Amaç: Fas (CD95-Apo1) ve bunun ligandý Fas –ligand (FasL) apoptozun (programlý hücre ölümü) düzenlenmesinde önemli bir moleküler marker’dýr. Bu retrospektif çalýþmada larinks kanserlerinin %96’sýný oluþturan skuamöz hücreli karsinomlarda (SHK) Fas ve Fas-ligand ekspresyonu ve bunun klinik, histopatolojik parametreler ile iliþkisi, prognoz üzerindeki etkileri araþtýrýlmýþtýr.
Materyal ve Metod: Larinkste SHK tanýsý almýþ 53 olgunun parafin bloklarýndan elde edilen kesitlere CD95 (FAS) Ab-4 (Rabbit Polyclonal Antibody, Lab Vision Corp. Neomarkers, Fremont CA, USA. 60 dakika) ve FAS Ligand (Rabbit Polyclonal Antibody, Lab Vision Corp. Neomarkers, Fremont CA, USA. 60 dakika) ile immünohistokimyasal boyama prosedürü uygulandý.
Bulgular: Tümör hücrelerinde Fas ekspresyonu ile; histolojik grade arasýnda (p<0.01) ve FasL arasýnda (p<0.05) pozitif yönde anlamlý bir korelasyon saptandý.
Sonuç: Bu çalýþmada Fas ekspresyonunun larinks SHK’larýnda histolojik grade ile iliþkili olduðu görülmüþtür.

Objective: Fas (Apo-1, CD95) and its ligand Fas-Ligand (FasL) are important molecular markers for the regulation of the apoptosis (programmed cell death). In this retrospective study, expression of Fas and FasL and their relationship with the clinical, histopathologic parameters and prognosis, in squamous cell carcinomas (SCC) which consists 96% of laryngeal cancers, was investigated.
Materials and method: Immunohistochemical staining for the CD95 (FAS) (Ab-4 Rabbit Polyclonal Antibody, Lab Vision Corp. Neomarkers, Fremont CA, USA. 60 minutes) and FasL (Rabbit Polyclonal Antibody, Lab Vision Corp. Neomarkers, Fremont CA, USA. 60 minutes) was applied on the slides obtained from paraffin blocks of the 53 laryngeal SCC.
Results: We found significantly positive relationship (p<0.01) between the Fas expression and histologic differentiation and between Fas and FasL (p<0.05) at the tumor cells.
Conclusion: In this study, Fas and FasL are found to be in correlation with histologic grade.

Amaç: Megaloblastik aneminin vitamin B-12 ye cevabýný ölçmede en doðru yöntem, retikülosit sayýmýdýr. Anemi/trombositopeni ya da pansitopeni kombinasyonu ile baþvuran vitamin B-12 eksikliði olgularýnda tedavi cevabýný ölçmede hayat siklusu daha kýsa olan trombositlerin retiküsitlere kýyasla nasýl davrandýðýný deðerlendirmek istedik.
Gereç ve yöntem: Ocak 2005-Aðustos 2009 tarihleri arasýnda servisimizde vitamin B-12 eksikliðine baðlý megaloblastik anemi tanýsýyla incelenen 102 hasta içinden anemi/trombositopeni ya da pansitopeni kombinasyonu olan transfüzyon yapýlmamýþ 46 hasta çalýþmaya alýndý. Vitamin B-12 tedavisi öncesi bakýlan düzeltilmiþ retikülosit yüzdeleri ve trombosit sayýlarý, tedavinin 6. günündeki deðerlerle karþýlaþtýrýldý. Ýstatistik analizi baðýmsýz (t) testi, eþlendirilmiþ (t) testi, Pearson korelasyon testi kullanýlarak NCSS 2007 paket proðramý ile yapýldý.
Bulgular: Tedavi öncesi ortalama trombosit sayýsý 63,98±30,28x 103/mm3, tedavinin 6. gününde 162,63±85,35x 103/mm3’e çýkarken (p=0,0001) düzeltilmiþ retikülosit ortalama deðeri tedavi öncesi %0.57±0.42’den tedavinin 6. gününde %4,61±2,66 ya yükseldi (P=0,0001). Düzeltilmiþ retikülosit deðiþim yüzdesi ile trombositteki deðiþim yüzdesi arasýnda anlamlý derecede pozitif korelasyon (r=0,480, P=0,001) gözlendi.
Sonuçlar: Vitamin B-12 eksikliðine baðlý megaloblastik anemi/trombositopeni veya pansitopeni kombinasyonu ile baþvuranlarda tedavinin erken döneminde kemik iliði cevabýný deðerlendirmede retikülosit sayma imkaný olmayan koþullarda trombositlerdeki artýþ. Cevap olarak kabul edilebilir. Þayet bu artýþ yoksa myelodisplastik sendromlarý araþtýrmak için kemik iliði aspirasyon ve biopsisi yapýlmalýdýr.

Purpose: The reticulocyte count is the exact method in the evaulation of therapeutic response of megaloblastic anemia to the vitamin B-12 treatment. In cases of vitamin B-12 deficiency presented with a combination of anemia/thrombocytopenia or pancytopenia, we aimed to study the therapeutic response of thrombocytes (which have shorter life span than reticulocytes) in relation to reticulocytes.
Material and methods: From 102 patients of megaloblastic anemia due to vitamin B-12 deficiency, who where followed up between January 2005 and August 2009 in our medical department, forty-six patients (who had no blood transfusion) with a combination of anemia/thrombocytopenia or pancytopenia were selected for this study. Pre and post (6th day) of vitamin B-12 treatment, corrected reticulocyte and platelet levels were compared using independent t-test, the paired t-test, and Pearson correlation test (NCSS 2007 software program).
Results: At 6th day of vitamin B-12 treatment (in compare to day 0), there was a significant increase in both platelet counts and corrected reticulocyte rates (63,98±30,28x 103 /mm3 versus 162,63±85,35x 103 /mm3, and 0.57±0.42% versus 4,61±2,66%, p=0,0001, and 0,001, respectively). Also there was a positive correlation between the changes in the corrected reticulocyte rate and the changes in platelet counts (r=0,480, and P=0,001).
Conclusions: Increase in platelet counts can be used (if fascilities for reticulocyte count is not available) as an indicator of early bone marrow response to vitamin B-12 replacement therapy in vitamin B-12 deficiency cases presented with a combination of anemia/thrombocytopenia or pancytopenia. If there is no such post-treatment increase in platelet counts, myelodysplastic syndrome should be excluded by bone marrow aspiration and/or biopsy.

Amaç: ABO ve Rh uygunsuzluðuna baðlý indirekt hiperbilirubineminin klinik ve laboratuar bulgularýnýn deðerlendirilmesi, ciddi hiperbilirubinemi açýsýndan her iki grubun karþýlaþtýrýlmasý.

Gereç ve Yöntem: Ocak 2008- Ocak 2010 tarihleri arasýnda ABO ve Rh uygunsuzluðuna baðlý indirekt hiperbilirubinemi tanýsý ile yatýrýlan term bebekler, retrospektif olarak incelendi. Ýki grubun serum total bilirubin düzeyleri, hematokrit, direkt coombs testi, ciddi hiperbilirubinemi oraný, fototerapi süreleri, intravenöz immünglobulin kullanýmý ve kan deðiþimi oranlarý karþýlaþtýrýldý.
Bulgular: Ýki yýl içerisinde yenidoðan yoðun bakým ünitesine yatýrýlan 1610 hastanýn 420’sinde (%26) indirekt hiperbilirubinemi saptandý. Bunlarýn 123’ü (%29,2) ABO uygunsuzluðu, 27’si (%6,4) Rh uygunsuzluðu idi. Ýki grubun demografik özellikleri benzerdi. ABO uygunsuzluðunda ciddi hiperbilirubinemi daha fazla görüldü (p: 0,04). Ýkinci ve üçüncü gün baþvuran ABO uygunsuzluðu olan hastalarýn serum total bilirubin düzeyi daha yüksekti (ikinci gün P: 0,01, üçüncü gün (p: 0,001). Rh uygunsuzluðunda intravenöz immünglobulin kullaným oraný daha fazlaydý (p: 0,009). Beþ hastaya kan deðiþimi yapýldý. Bunlarýn 4’ü ABO uygunsuzluðu, 1’i Rh uygunsuzluðu idi. Hastalarýn hiçbirinde iþitme kaybý görülmedi.
Sonuç: ABO uygunsuzluðu önemli bir indirekt hiperbilirubinemi nedenidir. ABO uygunsuzluðu olan hastalarýn antenatal ve postnatal yakýn takibi ABO uygunsuzluðuna baðlý morbiditeyi azaltabilir.

Aim: to evaluate clinical and labaratory findings between ABO and Rh incompatability and to compare the results of groups in terms of severe hyperbilirubinemia.
Methods: Term neonates with indirect hyperbilirubinemia due to ABO and Rh blood group incompatibilities who were hospitalized in Neonatal Intensive Care Unit between 2008 and 2010 were included and evaluated retrospectively. Among the two groups, Serum total bilirubin levels, hematocrit levels, direct coombs test results, existance of severe hyperbilirubinemia levels, phototherapy duration, IVIG usage and rates of exchange transfusion were compared.
Results: During the period, 1610 newborns were admitted to Neonatal Intensive Care Unit for two years. Of the patients, 420 (%26) were diagnosed as indirect hyperbilirubinemia. ABO and Rh incompatability were found in 123 (%29,2) and 27 (%6,4), respectively. There was similar to demographic characteristics. Severe hyperbilirubinemia was seen more often in ABO incompatibility group (p=0,04). Serum total bilirubin levels at 2nd (p=0,01) and 3rd days (p=0,001) were found to be higher in ABO incompatibility group. IVIG was used more often in Rh incompatibility group(p=0,009). Five patients; 4 of them with ABO group incompatibility and 1 with Rh group incompatibility had undergone exchange transfusion. None of the patients were diagnosed of hearing loss.
Conclusion: ABO incompatibility is an important cause of indirect hyperbilirubinemia. Close follow-up of patient with ABO incompatability in antenatal and postnatal period could decrease morbidity due to ABO incompatability.

Amaç: Laparoskopik splenektomi son yýllarda pek çok merkezde tercih edilen splenektomi yöntemi haline gelmiþtir. Çalýþmamýzda avantajlarý nedeniyle yaygýn bir operatif süreç haline gelen laparoskopik splenektomi deneyimimizi sunmayý amaçladýk. Bu amaçla için ameliyat süresi, kanama miktarý, açýk ameliyata geçiþ oraný, analjezik ihtiyacý, hastanede kalýþ süresi, ameliyat sonrasý komplikasyon oraný ve hasta fatura maliyeti gibi ölçütleri literatür bilgileriyle karþýlaþtýrdýk.
Gereç ve yöntem: Haziran–Eylül 2006 tarihleri arasýnda kliniðimizde laparoskopik yöntemle splenektomi uygulanan hastalar çalýþmaya alýndý.
Bulgular: Belirlenen süre içerisinde yaþý 1-16 yýl (ort 8.9 yýl) arasýnda deðiþen 25 çocuk (8 kýz, 17 erkek) splenektomi amacýyla yatýrýldý. Splenektomi endikasyonlarý: kronik ITP (n: 10), herediter sferositoz (n: 6), beta talesemi (n: 8), otoimmün hemolitik anemi (n: 1). US ile ölçülen dalak boyutlarý 80 ile 192 mm arasýndaydý (ort: 127.8 mm). Laparotif splenektomi için 16 hastada üç trokar kullanýldý. Ancak 9 hastada 4. Trokar gerekti. Tüm vasküler yapýlar ve splenik baðlar stapler veya düðüm teknikleri gerekmeksizin mühürleme cihazý (Ligasure) ile baðlanýp kesildi. Dalak büyüklükleri en büyük olan 2 hastadan birinde, diseksiyon tamamlanamadýðýndan; diðerinde diseksiyon bitirilmesine raðmen kan pCO2 yükselmesi sebebiyle, dalaðýn çýkarýlmasý aþamasýnda açýk ameliyata geçildi. Diðer olgularda karýn içerisinde torbaya konulan dalak, umbilikal trokar yerinden dýþarýya over klempi ile parçalanarak çýkarýldý. Ameliyat süreleri 45 ile 240 dk (ort: 154.6) arasýndaydý. Bir hastada plevral efüzyon dýþýnda komplikasyon geliþmedi. Ortalama taburcu süresi 4.04 (2-12) gün ve ortalama hasta fatura maliyeti 2376 TL idi.
Sonuç: Laparoskopik splenektomi, çocuk laparoskopisine yeni baþlayan kliniklerde dahi güvenle gerçekleþtirilebilir. Laparotif splenektomi sonrasý daha az aðrý, kýsa hastanede kalýþ suresi ve iyi kozmetik sonuçlar prosedürün en büyük tercih nedenleridir.

Aim: Laparoscopic splenectomy (LS) currently is preferential method of splenectomy in many centers. Because LS has many advantages, it is common. Thus we present our experience of LS. We compared with literature in terms of operative time, operative bleeding, conversion rate, requirement of analgesic, hospital stay, postoperative complication rate, operative cost.
Material ve method: Our study include patients undergone LS between June and September in 2006. Results: LS was performed in 25 children (8 girls and 17 boys) with mean age 8.9 years (age 1-6). Indications of LS were kronik ITP (10), herediter sferositoz (6), beta talesemi (8), otoimmün hemolitik anemi (1). Length of spleen were found to be 80-192 mm (mean spleen length 127.8 mm) in our patients. Three trocars were used in 16 patients, but four trocars were used in 9 patients. LigaSure Vessel Sealing System were used for achieving a safe vascular control, in two patients who had the biggest spleen size conversion to open procedure was necessary when spleen was removed. Because dissection could not completed in one of those, elevated level of pCO2 in arterial blood in other of those. The spleen was removed through the umbilical trocar by using a retrieval bag in other patients. Mean operative time was 154 min (45-240 min). No complication developed except one patient who suffered pleural effusion. Mean hospital stay was 4 days (2-12 days) and mean operative cost was found 2736 TL (1890 $).
Conclusion: LS can be performed safely even in clinic of pediatric surgery where LS has just been initiated. LS is preferred since advantages of LS are less postoperative pain, shorter of hospital stay and better cosmetic results.

Behçet Hastalýðý vaskülit ile karakterize, nedeni bilinmeyen multisistemik bir hastalýktýr. Behçet hastalýðýna baðlý pulmoner arter anevrizmasý gibi pulmoner vasküler problemler, kötü prognozu ve yüksek mortaliteyi göstermek amacý ile bildirilmiþtir. Hemoptizi þikayeti ile baþvuran 19 yaþýndaki erkek hastayý sunduk. Hastanýn 15 aydýr tekrarlayan oral ve genital aft hikayesi vardý. Uluslararasý Behçet Hastalýðý Çalýþma Grubu kriterlerine göre Behçet hastalýðý tanýsý konuldu. Akciðer grafisinde bilateral hiler geniþleme izlendi. Çok kesitli Bilgisayarlý Tomografi (BT) incelemesinde intramural tombüs içeren çok sayýda iki taraflý pulmoner anevrizma görüldü. Çok kesitli BT, Behçet hastalýðýndaki pulmoner tutulumu göstermede baþarýyla kullanýlabilir.

Behcet’s disease is a multisystem disorder of unknown cause that is characterized by vasculitis. Pulmonary vascular problems such as pulmonary artery aneurysms due to Behcet’s disease are reported to indicate poor prognosis and high mortality. We describe a 19-year-old man who presented with hemoptysis. He had a history of recurrent oral and genital aphthous ulcerations for 15 months. The diagnosis of Behcet’s disease was made on the basis of the criteria published by the International Study Group for Behcet’s Disease. His chest X-ray showed bilateral hilar enlargement. A multislice computed tomography (CT) scan showed bilateral multiple pulmonary aneurysm with intramural thrombosis Multislice CT could be used successfully in Behcet’s disease for the diagnosis of pulmonary involvement.

Duplikasyon kistleri, tüm gastrointestinal traktusta yerleþebilen, konjenital anomalilerdir. Genellikle asemptomatiktirler ve rutin tetkikler sýrasýnda insidental olarak saptanýrlar. Kistik duplikasyonlarýn nadiren kanama, invajinasyon, barsak obstrüksiyonu, volvulus, malignite gibi komplikasyonlarý görülebilir. Hastamýz, karýn aðrýsý ile polikliniðimize baþvurdu. Hastaya, ileri tetkik amacýyla yapýlan radyolojik incelemeler sonucunda batýn sol hipokondrial bölgeyi dolduran 8x10 cm kist saptandý. Ameliyatta kama þeklinde kýsmi ince baðýrsak rezeksiyonu ile beraber kist eksizyonu uygulandý. Piyesin histopatolojik incelenmesinde; intestinal duplikasyon kisti ile uyumlu olduðu görüldü. Olgu sunumunda, mezenterik yerleþimli kistlerin ayýrýmýn yapýlmasý ve literatür eþliðinde mezenterik yerleþimli intestinal duplikasyon kistlerinin deðerlendirilmesi amaçlanmýþtýr.

Duplication cysts are conjenital abnormanilaties that can be place in all gastrointestinal tractus.They are usualy asemptomatic and may usualy established incidentaly during rutin examinations. They may rarely have complications like bleeding, invagination, obstruction, volvulus or malignancy. Our patient, came to our policlinics with abdominal pain. During radiological examinations, at left hipocondrial teritory 8x10 cm cyst was found. In the operation partial wedge resection to intestines with cyst exsicion was performed. Histopathologycal examination of the piece reported as intestinal duplication cyst. In this case report, our aim is to make the discrimination of mesenteric cysts and by the literature guide,
evaluation of the intestine duplication cysts.

Anal bölge kanserlerinin tedavisinde belirgin deðiþiklikler olmuþtur. Otuz yýl önce abdominoperineal rezeksiyon gibi radikal cerrahiler tam kür için tek seçenekti. Ancak kombine kemoradyoterapi modalitelerinin gündeme gelmesi ve uygulanmasý ile hem saðkalýmda hem de sfi nkter koruyucu cerrahilerde belirgin artýþ olmuþtur

The treatment of squamous cancer of the anal region has undergone a major change. Thirty years ago, radical surgery in the form of abdominoperineal resection was the only possibility for cure. Combined modality treatment with radiation therapy and chemotherapy has resulted in increased survival and in sphincter preservation for most patients.

Warty diskeratom benign, genellikle soliter papül ya da nodül ile karakterize bir epitelyal tümördür. Klinik olarak sebase hiperplazi, piyojenik granülom, verruka vulgaris ve bazal hücreli karsinom ile benzerlik gösterebilir. 16 yaþýndaki erkek hastada göbekte bir yýldýr mevcut 6x5 mm kahverengi-krem renkli, ortasý krutlu papüler lezyon saptandý. Eksizyonel biopsi sonrasý histopatolojik olarak warty diskeratom ile uyumlu bulundu. Alýþýlmadýk yerleþimi nedeniyle vakayý literatür eþliðinde sunduk.

Warty dyskeratoma is a benign epithelial tumour, that is commonly characterised by soliter papul or nodule. Clinical findings may be similar to sebaceous hyperplasia, pyojenic granuloma, verruca vulgaris and basal cell carsinoma. In a 16 year old male patient a brown-cream colored, centrally crust formated papular lesion with a 6x5 mm diameter was detected in the umblical region. After excisional biopsy it was found to be compatible with warty dyskeratoma histapathologically. Because of it’s unusual localisation, we have presented the case with literature.

Birçok infeksiyöz etkenin akut infeksiyonu sýrasýnda karaciðerde deðiþen oranlarda hasar oluþmaktadýr. Bu hastalarýn takibi sýrasýnda olabilecek hepatik problemler göz önünde tutulmalýdýr. Özellikle viral hepatitler geliþmiþ ve geliþmekte olan ülkeler için ciddi bir sorun oluþturmaktadýr. Bunlardan hepatit A, E ve G akut seyrettiði için burada bahsedilmiþtir. Transfüzyon ile geçen virus (TTV), kýzamýk-kýzamýkçýk virusleri, parvovirus, paramiksovirus herpes simpleks virusu 1-2, coxsackie-b virus, echo virus 14-19, adenovirus, varisella-zoster virus, CMV, EBV, HIV ve herpes-6 gibi çok sayýda virus karaciðerde hasar oluþturabilmektedir. Daha az olmakla birlikte bakteriler (Escherichia coli, Streptokoklar, Stafilokokus aureus, Brusella mellitensis, Legionella pnömofillia, Clostridium perfringes, Listeria monositogenes, Mycobacterium tuberculosis ve Salmonella typhi), sipiroketler, protozoonlar, helmintler de etiyolojide rol oynarlar. Bu yazýda tüm bu etkenler hakkýnda kýsa bilgiler vererek karaciðer hasarý oluþturan akut infeksiyonlarýn toplu deðerlendirmesini saðlamayý amaçladýk.

The liver is damaged variable amount in the case of a lot of acute infections agents. This should be kept in mind at the progression of these patients. Especially viral hepatitis are important problem for developed or developing countries. Fromthese; hepatitis A, E and G progress acutely. Fort his reason; these are mentioned here. Transfussion transmitted virus (TTV), measles, rubella, rubeola, paramyxoviruses, parvovirus B19, herpes simplex virus 1-2, coxsackie B virus, echovirus 14-19, adenoviruses, varicella-zoster virus, cytomegalovirus, Ebstein-Barr virus, herpes virus-6, HIV, etc. can cause demage on liver. In the minority of etiology bacteria (Escherichia coli, streptococcus, Staphylococcus aureus, Brucella mellitensis, Legionella pneumophilia, Clostridium perfringes, Listeria monocytogenes, Mycobacterium tuberculosis and Salmonella typhii), spirochetes, protozoans and helminthes can be found. In this review; we will give a little information about these agents and we will eveluate acute infections that cause demage on liver totally.