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.

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 İndex) 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.

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. İnfection rates and cathehterization rates were calculated according to guidelines of Turkish National İnfection 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.

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.

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.

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.

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.

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.

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.

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’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.

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.