Amaç: Kliniðimizde uygulanan histerektomi operasyonlarýný, hastalarýn demografik özellikleri ile birlikte klinik açýdan deðerlendirmeyi amaçladýk.
Yöntem: Taksim Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum Kliniði’nde Ocak 2003-Haziran 2010 tarihleri arasýnda histerektomi operasyonu uygulanan 949 hastanýn demografik ve klinik özellikleri retrospektif olarak deðerlendirildi.
Sonuç: Çalýþmaya alýnan tüm hastalarýn yaþ ortalamasý 50.54±9.5 olup, vaginal yaklaþýmla yapýlan histerektomilerde yaþ ortalamasý 60.10±10.20’dir. Tüm histerektomilerin %13.17’si vaginal histerektomi olup, total abdominal histerektomi ise tüm histerektomilerin %86.83’sini oluþturmaktadýr. Histerektomi endikasyonlarý sýralamasýnda 311 (%32.77) ile myoma uteri ilk sýrada yer almakta, bunu 139 (%14.65) hasta sayýsý ile adneksiyal kitleler izlemektedir. Jinekolojik maligniteler ise endikasyonlarýn %6.74’ünü oluþturmaktadýr. Hem vaginal (%0.8’nde) hem abdominal histerektomi (%0.12’sinde) grubunda 1’er hasta olmak üzere toplam 2 hastada mesane onarýmý gerektiren mesane yaralanmasý gerçekleþmiþtir. Barsak yaralanmasý tüm vakalarýn %0.52’sinde görülmüþtür.
Yorum: Kliniðimizde abdominal histerektomi, vaginal histerektomiden daha sýk uygulanmakla birlikte, vaginal histerektomi, prolapsusu olan, özellikle anatomisi uygun vakalarda uygulanmakta ve bu kararý cerrahýn deneyimi de etkilemektedir. Bu deðerlendirmeler ýþýðýnda ülkemizdeki diðer Kadýn Hastalýklarý ve Doðum Klinikleri’nin de verileri doðrultusunda hem ülkemiz istatistiklerinin ortaya konulabileceði, hem de klinikler arasý bilgi alýþveriþinin saðlanabileceði kanaatindeyiz

Objective: The aim of the study was to evaluate the hysterectomies carried out in our clinic with demographic characteristics of patients.
Methods: The study retrospectively evaluates the clinical and demographic characteristics of the 949 patients that had hysterectomy procedures with various indications between January 2003-June 2010 in Taksim Training and Research Hospital, Gynecology and Obstetrics Department.
Results: The mean age was 50.54±9.5 in all groups and 60.10±10.20 in vaginal hysterectomy group. The ratio of vaginal hysterectomy was determined as 13.17%, whereas the ratio of abdominal hysterectomy was 86.83%. In our clinic, the most common hysterectomy indication was myoma uteri (311 patients, 32.77%) and the second most common indication was adnexial mass (139 patients, 14.65%). The ratio of hysterectomies performed for gynecological malignancies were 6.74%. We have seen 0.52% bowel injury in all groups and 0.12% bladder injury in abdominal hysterectomy group. Also, in vaginal hysterectomy group, there was 1 patient (0.08%) with bladder injury.
Conclusion: Abdominal hysterectomy has been performed more common than vaginal hysterectomy in our clinic. The vaginal hysterectomy has been performed in patients who have pelvic prolapse and appropriate anatomy fort he procedure. Also the variation of procedure depends on the experience of surgeon. In the light of these assesments, in line with data from other gynecology and obstetrics clinics in our country, both statistics of our country can be revealed and information can be exchanged between clinics.

Amaç: Mide ve/veya ince baðýrsak fitobezoarlarý nadir görülmekte ve zaman zaman akut batýn bulgularý ile kar- þýmýza çýkmaktadýr. Çalýþmamýzda mide ve/veya ince baðýrsak fitobezoarlarýna yönelik taný ve tedavi yaklaþýmýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Aralýk 1999-Kasým 2010 tarihleri arasýnda fitobezoar nedeniyle ameliyat edilen hastalarýn kayýtlarý retrospektif olarak deðerlendirildi. Bu hastalarýn yaþlarý, cinsiyetleri, daha önce geçirmiþ olduklarý ameliyatlar, ek hastalýklarý, baþvuru þikayetleri ve uygulanan tedavi yöntemleri incelendi.
Bulgular: Toplam hasta sayýsý 6 (4 kadýn, 2 erkek) olup, hastalarýn yaþ ortalamasý 63,3 yýl idi. Hastalardan 4’ü acil servise, 2’si ise elektif olarak polikliniðe baþvurmuþlardý. Ýki hasta peptik ülser perforasyonu nedeniyle ameliyat edilmiþ olup 1 hastada Diyabetes Mellitus (DM) var idi. Ýki hastaya batýn ultrasonografi (USG), 2 hastaya ise bilgisayarlý batýn tomografisi (BT) çekildi; ancak hiçbirinde fitobezoar tanýsý radyolojik olarak konulamadý. Üç hastaya ameliyat öncesi yapýlan gastroskopide mide fitobezoarý görüntülendi. Fitobezoarlar endoskopik tedaviye uygun olmadýðýndan cerrahi tedavi uygulandý. Ameliyatta 2 hastadaki mide fitobeozarlarý gastrotomi ile, 1 hastadaki mide ve incebarsak fitobezoarlarý gastrotomi ve enterotomi ile, 2 hastadaki incebarsak fitobezoarlarý enterotomi ile çýkarýldý. Ýncebarsak perforasyonu olan hastada segmenter incebarsak rezeksiyonu uygulandý ve fitobezoar çýkarýldý. Ameliyat sonrasý komplikasyon gözlenmeyen hastalar ortalama 7. günde taburcu edildiler.
Sonuç: Fitobezoarlar mekanik barsak týkanýklýðýnýn ender nedenlerindendir. Özellikle geçirilmiþ mide ve duodenum ameliyatý öyküsü olan ve incebarsak týkanýklýðý bulgularýyla baþvuran hastalarda fitobezoarlar da akla gelmelidir.

Purpose: Gastric and/or small intestinal phytobezoar are rare but occasionally apply with acute abdomen findings. In our study, we aimed to determine diagnosis and treatment approach for gastric and/or small intestinal phytobezoar.
Material and Method: Data of the patients operated for phytobezoar between december 1999-november 2010 were evaluated retrospectively. Age, sex, previous operations, comorbid disease, complaintments and treatments of the patients were studied.
Results: Sum of the patients were 6 (4 female and 2 male) and mean age of the patients was 63,3 year. Four of the patients were admitted to emergency service, 2 were admitted to policlinics with elective course. Two of the patients were operated for peptic ulcus perforations, and 1 patients has diabetes mellitus (DM). Abdominal ultrasonography (USG) was performed for 2 patients, and abdominal computed tomography (CT) was performed for 2 patients, but phytobezoars not diagnosed with radiologically in non of the patients. Phytobezoars were diagnosed with endoscopy before the operation in 3 patients. Phytobezoars are not suitable for endoscopic treatment so the patients have gone to operation. In the operation, gastric phytobezoars was removed with gastrotomy in 2 patients, gastric and intestinal phytobezoars removed with gastrotomy and enterotomy 1 patient and intestinal phytobezoar was removed with enterotomy in 2. Segmenter small intestinal resection was performed and phytobezoar was removed in the patient with intestinal perforation. Patient was discarged from
the hospital mean 7 days without postoperatif complication.
Conclusion: Phytobezoars was the rare cause of intestinal obstructions. Phytobezoars should be remembered in the patients with intestinal obtruction findindings and gastric-duodenal operation history.

Ayaktaki aksesuar kemikler genellikle asemptomatiktir. Aksesuar kemikler travma varlýðýnda yanlýþlýkla avulsiyon kýrýklarý olarak deðerlendirilebilir. Yanlýþ ön tanýlarý azaltmak için aksesuar kemiklerin lokalizasyonlarý ve sýklýðý iyi bilinmelidir. Çalýþmamýzda yaþlarý 21-83 arasýnda deðiþen, kadýn ve erkek, 277 olguya ait, ayak bileði-ayak ön-arka ve yan radyografileri, aksesuar kemikler açýsýndan retrospektif olarak incelendi. Aksesuar kemiklerin cinsiyete göre görülme sýklýðý, daðýlýmý, bilateral ve bir arada olma durumlarý araþtýrýldý. Ýncelenen 277 olgunun %45,4’ünde aksesuar kemik saptandý. En sýk görülen aksesuar kemikler aksesuar navikular kemik (%65,8), os peroneum (%16,6), os trigonum (%11,9), os vesalianum (%7,1), os subtibiale (%3,9), os talotibiale (%3,9), os intermetatarseum (%2,3) ve os interkuneiforme (%2,3) idi. Aksesuar kemikler, tüm kadýn olgularýn %45,8’inde ve tüm erkek olgularýn %44,4’ünde görüldü. Kadýn ve erkek olgularda en sýk görülen aksesuar kemik, aksesuar navikular kemikdi. Aksesuar kemikler olgularýn %55,5’inde her iki ayakta, %30,9’unda sað ayakta ve %13,4’ünde sol ayakta görüldü. En sýk bilateral olarak görülen aksesuar kemik, aksesuar navikular kemikti. Olgularýn %10,6’sýnda iki farklý aksesuar kemiðin ve %2,6’sýnda üç farklý aksesuar kemiðin bir arada olma durumu saptandý. Böylece bölgemizde ayak aksesuar kemiklerinin görülme sýklýðý ve daðýlýmý hakkýnda genel bir deðerlendirme yapmýþ olduk.

Accessory ossicles of the foot are generally asymptomatic. Accessory ossicles could be confused with avulsion fractures in the presence of trauma. Locations and frequency of accessory ossicles should be well known to reduce incorrect preliminary diagnosis. In our study, anterior-posterior and lateral radiography of anklefoot of 277 female and male cases with an age range of 21 to 83 years were examined retrospectively with regard to accessoy ossicles. Accessory ossicles were examined according to the sex, frequencies and divisions of the bones, bilaterality and coexistence. Accessory ossicles were determined in %45,4 of 277 cases. The most common accessory ossicles were accessory navicular bone (65,8%), os peroneum (16,6%), os trigonum (11,9%), os vesalianum(7,1%), os subtibiale (3,9%), os talotibiale (3,9%), os intermetatarseum (2,3%) and os intercuneiforme (2,3%). Accessory ossicles were seen in 45,8% of all female cases and 44,4% of all male cases. The most common accessory ossicle in female and male cases was accessory navicular bone. The accessory ossicles were seen in 55,5% of cases in both of the feet, in 30,9% of cases right unilaterally and in 13,4% of cases left unilaterally. The most common seen bilaterally accessory ossicle was accessory navicular bone. We determined the coexistencies of two different accessory ossicles as 10,6% of cases and three different accessory ossicles as 2,6% of cases. Thus, we have made an overall assesment about the incidence of accessory ossicles of the foot and distribution in our region.

Amaç: Kliniðimizde yapýlan Pars Plana Vitrektomi (PPV) operasyonlarýnda etyolojik daðýlýmýn incelenmesi amaçlandý.
Gereç ve Yöntem: Kliniðimizde Ekim 2008–Mayýs 2010 tarihleri arasýnda PPV uygulanan olgular hasta kayýtlarýndan retrospektif olarak incelendi ve etyolojik nedenler belirlendi.
Bulgular: Hasta grubumuzu, yaþ ortalamasý 54,45 (4-84 yaþ) olan 45’i erkek olmak üzere toplam 85 hastanýn 90 gözü oluþturdu. Etyolojilerine göre deðerlendirildiðinde; olgularýn %40’ý (36 göz) proliferatif diyabetik retinopati (PDR) komplikasyonlarý, %21,1’i (19 göz) yýrtýklý retina dekolmaný (RD), %17,8’i (16 göz) makuler yüzey hastalýklarý, %8,9’u (8 göz) penetran göz yaralanmasý (bunlarýn 3’ünde göz içi yabancý cisim mevcuttu), %3,3’ü (3 göz) vitre hemorajisi, %3,3’ü (3 göz) masif submakuler hemoraji, %3,3’ü (3 göz) katarakt cerrahisi sýrasýnda geliþen vitreye nükleus veya göz içi lens (GÝL) düþmesi, %2,2’si (2 göz) endoftalmi olarak daðýlým gösterdi.
Gözlerin 14’üne ilave 2. operasyon gerekti; %64’ü (9 göz) nüks retina dekolmaný, %29’u (4 göz) geçirilmiþ cerrahi sonrasý oluþan epiretinal membran, (ERM) %7’si (1 göz) rehemoraji sebebiyle 2. kez opere edildi. Gözlerin 7’si nüks retina dekolmaný (%57-4 göz) ve cerrahiye sekonder epiretinal membran (%43-3 göz) sebebiyle 3. kez opere edildi. Ýki göz ise nüks dekolman (dev yýrtýklý retina dekolman cerrahisi sonrasý proliferatif vitreoretinopati geliþimi) sebebiyle 4. kez opere edildi. Ayrýca 12 göze ise önceki ameliyatýnda verilmiþ olan silikonun alýnmasý için mükerrer cerrahi uygulandý.
Sonuç: Kliniðimizde geniþ bir spektrumda uygulanan vitreoretinal cerrahi operasyonlarýnýn literatürle benzer daðýlýmda; proliferatif diyabetik retinopati komplikasyonlarý, retina dekolmaný ve komplikasyonlarý nedeniyle daha sýk yapýldýðý saptanmýþtýr.

Aim: To evaluate the indications of pars plana vitreoretinal surgery in Þiþli Etfal Training and Research Hospital Eye Clinic.
Materials and Methods: The patients who underwent PPV between September 2008 and May 2010 were evaluated retrospectively using their charts and indications were determined in our clinic.
Results: The study included 90 eyes of 85 patients who underwent vitreoretinal surgeries. Demography and indications were analyzed. Mean age was 54,45 and 45 patients were male. According to etiology the distribution was as follows; proliferative diabetic retinopathy (PDR) complications in 36 eyes (40%), retinal detachment (RD) in 19 eyes (22%), macular surface disease in 16 eyes (17,7%), penetrating ocular trauma in 8 eyes (8,8%), vitreus hemorrhage in 3 eyes (3,3%), massive submacular hemorrhage in 3 eyes (3,3 %), nucleus or intraocular lens (IOL) indrop as a complication of previous cataract surgery in 3 eyes (3,3%) and endophthalmitis in 2 eyes (2,2%).
In 14 patients a second operation was required due to retinal redetachment in 64% (9 eyes), secondary epiretinal membrane formation (ERM) in 29% (4 eyes) and rehemorrhage in 7% (1 eye). Retinal redetachment in 4 eyes (57%) and secondary epiretinal membrane in 3 eyes (43%) necessitated third operation in 7 eyes. Two eyes received fourth operation because of retinal redetachment. In addition silicone oil removal as a consequence of primary operation was applied to twelve eyes.
Conclusion: A wide spectrum of vitreoretinal surgery operations were performed in our clinic. In accordance with the literature, vast majority of the indications were proliferative diabetic retinopathy complications, retinal detachment and its complications.

Primer sklerozan kolanjit (PSK), karaciðer içi ve dýþý safra yollarýnda inflamasyon, fibrozis ve bunlarýn sonucu geli- þen darlýklarla ortaya çýkan, idiopatik, kronik ve ilerleyici özellikte bir kolestatik karaciðer hastalýðýdýr. Genellikle erkeklerde ve 40’lý yaþlarda ortaya çýkar. PSK’le birlikte en sýk görülen hastalýk inflamatuar barsak hastalýklarý (ÝBH)’dýr. PSK ve ÝBH birlikteliði erkeklerde 2 kat daha sýk iken, tek baþýna PSK kadýnlarda daha sýktýr. Genellikle sarýlýk ve kaþýntý ilk bulgularýdýr. Bu makalede, normalden farklý olarak, nadir görülen örneðiyle hafif þiddette karýn aðrýsýyla kliniðe baþvuran, 17 yaþýnda, beraberinde ek hastalýk bulunmayan erkek bir primer sklerozan kolanjit vakasýný sunmayý amaçladýk.

Primary sclerosing cholangitis is an idiopathic, chronic and progressive liver disease which takes place as the inflamation, fibrosis and obliteration of the intrahepatic and extrahepatic bile ducts. It most commonly occurs in young men about forties. Primary sclerosing cholangitis is usually associated with inflamatory bowel disease. Inflamatory bowel disease and primary sclerosing cholangitis are seen together in men twice as in women. But primary sclerosing cholangitis especially seens in women without another disease. Usually first symptoms are jaundice and pruritus. In this case, our subject is an 17 years old male who has abdominal pain but no other diseases.

Fetal over kistleri diþi cinsiyetli fetüslerde abdominal lezyonlarýn önemli bir kýsmýný oluþturmakta olup, çoðunlukla unilateraldir. Bu kistlerin büyük kýsmý küçük ve asemptomatik olup spontan olarak rezorbe olabildikleri için klinik önem taþýmazlar. Bununla birlikte büyük kistlerde torsiyon, kanama ve rüptür gibi olasý komplikasyonlar cerrahi giriþim gerektirebildiðinden taný almalarý önem taþýmaktadýr. 30 yaþýnda diyabeti ve hipertansiyonu olan gebede, ultrason ile fetal pelvik bölgede kistik lezyonu saptanan ve postnatal cerrahi sonrasý hemorajik torsiyone over kisti kesin tanýsý alan olgunun ultrason ve manyetik rezonans görüntüleme bulgularýný sunmaktayýz.

Fetal ovarian cysts constitute an important part of the abdominal pathologies in female fetuses and are usually unilateral. The majority of these cysts are small and asymptomatic, and because they mostly could resolve spontaneously they pose no clinical threat. However, the diagnosis of large cysts is important because they may need surgical intervention due to the complications such as torsion, bleeding and rupture. Here, we present the ultrasound and magnetic resonance imaging findings of hemorrhagic torsion of an ovaian cyst in an infant that was firstly detected by antenatal ultrasound of an 30 year-old pregnant woman.

Renal küçük hücreli karsinom, ultrastrüktürel ve immunohistokimyasal olarak nöroendokrin ve epitelyal neoplazm karakteristikleri gösteren oldukça agresif ve uzak metastaz potansiyeli taþýyan, nadir bir malign tümördür. Küçük hücreli karsinomlarýn yaklaþýk %5’i ekstrapulmoner yerleþimlidir ve böbrek yerleþimine de oldukça az rastlanmaktadýr. Tedavi olarak, nefrektomi ve sonrasýnda kemoterapi önerilse de yaþam süreleri oldukça kýsadýr. Vakamýz, 75 yaþýnda, sað renal pelvis yerleþimli, primer renal küçük hücreli karsinomu olan bir kadýn hastaydý. Hastaya nefrektomi gerçekleþtirildi ve patolojik deðerlendirme sonrasý, yüksek dereceli deðiþici epitel hücreli karsinom alanlarý da içeren küçük hücreli karsinom olarak rapor edildi. Kontrollerinde karaciðer metastazý saptanan ve 5 kür kemoterapi (sisplatin, etoposid) uygulanan hasta, taný konulduktan 20 ay sonra yaþamýný kaybetti.

Renal small cell carcinoma is a highly aggressive malignant tumor that has the potential of distant metastasis and it shows neuroendocrine and epithelial neoplasm features which are ultrastructural and immunohistochemical. Approximately 5% of small cell carcinomas are localized in extrapulmonary and renal localization is rarely seen. Although nephrectomy and chemotherapy are recommended for treatment, life expectancies are quite short. A 75-year-old woman, who had a primary small cell carcinoma of the right renal pelvis, was the subject of our case. Nephrectomy was performed on the patient and small cell carcinoma -containing areas of high grade transitional epithelium cell was reported after pathological evaluation. The patient, who had liver metastasis and thus received 5 cures of chemotheraphy (cisplatinum, etoposide), died 20 months after the diagnosis.

Depresyon ve anksiyete bozukluklarý týbbi hastalýklarýn en sýk görülenlerindendir. Depresyon ve anksiyete sýklýkla birlikte görülür ve de diðer týbbi hastalýklara da çok sýk eþlik ederek onlarýn seyrini ve tedavi yanýtýný olumsuz olarak etkilerler. Depresyonun klinik olarak farklý ve bazen tanýsý zor olan birkaç alt tipi bulunur. Genel týbbi durum baðlý anksiyete bozukluklarýnýn yaný sýra, panik bozukluðu, yaygýn anksiyete bozukluðu, sosyal anksiyete bozukluðu, özgül fobi ve travma sonrasý stres bozukluðu olarak bilinen beþ ana anksiyete bozukluðu ve bunlarla iliþkili bozukluklar anksiyete bozukluklarý ailesini oluþturur. Bu bozukluklarýn taný ve tedavileri, psikiyatristler dýþýndaki hekimleri de, bu bozukluklarýn genel týbbi hastalýklarýn seyrini ve prognozunu etkilemesi bakýmýndan, ilgilendirmektedir. Bu yazýda depresyon ve anksiyete bozukluklarýnýn, epidemiyoloji, fizyopatoloji, komorbidite, taný ve tedavilerinin kýsa ve güncel bir özeti yer almaktadýr.

Depression and anxiety disorders are among the most commonly encountered medical conditions. Depression and anxiety disorders are commonly found together and frequently accompany general medical disease, adversely affecting their course and treatment. Depression has several clinically distinct subtypes which are sometimes difficult to diagnose. Five main anxiety disorders known as panic disorder, generalized anxiety disorder, social anxiety disorder, spesific phobia and post traumatic stres disorder and several related disorders, as well as anxiety disorders due to a medical condition, constitute the anxiety disorders family. Diagnosis and treatment of these disorders are of concern to physicians other than psychiatrists, because of their effect on course and prognosis of general medical diseases. This is a concise and up to date overview of the epidemiology, physiopathology, comorbidity, diagnosis and treatment of depression and anxiety disorders.