Amaç: Yaþamýn ilk iki yýlýnda anne sütü ile beslenmeye etki eden faktörlerin belirlenmesi.
Yöntemler: Ocak 2011 - Mayýs 2012 tarihleri arasýnda, Saðlam Çocuk Polikliniðinden doðumundan itibaren düzenli olarak takip edilen, 2 yaþýný doldurmuþ süt çocuklarý alýndý. Bebeklerin izlem dosyalarýndan doðum öncesi ve sonrasý bilgileri kaydedildi. Ailenin sosyoekonomik durumu ve annenin doðum öncesi ve sonrasý emzirme eðitimi alma durumu anket görüþmesi yapýlarak kaydedildi. Çalýþma sonucunda elde edilen verilerin yalnýz anne sütü ile beslenme ve toplam anne sütü ile beslenme sürelerine etkisi araþtýrýldý.
Bulgular: Çalýþma 200 çocuk ile tamamlandý. Hastalarýn %57,5’i erkek ve %56’sý sezaryen ile doðmuþtu. Yalnýz anne sütü alma süresi ortalama 4,3±2,0 ay, toplam anne sütü alma süresi 16,4±7,7 ay ve ilk 6 ay yalnýz anne sütü alma oraný %37,5 idi. Annenin eðitim düzeyinin yüksek olmasý ile ailenin gelir düzeyi artmasý ve annenin çalýþýyor olmasýnýn toplam anne sütü süresini olumsuz etkilediði saptandý (sýrasýyla p: 0,009,
p: 0,024, p: 0,001). Doðum öncesi emzirme eðitimi alan anne sayýsý 21 (%10,5), doðum sonrasý emzirme eðitimi alan anne sayýsý 163 (%81,5) idi. Doðum sonrasý anne sütü ile beslenme eðitimi alan annelerin yalnýz anne sütü ve toplam anne sütü alma sürelerinin yüksek olduðu belirlendi (sýrasýyla p: 0,001 ve p: 0,000). Bebekler bir yaþýna geldiðinde emzirmeye devam eden anne sayýsý 136 (%68) idi. Bir yaþýndan sonra emzirme eðitimi desteði alan annelerin toplam anne sütü alma süresinin daha fazla olduðu belirlendi (p: 0,001).
Sonuçlar: Yaþamýn ilk iki yýlýnda toplam anne sütü ile beslenme oranýnýn arttýrýlmasý çabasýnda, bir yaþýndan sonra emzirme eðitimi desteðinin saðlanmasý önemli bir faktör olarak saptanmýþtýr.

Objective: The aim of this study is to determine factors which effect breastfeeding in children in the first 2 years of life.
Methods: The study included infants attained 2 years of age who are followed by the Child Health Surveillance Clinic regularly since the birth, between January 2011 - May 2012. Infants prenatal and postnatal datas were collected from medical records. Socioeconomic state of family and mother’s prenatal/postnatal breastfeeding education recorded by survey interview. The factors which effects the exclusive breastfeeding and total breastfeeding time were investigated.
Results: The study was completed with 200 children. Among the study group 57.5% were male and 56% born with cesarean delivery. Mean exclusive breastfeeding time was 4.3±2.0 months and total breastfeeding time was 16.4±7.7 months and the ratio of exclusive breastfeeding in first 6 months was 37.5%. With mother’s higher education level, improvement of family’s income and working mother affected total breastfeeding time negatively (p: 0.009, p: 0.024, p: 0,001 respectively). 21 mothers educated for breastfeeding prenatally (%10,5), 163 mothers educated postnatally (%81,5). Mothers educated postnatally for breastfeeding had longer time for exclusive breatfeeding and total breastfeeding (p: 0,001 and p: 0.000, respectively). 131 mothers continued breastfeeding when their children attained 1 year of age. Mother’s who supported for breastfeeding after 1 year of age was found statistically significant longer total breastfeeding time (p: 0,001).
Conclusion: Among the efforts to increase total breastfeeding ratio at the first 2 years of life, support of breastfeeding education after 1 year determined as an important factor.

Amaç: Kalsiyum duyarlaþtýrýcý ajanlardan olan levosimendan ileri kalp yetmezliði tedavisinde kullanýlan farmakolojik ajanlardan biridir. Kardiyak performansý arttýrdýðý bilinmekte ancak aritmi geliþimi üzerine etkisi iyi bilinmemektedir. Bizim çalýþmamýzýn amacý levosimendanýn inotropik etkisi ve süresini saptamak ve aritmiye neden olup olmadýðýný araþtýrmaktýr.
Yöntem: Evre III-IV kalp yetmezliði olan sinüs ritmindeki 24 hasta çalýþmaya alýndý. Beyin natriüretik peptid (BNP), ekokardiyografi (EKO), 24 saatlik ritim Holter, kalp hýzý deðiþkenliðinin (KHD) analizi, sinyal ortalamalý EKG yapýldý. Levosimendan infüzyonu öncesi ve sonrasý [1, 15 (BNP ve EKO sadece), 28’inci günlerinde] bu testler tekrarlandý.
Bulgular: BNP düzeyleri baþlangýca göre 1. günde azaldý; 15 ve 28. günlerde arttý. Sol ventrikül ejeksiyon fraksiyon’u ilk gününde önemli ölçüde arttý; 15 ve 28. günlerde azaldý ve bu deðiþim istatistiki olarak anlamlý bulundu. Miyokardiyal performans indeksinin (Tei Ýndeksi) deðeri anlamlý olarak ilk günde azaldý. Geç potansiyel pozitifliði baþlangýçta 7 hastada tespit edildi. Tedavi sonrasýndaki 1. günde 5 ve 28. günde 8 hastada tespit edildi. Atriyal fibrilasyon ile ilgili olarak, baþlangýca göre tedavi sonrasý anlamlý artýþ tespit edilmedi. 28 gün de RR sürelerinin standart sapmasý (SDNN) ve ortalama RR sürelerinin standart sapmasý (SDANN) deðerlerinde anlamlý ölçüde artýþ saptandý.
Sonuç: Levosimendanýn sol ventrikül performansýný arttýran ve KHD analizlerinde kismi düzelme saðlayan etkisi vardýr aritmi geliþimini arttýrýcý etkisi yoktur.

Objective: The calcium sensitizer levosimendan is one of the best documented pharmacological agents used in the management of advanced heart failure syndromes. It improves cardiac performance, but It’s effect on arrhythmia development is not investigated well. The aim of this study was to determine the inotropic effect of levosimendan and its duration and to investigate whether it caused arrhythmia.
Methods: Twenty-four patients (in sinus rhythm) with stage III-IV heart failure were enrolled in the study. Brain natriuretic peptide (BNP), echocardiography, 24-hour rhythm Holter, heart rate variability analysis (HRV), signal-averaged ECG were performed. These tests were repeated on days 1, 15 (BNP and echocardiography only), and 28 following levosimendan infusion therapy.
Results: Brain natriuretic peptide level was reduced on day 1. and increased on days 15. and 28. left ventricular ejection fraction was increased significantly on the first day and reduced on days 15 and 28, however the difference remained significant. Reduction of miyocardial performance index (Tei Ýndex) was significantly on the first day. Late potential positivity was found in 7 patients at the baseline. After treatment it was found in 5 patients on Day 1 and in 8 patients on day 28. Regarding atrial fibrillation, no difference was found compared to the baseline. Standard deviation of all normal RR intervals (SDNN) and Standard deviation of average NN (RR) intervals (SDANN) increased significantly
on day 28.
Conclusion: Levosimendan increases left ventricular performance and does not have an effect on arrhythmia development and provides partial improvement in HRV analysis.

Amaç: Yoðun Bakým Ünitelerinde en sýk görülen nozokomiyal enfeksiyon pnömonidir. Nozokomiyal pnömonilerin önemli kýsmýný oluþturan ventilatör iliþkili pnömoniler (VÝP) önemli morbidite ve mortalite nedenidir. VIP oraný ve hýzýnýn belirlenerek enfeksiyon koruma önlemlerinin sürdürülmesi, etkenlerinin ve duyarlýlýklarýn belirlenerek tedavi seçiminin bu doðrultuda yapýlmasý gerekir.
Yöntemler: YBÜ’ne yatýrýlarak takip ve tedavi edilen hastalar ileriye dönük, hastaya ve laboratuvar verilerine dayalý aktif sürveyans yöntemiyle izlenmiþtir. Hastane enfeksiyonu tanýsý, Centers for Disease Control and Prevention (CDC) kriterlerine göre konulmuþtur. Enfeksiyon hýzlarý ve alet kullaným oranlarý ulusal enfeksiyonlarý sürveyans kontrol birimi (UHESKB) gerekliliklerine uygun sürveyans sistemi önerilerine göre hesaplanmýþtýr.
Bulgular: Bu çalýþmada, hastanemiz reanimasyon yoðun bakým ünitesinde Ocak 2011- 2012 tarihleri arasýnda 2 günün üzerinde yatan 252 hastada geliþen ve tümünde mekanik ventilatör uygulamasý olan 24 pnömoni olgusu incelendi. Ventilatör kullaným oranýnýn % 58 olduðu yoðun bakým ünitesinde 1000 hasta gününde VIP hýzý 16,49 olarak tesbit edildi. Hastalardan endotrakeal aspirat yöntemi ile alýnan örneklerden izole edilen etkenler deðerlendirildiðinde; olgularýn 18 (%75) inde tek mikroorganizma 6 (%25) inde iki ve ikiden fazla izole edildi. Bu suþlarýn 27’si (%79,4) gram-negatif bakteri iken 5’i (%14,7) gram-pozitif bakteri, ikisi (%5.8) Candida spp. idi.Gram-negatif etken olarak en sýk Acinetobacter spp. 10(%29.4) Acinetobacter baumannii 6(%17.6) elde edilirken bunu Pseudomonas aeruginosa 4 (%11.7), Pseudomonas spp. 4(%11.7), Klebsiella spp. 3(%8.8) takip etmiþtir. Gram-pozitif etken olarak da MRSA 2(%5.8), MRKNS 3 (%8.8)
izole edilmiþtir. Gram-negatif etkenlerin antibiyotiklere duyarlýlýklarý incelendiðinde; Acinetobacter suþlarýnýn imipeneme %90, siprofloksasine %60, amikasine %57 dirençli olduðu, seftazidim, netilmisin, kolitsin, tigesikline %100 duyarlý olduðu, diðer gram negatif etkenlerin karbapenemlere %100, siprofloksasine %85 duyarlýlðýný koruduðu tesbit edilmiþtir.
Sonuçlar: Görülen mikroorganizma ve elde ettiðimiz duyarlýlýk sonuçlarýna göre, hastanemiz yoðun bakým ünitesinde yatan hastalarda ampirik tedavi gram-negatif etkenlere yönelik düþünülmeli ve karbapenem dirençli Acinetobacter suþlarýn varlýðý durumu da göz önüne alýnarak kombine tedaviler uygulanmalýdýr.

Objective: Pneumonia is the most common nosocomial infection encountered in intensive care units. Pneumonia mostly occurs in form of ventilator-associated pneumonia (VAP) which is a maor cause of mortality and morbidity. Therefore, VAP rate should be determined while employing well grounded infection prevention measures. Also causative microorganisms and their susceptibilities should be determined to guide the antibiotic therapy.
Methods: Intensive care unit patients were prospectively surveyed in terms of nosoxomial infections through active surveillance methods. Centers for Disease Control and Prevention (CDC) criterias were used in detecting nosocomial infections. Ýnfection rates and cathehterization rates were calculated according to guidelines of Turkish National Ýnfection Surveillance Control Group (UHESKB).
Results: A total of 252 patients treated for longer than 48 hours in Anesthesia Intensive care Unit during January 2011 and January 2012 were surveyed. We detected VAP in 24 patients, all of whom received mechanical ventilator support. Mechanical ventilator usage rate was 58% and VAP rate was 16.49 in 1000 patient-ventilator days.
Cultures of endotracheal aspiration samples showed that 18 (75%) of cases contained a single microorganism whereas 6 (25%) of cases contained two or more microorganisms. Twenty-seven (79.4%) of these microorganisms were gram-negative bacteria, 5 (14.7%) were gram-positive bacteria and 2 (5.8%) were candida species. Most commonly cultured gram-negative bacteria were Acinetobacter spp. 10 (29.4%), Acinetobacter baumannii 6 (17.6%), Pseudomonas aeruginosa 4 (11.7%%), Pseudomonas spp. 4 (11.7%) and Klebsiella spp. 3 (8.8%). Gram-positive microorganisms were MRSA 2 (5.8%) and MRKNS 3 (8.8%). Susceptibility tests showed that Acinetobacter species were resistant to imipeneme by 90%, ciprofloxacine
by 60%, amikasine by 57%, and were totally susceptible to seftazidim, netilmisin, kolitsin and tigesikline. Other gram-negative bacteria were susceptible to carbapenems by 100%, ciproflxacine by 85%.
Conclusion: Culture and susceptibility test results showed that ampirical antibiotherapy in our intensive care unit should be against gram-negative bacteria and concerning carbapeneme resistant Acinetobacter species, combination therapies should be employed.

Bu çalýþmada, kliniðimizde çocukluk çaðý radius boyun kýrýðý nedeni ile açýk yerleþtirme ve K-teli ile tespit uygulanan hastalarýn orta dönem fonksiyonel sonuçlarýný analiz etmek amacý ile 11 çocuk hasta geriye dönük olarak deðerlendirildi Kýrýklarýn sýnýflandýrýlmasýnda Judet’in radius boyun kýrýklarý sýnýflandýrmasý, fonksiyonel deðerlendirmede ise Tibone ve Stolz sýnýflamasý kullanýldý. Hastalarýn ortalama izlem süresi 36,5 ay idi. Judet sýnýflamasýna göre 8 hasta tip 3, 1 hasta tip 4A, 2 hasta tip 4B olarak deðerlendirildi. Tip 3 kýrýðý olan bir ve tip 4A kýrýðý olan bir hastada yer deðiþtirmemiþ ve konservatif izlenen proksimal ulna kýrýðý mevcut idi. Tibone ve Stolz sýnýflamasýna göre 5 hastada mükemmel, 3 hastada iyi, 3 hastada orta sonuç elde edildi. Proksimal ulna kýrýðýnýn eþlik ettiði tip 4A hastada mükemmel, tip 3 hastada ise orta sonuç elde edildi. Hastalarýn hiçbirinde valgus deformitesi izlenmedi. Radyografik olarak hiçbir hastada avasküler nekroz, heterotopik ossifikasyon ve radyoulnar sinostoz geliþmedi. Çalýþmanýn sonuçlarýna göre çocukluk çaðý radius boyun kýrýklarýnýn cerrahi tedavisinde açýk yerleþtirme ve K-teli ile tespit yönteminin etkin ve güvenilir bir tedavi yöntemi olduðu kanaatindeyiz.

Eleven cases in which open reduction and K-wire fixation was performed in our clinic due to pediatric radial neck fracture were analysed in terms of functional outcome retrospectively. For fracture classification, Judet system was used where functional evaluation was performed using Tibone-Stolz classification. The mean follow-up was 36,5 months. Fracture type was 3 in 8 patients, 4A for one patient and 4B for 2 patients according to Judet system respectively. Two patients sustained non-displaced ulna fractures which were managed conservatively. Five patients were evaluated as perfect where 3 patients good and remaining 3 fair according to Tibone-Stolz classification respectively. Patients with ulna fracture were graded as perfect in one and as good in the other. Valgus angulation, avascular necrosis, heterotopic ossification and radioulnar sinostosis were not encountered in any of patients. Under the light of the data of the current study, open reduction and K-wire fixation of pediatric radial neck fractures seems to be a safe and efficient treatment modality.

Amaç: Bu çalýþmada rotator manþet yýrtýðý tanýsýyla artroskopik yardýmlý mini-açýk yöntemle rotator manþet tamiri yapýlan hastalar geriye dönük olarak deðerlendirildi.
Yöntemler: Rotator manþet yýrtýðý saptanan 35 hastaya (9 erkek, 26 kadýn; ortalama yaþ 56; daðýlým 41-75) artroskopik yardýmlý mini-açýk yöntemle rotator manþet tamiri yapýldý. 29 hastada sað, altý hastada sol omuz tutulumu vardý. Hastalar ameliyat öncesi fizik muayene, direk radyografi, manyetik rezonans görüntüleme ve omuz constant murley skorlarý ile ameliyat sonrasýnda fizik muayene, omuz constant murley skorlamasý ile deðerlendirildiler. Ortalama takip süresi 21 ay(daðýlým 12-48) idi.
Sonuçlar: Ameliyat öncesinde 41.7 (daðýlým 12-82) saptanan Constant-Murley skoru ortalamasý, ameliyat sonrasý dönemde 79.7’ye (42-100) yükseldi (p<0.05). Sadece 4 hastanýn ameliyattan memnun olmadýðý öðrenildi. Hiçbir hastada enfeksiyon görülmedi.
Çýkarýmlar: Seçilmiþ olgularda, rotator manþet yýrtýklarýnda artroskopik yardýmlý mini-açýk yöntemle tamirin klinik ve fonksiyonel sonuçlarý baþarýlý bulundu.

Objective: In this study, the diagnosis of rotator cuff tears repaired, with arthroscopic-assisted mini-open tecniques were retrospectively evaluated.
Methods: 35 patients with rotator cuff tears (9 males, 26 females, mean age 56, range 41 to 75) repaired with arthroscopically assisted mini-open tecniques. 29 patients had involvement of right shoulder, 6 patients had ivolvement of left shoulder. Preoperative physical examination, radiography, magnetic resonance and Constant–Murley score was performed at this evaluation. In the post operative period, phsical examination, radiography and Constant-Murley score are used. The mean follow-up period was 21 months (range 12 to 48 months).
Results: The mean Constant-Murley score increased from preoperative 41.7 (range 12 to 82) to postoperative 79.7 (range 42 to 100) (p<0.05). Only four patients showed dissatisfaction with the surgical outcome. There was no infection in any patient.
Conclusion: In “ed cases, rotator cuff tears repaired with arthroscopically assisted mini-open tecniques was found successful in clinical and functional results.

Amaç: Kapalý redüksiyon ve perkütan telleme ile tespit tekniði, proksimal humerus kýrýklarýnýn cerrahi tedavisinde bazý durumlarda tercih edilen kolay bir yöntemdir. Özellikle parçalý kýrýklarda mini açýk yöntem ile redüksiyon sonrasý perkütan telleme ile tespit tedavinin baþarýsýný etkileyebilecek bir faktör olabilir. Bizim bu çalýþmadaki amacýmýz; proksimal humerus kýrýklarýnýn cerrahi tedavisinde kapalý redüksiyon veya mini açýk redüksiyon sonrasý yapýlan telleme ile tespit tekniklerini karþýlaþtýrarak, klinik olarak her iki tekniðin etkinliklerinin araþtýrýlmasýdýr.
Yöntem: Kliniðimizde parçalý proksimal humerus kýrýðý nedeniyle cerrahi olarak tedavi edilen 26 hastanýn (grup I: kapalý yerleþtirme sonrasý telleme ile fiksasyon, 13 hasta ve grup II: mini-açýk yerleþtirme sonrasý telleme, 13 hasta) klinik sonuçlarý geriye dönük olarak deðerlendirildi. Her iki grupta da 7 adet Neer tip 3 ve 6 adet Neer tip 4 parçalý proksimal humerus kýrýðý mevcut idi. Her iki gruptaki Constant skorlarý, hareket açýklýðý deðerleri ve komplikasyonlar istatistiksel olarak karþýlaþtýrýldý.
Bulgular: Grup I’de ortalama Constant skoru 38,2(24-61) iken, grup II’de 47,3(17,5-64) olarak bulundu(p: 0,166). Grup I’deki ortalama öne fleksiyon 83°(60°-120°) ve abduksiyon 80°(60°-120°) iken, grup II’deki ortalama öne fleksiyon 90°(60°-150°) ve abduksiyon 85,4°(60°-150v) olarak belirlendi (p: 0,585 p: 0,638). Grup I’de bir hastada kaynamama, 1 hastada avasküler nekroz ve 2 hastada açýlý kötü kaynama tespit edilirken, Grup II’de 1 hastada glenohumeral eklem artrozu ve 1 hastada çivi migrasyonu geliþti. Hiçbir hastamýzda damar sinir yaralanmasý veya enfeksiyon görülmedi.
Sonuçlar: Proksimal humerus parçalý kýrýklarýnýn cerrahi tedavisinde mini-açýk ve kapalý redüksiyon ile telleme yöntemleri kullanýlarak benzer klinik sonuçlar elde edildi. Fakat her iki yöntem ile çok parçalý kýrýklarda baþarýlý olmak oldukça zor gözükmektedir.

Objective: The closed reduction and fixation by percutaneous pinning is a simple method for treatment of the proximal humeral fractures. Especially in the comminuted fractures, mini-open reduction may be a raising factor for the treatment success. The aim of this study, was to evaluate of clinical effectiveness of pinning and fixation methods using mini-open reduction and closed reduction in the surgical treatment of proximal humeral fractures.
Methods: The clinical outcomes of 26 patients with comminuted proximal humeral fractures treated surgically (Group 1: 13 cases, closed reduction, pinning and fixation and Group 2: 13 cases mini-open reduction, pinnig and fixation) were evaluated retrospectively. Both groups were consisted of 7 Neer type 3 and 6 Neer type 4 proximal humeral fracture cases. The Constan scores, range of motion and complicationsof the two groups were compared statistically.
Results: Mean Constant scores were 38.2 (24-61) and 47.3 (17,5-64) in group 1 and in group 2, respectively. (p: 0,166). In group 1 the mean anterior flexion was 83° (60°-120°) and abduction was 80°(60°-120°). In group 2 anterior flexion and abduction were 90°(60°-150°) and 85.4° (60°-150°), respectively (p: 0,585, p: 0,638). One psodoarthrosis, one avascular necrosis and two malunion were seen in group 1, while in group 2, one glenohumeral joint arthrosis and one pin migration were seen. No neuro-vascular injury or infection was seen.
Conclusions: In the surgical treatment of comminuted proximal humeral fractures, using mini-open or closed reduction and pinning methods, similar clinical results may be obtained, but it seems quite difficult to be succesfull by both methods especially in the comminuted fractures.

Amaç: Rotator manþetin korakoakromial arkusta sýkýþmasý (impingement sendromu) en önemli omuz aðrýsý sebeplerindendir. Son yýllarda artroskopik cerrahi prosedürlerinin geliþmesi sonucunda, omuz artroskopisi geçerli bir yöntem olarak uygulamaya girmiþtir. Bu çalýþmada artroskopik subakromial dekompresyon yaptýðýmýz hastalar ileriye yönelik olarak deðerlendirildi.
Yöntemler: Çalýþmaya artroskopik subakromial dekompresyon uygulanan ve en az bir yýl süreyle izlenen 31 hasta (18 kadýn, 13 erkek; ortalama yaþ 57.7; daðýlým 23-78) alýndý. 20 hastanýn sað kolu, 11 hastanýn sol kolu etkilenmiþti. Deðerlendirmeler ameliyat öncesinde fizik muayene, direk radyografi, manyetik rezonans ve omuz Constant-murley skoru ile yapýldý. Ameliyat sonrasýnda fizik muayene, direk radyografi ve omuz constant-murley skorlamasý kullanýldý. Ortalama takip süresi 18.6 aydý (daðýlým 12-48 ay).
Sonuçlar: 27 hastada (%87) çok iyi ve iyi, 4 hastada (%13) tatmin edici sonuç alýndý. Kötü sonuç alýnan hasta olmadý. Ameliyat öncesi omuz constant-murley skor ortalamasý 42.8 (daðýlým 17-69) idi. Ameliyat sonrasýnda omuz constant-murley skor ortalamasý 79.2 (daðýlým 75-93) olarak bulundu (p<0.05).
Çýkarýmlar: Artroskopik subakromial dekompresyon, tecrübe kazanmýþ kiþiler için uygun seçilen olgularda üstün bir cerrahi tedavi seçenektir. Artroskopik cerrahi yapýlan hastalar, yara bakýmýnýn kolay olmasý ve deltoid yapýþma yerine zarar verilmemesi nedeniyle çok çabuk rehabilite olmasý ile açýk tekniklere göre daha üstündür.

Objective: Rotator cuff jam at the corocoacromial arcus, (impingement syndrome) is the most important cause of shoulder pain. Procedures in recent years through the development of arthroscopic surgery, shoulder arthroscopy as a valid method has been implemented. In this study, patients who underwent arthroscopic subacromial decompression evaluated prospectively.
Methods: In this study, artroscopic subacromial decompression is applied and followed at least one year, 31 patients (18 female, 13 male) were paticipated. 20 patient‘s right arm, 11 patient’s left arm was affected. Preoperative physical examination, radiography, magnetic resonance and Constant –Murley score was performed at this evaluation. In the post operative period, phsical examination, radiography and Constant-Murley score are used. The mean follow-up period was 18.6 months (range 12 to 48 months).
Results: 27 patients (87%) very well and good, 4 patients (13%), satisfactory results were obtained. There were no poor results. Preoperatively the mean of Constant-Murley score was 42.8 (Range 17 to 69 years). Postoperatively, the Constant-Murley shoulder score was 79.2 (range 75 to 93).
Conclusion: Arthroscopic subacromial decompression, is a superior surgical treatment option in appropriately “ed patients. Arthroscopic subacromial decompression is preferred instead of open techniques; because of easy wound care, protecting the integrity of deltoid muscle and quickly rehabilitated.

Amaç: Bu çalýþmada hastanemiz ortopedi polikliniðine getirilen altý aydan küçük bebeklerde kalça ultrasonografisi ile tespit edilen geliþimsel kalça displazisi sýklýðýnýn araþtýrýlmasý, risk faktörü olarak kabul edilen etkenlerle displazi arasýndaki iliþkinin incelenmesi amaçlanmýþtýr.
Yöntemler: Çalýþmaya Temmuz 2011- Temmuz 2012 tarihleri arasýnda polikliniðimize çeþitli sebeplerle getirilen veya yönlendirilen 6 aydan küçük 259 bebeðin 518 kalçasý dahil edilmiþtir. Bebeklerin 145’i (%56) kýz, 114’ü (%44) erkekti. Yaþ ortalamasý 11,1 (1-24) haftaydý. Bebeklerin doðum ve aile öyküleri öðrenilip fizik muayenede herhangi bir anormallik olup olmadýðýna bakýldý. Her bebeðe Graf yöntemi ile kalça ultrasonografisi yapýlarak kalçalarýn tiplendirmesi yapýldý ve gerekli durumlarda tedaviye baþlandý.
Bulgular: Kalçalarýn ölçülen alfa açýsý ortalamasý 64,3° (40-79), beta açýsý ortalamasý ise 60,6° (40-80) olarak hesaplandý. Ölçülen deðerlere göre 436 (%84,2) kalçada alfa açýsý normal kabul edilen 60°’nin üstündeydi. Buna karþýn 58 (%22,4) bebeðin 82 (%15,8) kalçasýnda ise alfa deðerinin normalin altýnda olduðu belirlendi. Toplam 34 bebeðin (%13,1) 43 kalçasý (%8,3) pavlik bandajý ile tedaviye alýndý. GKD açýsýndan risk etkeni olarak kabul edilen özelliklerden herhangi birine (fizik muayene bulgusu, aile veya doðum öyküsü) sahip olduðu gözlemlenen 92 (%35,5) bebek vardý. Fizik muayenede 71 (%27,4) bebekte GKD açýsýnda dikkat uyandýracak bulgular tespit edildi. Bu bebeklerden sadece 16’sýnda (%6,2) displazi vardý.
Sonuç: Displazi oranlarýnýn fizik muayene bulgularý olan ve olmayan gruplarda benzer çýkmasý bizi evrensel taramanýn daha uygun olabileceði açýsýndan düþündürtmektedir.

Objective: The aim of this study is to investigate the incidence of developmental dysplasia of the hip of the infants younger than six months old that were diagnosed by hip ultrasonography in our orthopaedics outpatient clinic. The relationship between risc factors and dysplasia were also discussed.
Methods: Between July 2011 and July 2012, 518 hips of 259 infants younger than six months old attended to our outpatient clinic for several reasons and those were included in this study. Among them 145 (%56) were female and 114 (%44) were male. Mean age was 11,1 (1-24) weeks. Obstetric and family histories of the infans and physical examination findings were recorded. Hip ultrasonography was performed and hips were classified for all infants according to the Graph’s method. Treatment was started according to the ultrasound findings.
Results: The mean of alfa angle was 64,3° (40-79) and beta angle was 60,6° (40-80). The alfa angle was normal (>60°) in 436 (%84,2) hips. In 82 (%15,8) hips of 58 (%22,4) babies, alfa angle was lower than 60°. Treatment with pavlik harness was performed in 43 hips (%8,3) of 34 (%13,1) babies. Among all infants, 92 (%35,5) of them had features (physical examination finding, family or obstetric history) which may be related with hip dysplasia. In physical examination 71 (%27,4) infants had abnormal findings but only 16 (%6,2) of them had dysplasia.
Conclusion: The rate of dysplasia in infants with abnormal findings was similar to the ones without abnormal findings. This made us think about the importance of universal screening.

Hidrojen peroksit çeþitli konsantrasyonlarda dezenfektan, leke çýkarýcý, boya temizleyici gibi farklý amaçlar için kullanýlan, kokusu ve rengi olmayan, kararsýz bir sývýdýr. Ýçildiði anda açýða çýkan oksijen, gastrik distansiyona ve dolayýsýyla hava embolisine yol açabilir. Ayrýca koroziv etkisi de vardýr. Yazýmýzda kazara %3’lük hidrojen peroksit içen dört hasta sunulmuþtur.
Hastalar ve yöntem: Ýki erkek çocuk kusma ve aðýz köpürmesi nedeniyle acil servise getirildi. Öykülerinden sýnýf arkadaþý olan ve hepsi 13 yaþýnda toplam 4 erkek çocuðun, su zannederek sýnýfta bulduklarý hidrojen peroksit solüsyonunu içtikleri öðrenildi. Diðer 2 çocuk da acile çaðýrýldý. Hepsi yatýrýlarak monitorize edildiler. Hastalarýn klinik bulgularý stabildi, yapýlan özofagoskopilerinde 1 hastada ikinci derece, diðerlerinde birinci derece özefagus yanýðý saptandý. Hastalara iþlem sonrasý oral baþlanarak sorunsuz taburcu edildiler. Kontrollerinde komplikasyon saptanmadý.
Sonuç: Hastalarýmýzda düþük konsantrasyondaki hidrojen peroksitin oral alýmý ciddi bir hasara yol açmamýþsa da, hidrojen peroksitin olasý etkileri göz önüne alýnarak, bu tür hastalarýn hava embolisi ve gastrik distansiyon açýsýndan en az 24 saat gözlemde tutulmasýný ve özofagustaki koroziv etkinin deðerlendirilmesini öneriyoruz.

Hydrogen peroxide is a colorless and tasteless unstable liquid which has several uses such as disinfectant, bleach or fabric stain remover in various concentrations. If taken orally, rapid generations of oxygen cause gastric distension and may lead to air embolism. There also corrosive effect. Here we present 4 children that ingested 3% hydrogen peroxide and discuss the clinical findings.
Patients and method: Two boys were admitted to the emergency department with vomiting and bubbling.
We were informed that they drank hydrogen peroxide solution that they found in the classroom with 2 other classmates, because they were thirsty. They were all aged 13. Other two boys were also called to the emergency department. All were hospitalized and monitorized. All had a stable course and esophagoscopy revealed second degree burn in one and first degree burn in the others. Oral feeds were started and they were discharged with no other problems. No complications were detected at during follow-up.
Conclusion: Although the concentration of hydrogen peroxide was low and oral ingestion did not cause serious problems in our patients, we propose hospitalization and monitorization of such a child at least for 24 hours for air embolus and gastric distention and evaluation of the esophageal mucosa for corrosive burns.

Hemolitik üremik sendrom (HÜS); hemolitik anemi, trombositopeni ve akut renal yetmezlik ile karakterize klinik bir tablodur. Ýnfant ve çocuklarda akut böbrek yetmezliðinin en sýk nedenlerinden biridir. HÜS’ün iki tipi mevcuttur. Tipik HÜS; Shigatoksine baðlý olarak geliþen, %90 diyare veya üst solunum yolu enfeksiyonunu takiben ortaya çýkan ve çocuklarda en sýk görülen formdur. Atipik HÜS, kompleman alternatif yolunun regülasyonundaki bozukluða baðlý geliþen primer hastalýktýr ve non Shigatoksin-HÜS olarak da bilinir. HÜS geliþen çocuklarýn %5-10’u atipik HÜS’dür ve bu olgularýn %20’sine ekstra-renal hastalýklar eþlik eder. Ýlk atakta son dönem böbrek yetmezliði geliþme ve mortalite oranlarý yüksektir. Hipertansiyonun hemen düzeltilmesi, uygun elektrolit ve sývý tedavisi, erken diyaliz ve nütrisyonel destek mortaliteyi azaltýr. Günümüzde, yoðun plazmaterapi en etkin tedavi yöntemidir. Biz de olgumuz eþliðinde HÜS’de yoðun destek tedavisini, plazmaferezi ve uzun süreli renal replasman tedavisini tartýþmayý amaçladýk.

Hemolytic uremic syndrome (HUS) is a clinical situation which is characterized by hemolytic anemia, thrombocytopenia and acute renal failure. This syndrome is one of the most common causes of acute renal failure in infants and children. There is two types of HUS. Typical HUS is the most frequent form of HUS in children, occurs due to Shigatoxin and %90 presents after diarrhea and upper airway infection. Atypical HUS is a primary disease due to a disorder in complement alternative pathway regulation and known as non Shigatoxin-HUS. 5-10% of HUS in children is atypical HUS and 20% of these cases have extra renal manifestations. Rates of deterioration to the end-stage renal failure and mortality are high at first episode. Normalizing hipertansion, appropriate fluid and electrolyte therapy, early dialysis and nutritional support decreases the mortality. Nowadays, intensive plasmatherapy is the first line treatment. By our case; we aimed to discuss the intensive support treatment, longterm renal replacement treatment and plasmatherapy in HUS.

Castleman Hastalýðý nadir görülen, nedeni bilinmeyen, en sýk mediastende saptanan, lenfoepitelial benign bir hastalýktýr. Bu makalede, parotis yerleþimli Castleman Hastalýðý olan 45 yaþýndaki hastanýn tedavi yaklaþýmý ve tedavi sonucu sunulmuþtur. Subtotal rezeksiyon uygulanan parotis yerleþimli kitleye adjuvan radyoterapi uygulanmýþtýr. Radyoterapi sonrasý 12. ayda klinik ve radyolojik olarak rekürrens tespit edilmemiþtir.

Castleman’s Disease (CD) is a rare, benign lymphoepithelial disease of unknown cause, most commonly in the mediastinum. In this article; we report a new case of CD arising from the parotid gland. A 45 year-old male patient with parotid CD’s treatment approach and treatment result are presented. Subtotal parotidectomy was performed. After operation; adjuvan radiotherapy was performed. Clinically and radiologically no recurrence was noted during a follow up period of twelve months.

Dopamin agonistleriyle tedavi edilebilen agresif prolaktinomalar dýþýndaki agresif hipofiz adenomlarýnda ilk tedavi seçeneði cerrahidir. Fakat sýklýkla bu tümörlerin çaplarýnýn büyük olmasý, çevre dokulara invazyon yapmasý ve nüks oranlarýnýn yüksek olmasý nedeniyle cerrahi ve radyoterapi gibi standart tedaviler yetersiz kalmaktadýr. Hipofiz karsinomlarý ise nadir görülen tümörler olup agresif hipofiz adenomlarýnýn kraniyospinal veya sistemik metastaz yapmalarý þeklinde tanýmlanýr. Bu karsinomlar oldukça invaziv olup cerrahi, radyoterapi ve kemoterapiye dirençlidirler ve prognozlarý kötüdür. Son zamanlarda, kimyasal olarak dakarbazin ile iliþkili, imidazoltetrazin derivesi alkilleyici bir ajan olan temozolomid agresif hipofiz adenomlarý ve hipofiz karsinomlarýnýn tedavisinde
baþarýyla kullanýlmýþtýr. O-6 metilguanin DNA metiltransferaz bir DNA tamir enzimi olup temozolomid tedavisine yanýtta rolü olduðu gösterilmiþtir. Temezolomid tedavisinin genellikle hafif derecede yan etkileri olmakla birlikte bazen ciddi yan etkilere neden olabileceðinden yakýn takip gerekmektedir. Temozolomid, konvansiyonel tedavilere yanýtsýz ve O-6 metilguanin DNA metiltransferaz düzeyi düþük olan agresif hipofiz adenom ve hipofiz karsinomlarýnda alternatif bir tedavi ajaný olarak düþünülebilir.

Except for aggressive prolactinomas, which are could be treated with dopamin agonists, surgery is the first-line treatment option for most aggressive pituitary adenomas, but usually, due to their size, invasion of surrounding tissues, and high frequency of regrowth, they are difficult to treat with standard treatment paradigms, including surgery and radiotherapy. Pituitary carcinomas are rare tumours, and are defined by aggressive adenomas with brain and/or systemic metastasis. These carcinomas are highly aggressive, resistant to surgery, radiotherapy and systemic chemotherapy, and are associated with poor survival. Recently, temozolomide, an alkylating imidazoltetrazine derivative, chemically related to dacarbazine, have been used successfully in the management of aggressive pituitary adenomas and pituitary carcinomas, resistant to conventional treatments. O-6 methylguanine DNA methyltransferase, a DNA repair enzyme, have been demonstrated to be associated with sensitivity to temozolomide. Temozolomide is considered to be a novel drug in the treatment of aggressive
pituitary adenomas and pituitary carcinomas, with few side effects, however it may cause serious side effects and proper follow-up of patients is essential.