Giriþ ve Amaç: Ekstravazasyon yaralanmasý, damar dýþýna kaçan farmakolojik veya fizyolojik olmayan ajanlarýn doku yýkýmý yapmasý ile karakterize bir durumdur. Kemoterapötik olarak sýkça kullanýlan doksorubisinin ekstravazasyonu sonucu geliþen tam kat cilt nekrozu kanser hastalarýnýn önemli bir morbidite kaynaðýdýr. Bu ilerleyici doku nekrozu aðrý, ülserasyon, þekil ve fonksiyon bozukluðuna neden olan doku kaybýna yol açabilir. Bu yaralanmalarda çeþitli tedavi seçenekleri önerilmesine raðmen, bu gibi lezyonlarýn tedavisi hakkýnda fikir birliði saðlanmamýþtýr. Bu çalýþmanýn amacý sýçan ekstravazasyon modelinde pentoksifilinin etkisini ve kullaným zamanýyla etkinlik iliþkisini belirlemektir.
Gereç ve Yöntem: Aðýrlýklarý 300-350 gr olan 30 adet Wistar-Albino sýçanlarýn tümüne 1 mg doksorubisin, 1cc izotonik içinde intradermal olarak enjekte edildi. Hayvanlar 3 gruba ayrýlarak 50mg/kg/gün pentoksifilin intraperitoneal olarak günde iki kez (12 saat ara ile) uygulandý. Gruplar sýrayla: Grup 1: hasar ile ayný gün tedaviye baþlandý (n=10), Grup2: hasardan sonraki gün tedaviye baþlandý (n=10), Grup 3: kontrol grubu (sadece serum fizyolojik verildi). Yaralanmadan 7, 10, 12 ve 15 gün sonra enjeksiyon yerinde ülser boyutu görüntü analiz programý yöntemi ile ölçüldü. Biyopsi materyali tüm nekrotik dokularý ve çevresindeki saðlýklý dokuyu içerecek þekilde elde edildi.
Bulgular: Grup 1 ve 2‘deki nekroz boyutlarý, grup 3 (kontrol grubu) ile karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý fark saptandý (p<0,01). Grup 1 nekroz alaný grup 2 ile benzerdi, iki grup arasýnda istatistiksel olarak anlamlý fark saptanmadý (p>0,05).
Sonuç: Bu veriler sýçanlarda doksorubisin ile gerçekleþtirilen ekstravazasyon hasarýnýn azaltýlmasýnda pentoksifilinin hasardan hemen sonra ya da 1 gün sonra kullanýlmasý anlamlý fark olmadýðýndan yaralanmanýn süresi ne olursa olsun kullanýlmasýnýn yararlý olduðunu göstermektedir.

Objectives: Extravasation injury is characterized by leakage of pharmacologic or non-physiologic substances from the vessel into the tissue, causing destruction. Full-thickness skin necrosis after extravasation of the widely used chemotherapeutic agent doxorubicin, is a significant source of morbidity in cancer patients. This progressive tissue necrosis may lead to pain, ulceration and disfiguring tissue loss. Although, various treatment options have been proposed for this type of injury, there is no consensus regarding the management of such lesions. The aim of this study was to determine the effectiveness of pentoxifylline and the relationship between usage duration and efficiency of the drug as a treatment in a rat extravasation model.
Study Design: The study was done on forty Wistar-Albino rats, weighing 300 to 350 g, All rats received 1 mg of doxorubicin in 1 cc of saline intradermal flank injection to stimulate extravasation injury. The rats were divided into three groups and intraperitoneal pentoxifylline of 50 mg/kg/day was administered within 12-hour intervals. Group1: they got the treatment on the same day with the injury (n=10). Group 2: they got the treatment 1 day after the injury (n=10). Group 3: Control group (saline infusion was administered). At the end of seventh, tenth, twelfth and fifteenth days, the size of ulcers at the injection site were calculated via Planimetri ® software image analysis program. A biopsy specimen, including all necrotic tissue and surrounding healthy tissue, was obtained at the end of the fifteenth day.
Results: In groups 1and 2 there were statistically significant differences in the sizes of necrosis compared with control group (P<0,01). In group 1 and 2, these was not statistically significant difference. Area of necrosis in Group 1 was similar to that in Group 2.
Conclucion: The data suggest that pentoxifylline is effective in the treatment of doxorubicin induced extravasation injury when administered on the day of and after doxorubicin injection.

Amaç: Bu çalýþmada akut pankreatit (AP) tanýsý ile takip edilen hastalarý tedavi yaklaþýmlarý açýsýndan deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: 2005-2010 tarihleri arasýnda hastanemizde AP tanýsý alan 184 hasta geriye dönük olarak incelendi. Olgularýn demografik özellikleri, etyolojik bulgularý, hastalýk þiddeti, tedavi þekilleri, açlýk süreleri, antibiyotik kullanýmý, total verilen günlük hidrasyon miktarý, paranteral beslenme süresi, analjezi tedavisi, hastanede yatýþ süresi ve prognoz kaydedildi. Uygulanan tedavi yöntemleri ile hastanede kalýþ süresi ve mortalite arasýndaki iliþki incelendi. Hastalýk klinik þiddetine göre hafif ve þiddetli olarak ayrýldý.
Bulgular: Hastalarýn 27’sinde (%14,7) komplikasyon geliþti. On hastada (%5,4) peripankreatik sývý birikimi, 7 hastada (%3,8) psödokist, 1 hastada (%0,5) pankreatik abse görülürken 10 hastada (%5,4) akut renal yetmezlik, 3 hastada da hipotansiyon ve þok görüldü. Mortalite oraný %3,8 (7 olgu) bulundu. Yüzkýrkaltý hastaya (%79,3) antibiyotik tedavisi verilmiþ olup, antibiyotik verilenler ile verilmeyenler arasýnda hastanede yatýþ süresi ve mortalite oranlarý arasýnda istatistiksel fark saptanmadý (p=0,077, p=0,557). Hastalýk þiddetine göre total paranteral nutrisyon (TPN) alan ve almayan hastalar karþýlaþtýrýldýðýnda þiddetli AP olgularýnýn daha fazla TPN aldýðý istatistiksel olarak anlamlý bulundu. Oral alýmýn kesilmesiyle hastanede yatýþ süresi ve mortalite oranlarý kýyaslandýðýnda ise istatistiksel olarak anlamlý farklar
saptanmadý (p=0,182, p=0,54).
Sonuç: AP mortal seyir gösterebilen önemli bir klinik sorundur. Tedavisinde halen birçok tartýþmalý konu bulunmaktadýr. Ampirik antibiyotik kullanýmýnýn hastalarýn yatýþ süresi ve mortalitesini etkilemediðinden sadece seçilmiþ vakalarda kullanýlmasýný önermekteyiz. Enteral veya paranteral beslenme tedavisine hastalýk þiddetine göre karar verilmelidir.

Aim: The aim of this study was to evaluate the approaches to the treatment of patients who are followed with diagnosis of acute pancreatitis (AP).
Patients and Methods: Total of 184 patients, diagnosed with AP in our hospital between 2005-2010 were assessed retrospectively. Demographic characteristics, etiologic findings, disease severity, treatment modalities, duration of fasting, the use of antibiotics, given the total amount of daily hydration, duration of parenteral nutrition, pain treatment, prognosis and hospital stay were recorded. The relationship between treatment and the length of hospital stay and between treatment and mortality were examined. The disease were divided into
mild and severe stage according to the clinical severity.
Results: Complications developed in 27 patients (14.7%). Peripancreatic fluid accumulation in 10 patients (5.4%), pseudocys in seven patients (3.8%), pancreatic abscess in one patient (0.5%), acute renal failure in 10 patients (5.4%), and hypotension and shocked in three patients were observed. The mortality rate was 3.8% (7 cases). Antibiotic therapy was given to146 patients (79.3%) and there was no significant difference in terms of the duration of hospitalization and mortality rates between the groups of patients treated with treated with antibiotics, and not treated with antibiotics (p= 0.077, p= 0.557). When the patients who did and did not receive TPN were compared, Patients with severe cases of AP were received significantly more TPN. On the other hand, when discontinuation of oral intake and duration of hospitalization and mortality rates were compared, there was no significant difference (p= 0.182, p= 0.54).
Conclusion: AP is an important clinical problem which can be mortal. There are still many controversial treatment methods. Since empirical use of antibiotics does not affect patients’ length of hospitalization and mortality, it has been recommend only in “ed cases. The treatment of enteral or parenteral nutrition therapy should be chosen according to the severity of disease.

Amaç: Eriþkin döneme gelmiþ ve asetabuler displazisi olan semptomatik hastalarda Steel tipi üçlü pelvik osteotomi uygulamalarýmýzýn klinik ve radyolojik sonuçlar üzerine etkisini incelemektir.
Gereç ve Yöntem: Kasým 2003 - Mart 2007 yýllarý arasý 30 hastanýn (27 bayan, 3 erkek) 31 kalçasýna steel tekniði ile üçlü osteotomi uygulandý. Ortalama takip süresi 24,1 ay (12-52), ortalama yaþ 31,1 (16-52) idi. Klinik deðerlendirmede Harris kalça skorlamasý kullanýldý. Radyolojik deðerlendirmede pelvis AP grafide CE (merkez-kenar) açýsý, Sharp’ýn asetabuler açýsý, Tönnis açýsý, asetabuler derinlik ve geniþlik indeksi, femur baþý örtünme oraný ve asetabuler anteversiyonun ölçümü yapýlýrken, false profil grafide VCA (vertikal-merkez ön açý) ölçümü yapýldý.
Bulgular: Harris kalça skoru preoperatif ortalama 64,3’ten postoperatif 82,9’a çýktý. Bu artýþ istatistiksel olarak anlamlý idi. Radyolojik deðerlendirmemizde CE açýsý preoperatif 5,42°’den postoperatif 24,52°’ye, VCE preoperatif 8,94°’den postoperatif 29,1°’e yükseldi. Yine Sharp açýsý preoperatif 50,71°’den 37, 68°’e düþtü. Tönnis açýsý preop 22,32°’den postop 11,52°’e gerilerken, kaplama preoperatif %59,23’den %79,77’ye yükseldi. Postoperatif tüm bu deðiþiklikler istatistiksel olarak anlamlý bulundu.
Sonuç: Çalýþmamýz sonucunda Steel tipi üçlü osteotomi, diðer pelvik osteotomilerle karþýlaþtýrýldýðýnda, kýsa operasyon süresi ve erken dönemde alýnan klinik ve radyolojik olumlu sonuçlar göz önüne alýnarak hafif ve orta derece asetabuler displazili hastalarda iyi bir tedavi alternatifi olarak saptanmýþtýr.

Objectives: The goals of surgery are to reorient the biomechanical relationships such that the development of degenerative hip disease is delayed or prevented. To achive these goals, various pelvic osteotomies have been used. We preferred the Steel Triple Innominate Osteotomy to treat acetabular dysplasia.
Materials and Methods: During the period between November 2003 and March 2007, triple innominate osteotomy was performed on 30 patients and 31 hips. There were 27 women and 3 men. The average clinical follow-up was 24.1 months (range 12-52 months). The average age at surgery was 31.1 years (range 16-52 years).
Results: Preoperative hip score increased from an average 64.3° preoperative to 82.9° postoperative. The CE angle was increased from an average 5.42° preoperative to an average 24.52° postoperative. The VCE angle was increased from an average 8.94° preoperative to an average 29.1° postoperative. The Sharp angle was decreased from an average 50.71° preoperative to an average 37.68° postoperative. The Tönnis angle was decreased from an average 22.32° preoperative to an average 11.52° postoperative. The percentage of the femoral head covered by the acetabulum increased from 59.23% to 79.77%. These parameters were significant statistically (p<0.05). Anteversion was 20.39° preoperative and 19.84° postoperative. Acetabular index of depth and width changed from 27.97° preoperative to 28.39° postoperative. Lateralization was 20.32 mm. preoperative and 21,81 mm postoperative. These parameters were not statistically significant. The complications were implant failure in two patients, deep infection in one patient, and hematoma in one patient.
Conclucion: As a result of this experience, we concluded that the Steel Triple Innominate Osteotomy is a safe and succesful treatment method that is helpful for patients with mild to moderate dysplasia.

Þilotoraks; konjenital veya edinsel nedenlerle, plevral boþlukta þilöz mayi birikimidir. Yenidoðan döneminde þilotoraks tedavisinde konservatif yaklaþýmlar (plevral drenaj, enteral beslenmenin kesilmesi, total parenteral nutrisyon, orta zincirli trigliserid ile beslenme) ve cerrahi yöntemler (duktus torasikus ligasyonu, pleuro-peritoneal þant veya plörodesis) kullanýlmaktadýr. Günümüzde konservatif yaklaþýmlarla sonuç alýnamayan olgularda, oktreotid tedavisi ile baþarýlý sonuçlar alýndýðý bildirilmektedir. Bu yazýda, yenidoðan döneminde konjenital diyafragma hernisi operasyonu sonrasý þilotoraks geliþen, konservatif yöntemlerle yanýt alýnamayan, oktreotid verilerek baþarýyla tedavi edilen bir olgu sunuldu.

Chylothorax is defined as accumulation of chylous fluid in pleural cavity which may be caused by congenital and acquired diseases. During neonatal period, chylothorax treatment is composed of conservative( pleural drainage, termination of enteral feeding, total parenteral nutrition and supplementation with medium-chain triglycerides) and surgical therapies(ductus thoracicus ligation, pleuredesis). Nowadays, for cases among which conservativ therapies fail, treatment with octreotide has been reported to be beneficial with promising results. A neonate who developed chylothorax after congenital diaphragmatic hernia operation and who was successfully treated with octreotide after failure of conservative treatment is presented in this case report.

Amaç: Safra kesesi gastrik metaplazi, safra taþý olan hastalarda görülebilen epitelyal bir deðiþikliktir. Bu olgu sunumunda gastrik metaplazi lezyonunun önemi tartýþýlmýþtýr.
Olgu Sunumu: Bu olguda, özelikle yaðlý yemeklerden sonra ortaya çýkan, karýn sað üst kadranda aðrý þikayeti olan 34 yaþýnda kadýn hasta tartýþýlmýþ ve literatür deðerlendirmesi yapýlmýþtýr. Olgunun batýn ultrasonografisinde safra kesesi içinde en büyüðü 1 cm olarak ölçülen multipl kalküller tespit edildi. Olguya elektif þartlarda laparoskopik kolesistektomi uygulandý. Patolojik inceleme sonucunda safra kesesinde gastrik metaplazi tespit edildi.
Sonuç: Safra kesesi metaplazi-displazi döngüsünün safra kesesi kanserinin baþlangýcý olabileceði bildirilmektedir. Bu nedenle safra kesesi gastrik metaplazi lezyonlarýnýn histopatolojik olarak daha dikkatli incelenmesi gerektiði kanýsýndayýz.

Purpose: Gastric metaplasia is an epithelial change in gallbladder, seen at patient with gallstones. In this case presentation, the significance of gastric metaplastic lesion is discussed.
Case Presentation: In this case report, 34 years old female with a pain complaint in right upper quadrant, that arised especially after fatty food, is discussed and literature is evaluated. Multiple calculi - the greatest is 1 cm - were determined in gallbladder in the abdominal ultrasonography. Laparoscopic cholecystectomy was performed under elective conditions. Gastric metaplasia in gallbladder was determined in pathological examination.
Conclusion: It is stated that metaplasia-dysplasia sequence in gallbladder may be the beginning of gallbladder cancer. For this reason, we consider that histopathological examination of gastric metaplastic lesions in gallbladder should be performed more carefully

Prilokain, pek çok alanda kullanýlan lokal anestetik bir ajandýr. Oldukça yaygýn kullanýmýnýn yaný sýra potansiyel hayatý tehdit edebilen bir yan etki olan methemoglobinemiye neden olabilir. Methemoglobinemi deðiþen derecelerde siyanozla karakterize olup bu olgularda okside demir içeren hemoglobin konsantrasyonu artar. Bu hemoglobin oksijen (O2) taþýmakta yetersizdir. Bu olgu sunumunda 4 aylýk erkek bir bebek tartýþýlmýþtýr. Olguya sünnet iþlemi öncesinde lokal prilokain uygulanmýþ olup sünnet sonrasý siyanoz geliþmiþti. Santral siyanoz sünnet sonrasý altýncý saatte geliþmiþ olup methemoglobin seviyesi %23’e yükselmiþti. Olgu, yoðun bakýma alýnmýþ olup maske oksijen desteði ile birlikte askorbik asit tedavisi baþlandý. Maske ile oksijen desteði altýnda olgunun sPO2 seviyesi %88 idi. Postoperatif 12. saatte methemoglobin seviyesi %12,3’e ve postoperatif 24.saatte methemoglobin seviyesi %1,3’e düþtü. Olguda ek bir yan etki geliþmeyip postoperatif 24. saatte yoðun bakým ünitesinden çýkartýldý. Bu olgu sunumunda olgunun özellikleri ve prilokaine baðlý olarak geliþen methemoglobinemi literatür eþliðinde tartýþýldý

Prilocaine is a local anesthetic agent that using in various fields of medicine. Besides its widespread use it has a potentially life treating complication –methemoglobinemia. Methemoglobinemia is presented with varying degrees of cyanosis. In these cases hemoglobin concentration which contains oxidized iron increased. This hemoglobin is insufficient to carry out the oxygen. In this case report we discussed one male infants (4 months age) who developed cyanosis after circumcision. Infant was an anesthetized with local prilocaine. Central cyanosis appeared six hour after surgery. The methemoglobine level reached to 23%. Subject was interned to intensive care unit and ascorbic acid therapy as well as O2 therapy with mask was started. The subjects sPO2 levels were %88 with the O2 therapy with mask. The cases methemoglobine levels was decreased to 12, 3% in 12th hour and 1,3% in 24th hour postoperatively. 24 hours after surgery, subject was discharged from intensive care unit. No additional complication was observed. Ýn this presentation; cases features and methemoglobinemia due to prilocaine use are discussed in the accompaniment of the literature.

Yenidoðan döneminde sývý ve elektrolit dengesi eriþkin ve diðer çocukluk çaðlarýna göre farklýlýklar gösterir. Doðumdan sonra çeþitli fizyolojik adaptasyon mekanizmalarý ile total vücut sývýsý azalýrken bir miktar sývý kaybý gerçekleþir. Term ve preterm bebeklerin bakýmýnýn yapýldýðý yenidoðan yoðun bakým ünitelerinde çalýþanlarýn ekstrauterin hayata geçiþteki fizyolojik mekanizmalarý ve prematüreliðin bu mekanizmalar üzerindeki etkilerini iyi bilmeleri ve anlamalarý gerekmektedir. Bu bebeklerde sývý ve elektrolit dengesinin saðlanmasýnda klinisyenler yönetici olarak önemli rol alýr. Derlememizde preterm ve term bebeklerde sývý ve elektrolit tedavi yönetimi ve postnatal adaptasyon mekanizmalarý ele alýnmýþtýr.

Water and electrolyte homeostasis in newborn infants is different from adults and other childhood ages. This homeostasis is affected by physiologic adaptations following birth. Physiologic adaptations include distribution of total body water and water loss. Caring for the newborn and prematurity in the NICU requires knowledge and understanding of the physiologic adaptation to extrauterine life and how prematurity affects that transition. Clinicians play an integral role in managing fluid and electrolyte balance in these infants. This review addresses postnatal adaptation and all aspects of fluid and electrolyte management of the term and preterm infant.