 or three doses of premixed insulin lispro %50 to existing OAD treatments, on HbA1C levels in Type II Diabetics with poor glycemic control.
Materials and Methods: 112 patients with Type II DM with HbA1c levels >%7, despite using one or more OAD, and 29 patients with HbA1c levels >%7, despite using premixed insulin lispro %25 and %75 insulin lispro protamin suspension twice a day, and/or one or more OAD, were included in our study. Injectable premixed insulin lispro %25 twice a day was prescribed to patients, whose blood glucose levels didn’t regulate at the end of the 3rd month with additive premixed insulin lispro %25 to their existing OAD treatment. At the end of the 6th month, the patients with still unregulated blood glucose levels had premixed insulin lispro %25 or premixed insulin lispro %50 three times a day. The HbA1c levels were checked at 3, 6, and 9th months and compared with the basal levels.
Results: %25 of the patients using premixed insulin lispro %25 once a day, 47.5% of the patients using it twice a day, and 77% of the patients using premixed insulin lispro %25 three times a day reached to the HbA1c <7% target levels to maintain American Diabetes Association’s glycemic control. 53.6% of the patients using premixed insulin lispro %25 three times a day, and 71.4% of the patients using premixed insulin lispro %50 reached to HbA1c <7% target levels.
Conclusion: Our study can be an example model for treatments in which single
dosage of premixed insulin lispro 25% can be started and the dose can be titrated
and the treatment condensed, until the glycemic targets are reached.
Furthermore, our study resulted that with premixed insulin lispro %50 three times
a day, we can reach to the glycemic target levels in patients with large
fluctuations in postprandial blood glucose levels and in patients with severe
chronic hyperglycemia and high HbA1c levels with further insulin deficiency

Amaç: Bu çalýþmadaki amaç, insülin tedavisi baþlanan hastalarda bir yýllýk takip süresi içinde gözlenen toplam kilo deðiþimi ve bunu etkileyen faktörlerin irdelenmesidir.
Gereç ve Yöntem: 279 (%58,8) kadýn, 195 (%41,2) erkek hasta olmak üzere toplam 474 hasta çalýþmaya dahil edildi. Tüm hastalara diyabet eðitim hemþireleri ve diyetisyenler tarafýndan insülin kullanma, diyabet ve diyet eðitimi verildi. Tedavide kullanýlan insülin tipi ve dozu, hastalarýn egzersiz ve diyete uyumu, oral antidiyabetik kullanýmý olup olmadýðý, diyabet kaynaklý komplikasyon varlýðý, tedavi öncesi ve sonrasý glukoz, aðýrlýk ve HbA1c deðerleri tespit edildi.
Bulgular: >5 kg grubunun insülin dozu, ≤5 kg grubundan istatistiksel olarak anlamlý derecede yüksek bulunmuþtur (p=0,033). ≤5 kg alan ve > 5 kg alan hastalarýn insülin tipi daðýlýmlarý arasýnda, istatistiksel farklýlýk gözlenmemiþtir. (p>0,05) Ortalama kilo deðiþikliði, intensif insülin tedavisi alan grupta en fazla izlenmiþtir.
Sonuç: Diabet tedavisi yalnýzca bir hastalýk tedavisi olmakla kalmayýp yeni bir hayat tarzý geliþtirmeyi gerektirir. Ömür boyu sürecek iyi bir tedavi sürecini yakalamak için hastanýn uyumu ve ekip çalýþmasý þarttýr. Ýnsülin tedavisi, tek baþýna kilo artýþýna sebep olmaktadýr. Ýnsülin kullanan diyabetiklerde yýllýk kilo artýþý ortalama 2-4 kg olup bizim çalýþmamýzda 3,23 kg kilo artýþý saptanmýþtýr (1). Kilo alýmýný azaltmak için hipogliseminin ve hipergliseminin çok iyi takip edilmesi, tedavinin buna göre düzenlenmesi, kalori alýmýnýn bilinçli olmasý ve yaþam tarzýna uygun egzersiz alýþkanlýðýnýn edinilmesi çok önemlidir.

Objective: The aim of this study is to investigate the total weight change in a year of follow-up in patients who were initiated to use insulin, and the parameters that affect this situation.
Materials and Method: A total of 474 patients (279 female (58.8%), 195 male (41.2%)) were included in the study. All the patients were trained by diabetes training nurses and nutritionists for using insulin, diabetes and diet. The insulin type and dose used in the treatment, the patients’ compliance to exercise and the diet, the existance of oral anti-diabetics usage, the existance of complications, originating from diabetes, the glucose, and HbA1c levels and the weight before and after treatment were established.
Results: The insulin dose of the > 5 kg group was significantly higher than the ≤5 kg group’s dose (p= 0.033). There were no statistically significant difference between the putting on ≤ 5 kg and putting on > 5 kg groups in the distribution of the insulin type (p> 0.05). The average weight change was observed in the intensive insulin treatment group the most.
Conclusion: The treatment of diabetes is not just a treatment of a disease, but also requires a build up of a new way of life. For a life time good treatment course, the compliance of the patients and a team work are essential. The insulin treatment alone causes gain in weight. The mean annual weight gain in diabetics on insulin is 2-4 kg, as in our study it was determined as 3.23 kg (1). For reducing this gain, it is very important to follow up hypoglisemia and hyperglisemia, to manage the treatment according to this, the conscious calory intake, and to catch the exercise that is suitable to the life style as a habit.

Amaç: Preterm ve term bebeklerde beslenme durumunun tiroid hormonlarý ve idrar iyot düzeyleri üzerine etkisinin incelenmesi.
Gereç ve Yöntem: Yenidoðan Kliniðinde 6 aylýk süre içerisinde yatarak tedavi gereksinimi olan, yenidoðan tarama testleri için kan alýnmasý gereken tüm bebekler çalýþmaya alýndý. Çalýþmaya alýnan bebekler preterm ve term olarak ayrýldý. Konjenital anomalili bebekler, annesinde tiroid fonksiyon bozukluðu olan bebekler ve öyküsünde annenin iyot içeren ilaç kullanýmý bulunan bebekler çalýþmaya alýnmadý. Çalýþma grubundaki bebeklerin yaþamlarýnýn 5 ile 7. günleri arasýnda T3, T4, sT3, sT4 ve TSH düzeyleri ve eþ zamanlý olarak 5 ml spot idrar toplanarak idrar iyot düzeyi ölçüldü. Kan ve idrar örneðinin alýndýðý günde, bebeklerin eþlik eden hastalýklarý, parenteral ve enteral beslenme miktarý ile beslenme þekli (anne sütü ve/veya formül mama) bilgileri prospektif olarak kaydedildi.
Bulgular: Çalýþma kriterlerine uyan 44 bebek çalýþma grubunu oluþturdu. Bebeklerin 32’si preterm, 12’si term idi. Preterm bebeklerin gebelik yaþý ortalamasý 31.9±2.4 hafta (sýnýr 26-37 hafta), doðum aðýrlýðý ortalamasý 1474±447 g (sýnýr: 700-2450 g) bulundu. Term bebeklerin gebelik yaþý ortalamasý 38.9±0.9 hafta (sýnýr 38-40 hafta), doðum aðýrlýðý ortalamasý 3031±521 g (sýnýr 2400-4050 g) bulundu. Preterm bebekler ile term bebeklerin tiroid hormon düzeyleri karþýlaþtýrýldýðýnda, preterm bebeklerin ortalama T4 (µg/dl), sT4 (ng/dl), sT3 (pg/ml) deðerleri (sýrasýyla: 7.45±3.47, 1.50 ± 0.95, 2.69±1.22) term bebeklere (sýrasýyla: 9.90±2.05, 1.64±0.27, 3.02±0.58) göre anlamlý olarak düþük bulundu (sýrasýyla: p deðerleri 0.016, 0.014, 0.037). T3 ve TSH ortalamalarý arasýnda fark yoktu. Preterm bebeklerde idrar iyot düzeyinin (ortalama 168.6±198.7 µg/L) term bebeklere (ortalama 320.0±168.7 µg/L) göre düþük olduðu saptandý (p=0.003). Parenteral beslenen bebeklerde idrar iyot düzeyi enteral beslenenlere göre anlamlý derecede düþüktü (p: 0,017).
Sonuçlar: Preterm bebeklerin tiroid hormon düzeyleri ve idrar iyot düzeyleri term bebeklere göre düþüktür. Özellikle parenteral yolla beslenen prematüre bebekler yaþamlarýnýn ilk haftasýnda iyot eksikliði geliþimi açýsýndan yüksek riske sahiptir.

Objective: The present study was performed to evaluate the effect of nutrition on the thyroid function and urine iodine concentration in preterm and term newborns.
Study Design: This prospective study inculuded all newborns admitted in NICU in 6 months period whose blood samples for neonatal screening were not collected. The neonates were divided into two groups as preterm and term. Infants with congenital malformation and history of maternal thyroid function disorders and maternal use of drug with iodine were not included. Plasma free T3 (FT3), free thyroxine (FT4), total T3, total T4, thyroid-stimulating hormone (TSH) and simultaneous urine iodine concentration in 5 ml spot urine were measured in 5-7 days of life. Other factors including amount of enteral and parenteral nutrition, feeding model (human milk and formula) and accompanying illness were recorded.
Results: The study group was composed of 44 newborns inculuding 32 preterm and 12 term babies. The mean gestational age and mean birth weight of preterm infants were 31.9±2.4 weeks (range 26-37 weeks) and 1474±447 g (range 700-2450 g) respectively. The mean gestational age and mean birth weight of term infants were 38.9±0.9 weeks (range 38-40 weeks) and 3031±521 g (range 2400-4050 g) respectively. Plasma FT3, FT4 and T4 levels were found to be lower in preterm than term babies. The TSH and T3 levels were not found to be different in two groups. Amount of urine iodine was lower in preterm babies (p=0.003). Amount of urine iodine was significantly decresead in babies who were fed with parenteral nutrition (p: 0,017).
Conclusions: This study confirms that thyroid hormone levels in preterm infants were much lower than term infants. The urine iodine level was found to be lower in preterm newborns especially who were fed with parenteral nutrition.

Amaç: Yenidoðan yoðun bakým biriminde (YYBB) görülen hastane enfeksiyonu (HE) prevalansýnýn, etken daðýlýmýnýn ve antibiyotik direncinin belirlenmesi amaçlandý.
Gereç ve Yöntem: YYBB’de 1 yýllýk süre içerisinde, prospektif olarak yatan tüm hastalar çalýþmaya alýndý. Hastane enfeksiyonu olarak; yatýþýndan 72 saat sonra alýnan kültürde üreme olmasý veya NOSEP (Nosocomial Sepsis Prediction for Newborns) skorunun ≥11 olmasý kabul edildi. Üretilen patojenlerin antibiyotik dirençleri kaydedildi.
Bulgular: Bir yýllýk süre içerisinde 1094 bebek yatýrýldý. Belirlenen sürede 793 bebekten, 675 kan kültürü ve 138 diðer bölge kültürü toplandý. Alýnan tüm kan kültürlerinde 50 vakada 62 üreme saptandý. Klinik olarak hastane enfeksiyonu düþünülen 124 vaka NOSEP kriterleri açýsýndan deðerlendirildi. NOSEP puanlamasý ≥11 olan 26 vaka saptandý. Diðer bölgelerden alýnan 138 kültürün 46’sýnda üreme saptanýrken, HE kabul edilen kültür sayýsý 30 idi. Çalýþma kriterlerine göre 56 hastada HE tanýsý kondu. HE insidansý 5.1 enf /1000 gün, ventilatör iliþkili HE insidansý: 1.8/1000 gün ve kateter iliþkili HE insidansý 1.6/1000 gün bulundu. HE olarak saptanan etkenlerin daðýlýmý %61.9 gram pozitif bakteri, %30.9 gram negatif bakteri ve %7.2 mantar þeklindeydi. En sýk saptanan direnç geliþimi koagülaz negatif stafilokoklarda %55 oranýnda metisiline direnç idi.
Sonuçlar: HE etkeni olarak en sýk gram pozitif bakteriler ve enfeksiyon odaðý olarak en sýk konjonktivit saptandý. Üretilen mikroorganizmalarda antibiyotik direncinin az olmasýnýn, ünitemizde geniþ spektrumlu antibiyotiklerin kýsýtlý kullanýlmasýna baðlý olduðu düþünüldü.

Objective: The aim of this study was to evaluate the prevalence of nosocomial infection, distrubition and antibiotic resistance patterns of pathogen organisms in NICU (Neonatal Intensive Care Unit).
Study Design: This prospective study included all neonates hospitalized in NICU for one year period. The nosocomial infection was defined as hemoculture positivity after 72 hours of hospitalization or NOSEP (Nosocomial Sepsis Prediction for Newborns) score ≥11. The antibiotic resistance of identified microorganisms were recorded.
Results: In 1 year period, 1094 neonates were hospitalized. Of the 793 neonates, 675 blood cultures and 138 cultures from the other sites were collected. In 50 patients 62 hemoculture positivity were found among total hemocultures collected. Hundred and twenty four patients clinically thought to have nosocomial infection was evaluated for NOSEP criteria. In 26 neonates NOSEP score was found to be ≥11. In 138 cultures collected from the sites other than blood, 46 cultures were positive and 30 of them were accepted as nosocomial infection. According to the study criteria, 56 patients were found to have nosocomial infection. Nosocomial infection, ventilator and catheter associated nosocomial infection incidence were found to be 5.1 infection/1000 days, 1.8/1000 days and 1.6/1000 days respectively. Gram positive, gram negative bacteria and fungus were identified in 61.9%, 30.9% and 7.2% of cases respectively. The most common resistance pattern was meticilline resistance (55%) in coagulase negative staphylococci.
Conclusions: The most common pathogenic agents and the most common focus of infection were gram positive bacteria and conjunctivitis respectively. The low antibiotic resistance pattern of identified microorganisms was thought to be due to the restricted use of wide spectrum antibiotics in our unit.

Amaç: Kalýcý hipoparatiroidism tiroidektomide korkulan komplikasyonlardan biridir. Kalýcý hipoparatiroidismden kaçýnmak için dikkatli diseksiyonla paratiroid bezlerinin korunmasý dýþýnda paratiroid ototransplantasyonu artarak uygulanmaktadýr. Bu çalýþmada tiroidektomi sýrasýnda paratiroid ototransplantasyonu uygulanan hastalarýn sonuçlarýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: 2002-2005 arasýnda tiroidektomi uygulanan 354 hastadan 18’inde damarlanmasý bozulan veya istemeden çýkarýlan paratiroid bezleri seçilmiþ olarak ototransplante edildi.
Bulgular: 18 hastanýn 5’inde (%27.7) postoperatif hipokalsemi geliþti. Bunlarýn 4’ü geçici olup, 1 hastada kalýcý hipoparatiroidism geliþti. Paratiroid ototransplantasyonu uygulanmayan 336 hastanýn hiçbirinde kalýcý hipoparatiroidism geliþmedi.
Sonuçlar: Tiroidektomi sýrasýnda damarlanmasý bozulan veya hasarlanan paratiroid bezleri seçici olarak ototransplante edilmelidir. Paratiroid ototransplantasyonunda seçici yaklaþým kalýcý hipoparatiroidism oranýný en aza indirmek için etkili bir yöntemdir.

Objective: Permanent hypoparathyroidism is one of the most distressing complications following throidectomy. Apart from preservation of
parathyroid glands in situ by meticulous dissection, parathyroid autotransplantation has been performed increasingly to avoid permanent
hypoparathyroidism. The aim of this study was to evaluate the surgical outcomes in patients undergoing thyroidectomy with parathyroid
autotransplantation.
Study design: From 2002 to 2005, selective parathyroid autotransplantation was performed for devascularized or inadvertently
removed glands in 18 (5.08%) of 354 patients undergoing thyroidectomy.
Results: Total postoperative hypocalcemia occured in 5 (27.7%) of the parathyroid autotransplantation patients, and four patient had transient hypoparathyroidism, whereas 1 patient had permanent hypoparathyroidism. None of the 336 patients who did not undergo parathyroid autotransplantation had permanent hypoparathyroidism.
Conclusion: Selective autotransplantation of the parathyroid glands should be performed whenever the parathyroid is devascularized or damaged. Selective approach to parathyroid outotransplantation is an effective strategy for minimizing the rate of the permanent hypoparathyroidism.

Lingual tiroid nadir bir konjenital anomali olup tiroid bezinin foramen çekumdan aþaðý inmesindeki yetersizliðe baðlý oluþmaktadýr. Dil ektopik tiroidin en çok yerleþim alanýdýr. Solunum obstrüksiyonu ve disfaji geliþen 37 yaþýnda bayan lingual tiroidli hastayý sunmayý amaçladýk.

Lingual thyroid is a rare congenital anomaly of thyroid development resulting from failure of the thyroglossal duct to migrate from the foramen cecum to the prelaryngeal site. Tongue is the most common localisation. We report a 37 year old female patient with lingual thyroid presenting with obstructive and dysphagia symptoms and absence of the normal thyroid gland.

Hidatik kistin en sýk komplikasyonu kist rüptürüdür. Rüptür 3 baþlýk altýnda sýnýflanabilir: Kendi içine rüptürde, endokist rüptüre olup perikist saðlamdýr. Kist sývýsý endokist ile perikist arasýna girer, endokist kollabe olur. Baðlantýlý rüptürde, perikist bronþial veya safra yollarý ile iliþkili olduðunda endokist rüptüre olup, kist bilier sistem içine veya bronþial sistem içine açýlýr. Direkt rüptürde ise perikist ve endokist rüptüre olup, kist direkt periton boþluðuna veya plevral boþluða açýlmýþtýr. Baðlantýlý rüptür ve direkt rüptür, kendi içine rüptüre göre daha ciddi formlardýr. Biz akut batýn bulgularý ile baþvuran hem kendi içine hem de direkt peritoneal kist rüptürlü nontravmatik 21 yaþýnda erkek hastayý sunduk.Peritoneal rüptürle iliþkili klinik bulgular,teþhis ve tedavi metodlarýný tartýþtýk.

The most common complication is rupture of the hydatid cyst. Rupture was clasified in to three categories: contained, communicating, and direct. Contained rupture is when only the parasitic endocyst ruptures and the cyst contents are confined within the host-derived pericyst. When cyst contents escape via biliary or bronchial radicles that are incorporated in the pericyst, the rupture is communicating. Direct rupture occurs when both the endocyst and the pericyst tear, spilling cyst contents directly into the peritoneal or pleural cavities or occasionally into other structures. Communicating and direct forms have more serious clinical implications than contained rupture. Here we report a 21 year old nontraumatic, male patient with both contained and direct peritoneal rupture cysts presenting with acute abdominal finding. The clinical findings, diagnosis, and the treatment methods related to the petitoneal rupture were discussed.

Ýki taraflý omuz çýkýklarý nadirdir. Anterior omuz çýkýðý aþýrý ekstansiyon, abduksiyon ve dýþ rotasyon zorlamasý ile oluþur. 29 yaþýnda kadýn hasta pilates sporu yaparken her iki omuzda baþlayan ani aðrý þikayeti ile Ekim 2007 tarihinde acil servise baþvurdu. Yapýlan klinik ve radyolojik inceleme sonrasý iki taraflý anterior glenohumeral çýkýk tespit edildi. Her iki omuzu Kocher metodu ile redükte edildi.

Bilateral shoulder dislocations are rare. Anterior shoulder dislocation occurs by extreme extension, abduction and external rotation strain. Twenty nine years old female patient admitted to emercency service on October 2007 by bilateral shoulder pain with an acute onset during plates sport. After clinical and radiological evaluation bilateral anterior glenohumeral dislocation was detected. Both shoulders were reducted by Kocher method.

Feokromasitoma, genellikle orta yaþ grubunda görülen ender bir tümördür. Pediatrik olgularda ise daha da nadir ve genellikle bilateraldir. Bu çalýþmada iki kardeþ çocuk olgu üzerinden kalýtsal feokromasitomada anestezi özellikleri tartýþýldý.

Pheochromositoma is a rare tumor seen generally in middle aged group patients. This tumor is generally bilateral and much more rarely seen in peadiatric patients. In this study we present two peadiatric siblings cases of hereditary pheochromositoma and discuss their anesthesia characteristics.

Preeklampsi gebeliðin 20. haftasýndan sonra görülen hipertansiyon, proteinüri ve yaygýn ödemle karakterize olan ve yaklaþýk %5 gebelikte görülen, sebebi tam olarak bilinemeyen obsterik bir hastalýktýr. Aðýr preeklampsi sistemik kan basýncý 160/110 mmHg’nn üzerinde olmasý, proteinüri >5 gr/24 saat, oligüri (<500 ml/gün), trombositopeni, serebral ve görsel bozukluk, epigastrik aðrý, pulmoner ödem ve siyanozla kendini gösterir. Retina dekolmaný preeklampsinin nadir bir komplikasyonu olmakla birlikte görme sistemi deðiþik derecelerde etkilenebilir. Preeklampsiye baðlý retina dekolmaný genellikle bilateral ve seröz olup patogenezi yoðun arteriolar vasospasma sekonder olarak geliþen koroidal iskemiye baðlýdýr. Bu olgu sunumu ilk gebeliðinde aðýr preeklampsi geliþen 23 yaþýndaki bir hastanýn sunumudur. Ýlerleyici görme bulanýklýðý geliþen hastanýn yapýlan oftalmolojik muayenesinde yaygýn ve bilateral retina dekolmaný saptandý. Postpartum olarak sistemik kan basýncý kontrol altýna alýnan hastanýn retina dekolmaný geriledi ve görmesi düzeldi.

Preeclampsia is an obstetric disease of unknown cause that affects approximately 5% of pregnant women, which is characterized by hypertension, proteinuria and extensive edema seen after 20th week of pregnancy. Severe pregnancy is characterized by systemic hypertension above 160/110 mmHg, proteinuria above 5 gr/24 hr, oliguria (<500 ml/day), trombocytopenia, cerebral and visual disturbances, epigastric pain, pulmonary edema and cyanosis. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. This is a case report of a 23 year old patient who developed the severe form of preeclampsia on her first pregnancy. She had progressive blurred vision, Ophthalmic examination diagnosed spread and bilateral retinal detachment. With blood pressure control at the postpartum period, the patient had her retina reattached, and recovery of vision.

Rabdomyosarkom, çizgili kas öncül hücrelerinden köken aldýðý kabul edilen genellikle çocukluk çaðýnda görülen bir sarkom türüdür. Eriþkinde mülleryan sistemin saf rabdomyo- sarkomu oldukça nadir görülür. Sunulan yazýda premenopozal dönemde saptanan ve kliniðimizde takip edilen bir uterus rabdomyosarkomu olgusu deðerlendirilmiþtir.

Rhabdomyosarcoma is a type of sarcoma accepted to arise from the skeletal muscle progenitors and seen mostly in childhood period. Pure
rhabdomyosarcoma of the müllerian system of the adult is very rare. Here, a case of rhabdomyosarcoma of the uterus in the premenopausal period and followed up by our clinic is presented.