Background: Stroke is the third leading cause of death and is a major cause of disability in our country. Up to 80% of all strokes are of ischemic origin. It is a clinical emergency requiring urgent medical intervention. Recombinant tissue plasminogen activator (rt-PA) is the best treatment of acute ischemic stroke (AIS) when given within three hours of symptom onset. The main aim of this study was to review our thrombolithic treatment experience.
Methods: In our study, data of the 15 patients who were treated with intravenous thrombolytic therapy in the Intensive Care Unit of the Neurology Department of Şişli Etfal Research and Education Hospital between the years 2006 and 2012 were evaluated prospectively within the context of database of Stroke Study Group of Turkish Neurological Society. 0.9 mg/kg IV rt-PA had been administered to all
of the patients in first 3 hours.
Results: Fifteen patients with acute ischemic stroke received rt-PA. Mean age ± SD of our patients was 66.2±13.8 years (range 35–80). Eight of the patients (53.3%) were female. Patients presented in 10-90 (mean: 50.1) minutes and they were treated in 75- 205 ( mean 132.6) minutes after stroke onset. We observed clinical improvement of > 25% in NIHSS points in 8 of the 15 (53.3%) patients within 24 hours of therapy. 5 patients were improved %100 at the and of the first week.
Conclusion: Our analysis suggests that administration of 0.9 mg/kg IV rt-PA is safe and is associated with better functional outcome in the first 3-month- period. Hospitals must have the ability to provide treatment with intravenous (IV) rt-PA 24 hours a day, 7 days a week and have to provide brain imaging facilities necessary to perform before this therapy. Our hospital covers these requirements. Nevertheless, it is necessary to provide coordination between the members of the medical staff and a corporate organization scheme is required.

Objective: Urinary incontinence (UI); is a common health problem; affects people psychologically, physically and socially.In this study we try to determine the prevelance, causes and types of urinary incontinence in the female patients that visited our family medicine primary clinic and also to see the effects of this conditions on patients daily life.
Method: Female patients, aged more then 35 years old who visited our clinic in between 01-31 May 2012 were included in this study.Direct face to face Questionnaire by doctor was applied to each patient. The collected data were analyzed accordinally.
Results: Of total 201 patinets 86 (%42,8) had urinary incontinence. There was significant relation between uriner incontinence age, obesity and menopause (p=0.017; p=0,001; p=0,000). The urge incontinence was the most common type of UI (%43, n=37). There was no relation between UI and parity, delivery type, past urinary / gynecological operation. Regarding effects of UI on life quality.41 patinets had a ICIQ-SF questionnaire scale of more then 5 points and about 1/3 of them asked a doctor help for this.
Conclusıon: Although UI is common problem in females, it has been ignored by the patients and doctors as well. It should be looked for carefully by doctors in all female patients as a whole and in postmenopausal women specially.

Objective: Atherosclerosis at the carotid bifurcation is likely the major cause of ischemic stroke. Besides degree of stenosis, plaque characteristics are suggested to play a potentially important role as risk factors for stroke. The main aim of this study was to evaluate, morphological features such as intraplaque hemorrhage (IPH ), fibrous cap of the plaque with MRI.
Methods: A total of 23 patients with large artery atherosclerotic ischemic stroke were enrolled in this study. All underwent MRI assessment of the carotid arteries for intraplaque hemorrhage and fibrous cap rüpture. We compared plaque morphology with degree of stenosis.
Results: Mean± SD age of the patients was 60.7± 6.9 and 8 of 23 were female. Of the 11 symptomatic carotid arteries included, 5 had IPH and 5 had fibrous cap rupture. Non of the asymptomatic arteries had these pathologies. The relationship between degree of stenosis, IPH and fibrous cap rupture were not statistically significant (p= 0.63 and 0.25).
Conclusion: Besides the degree of stenosis, plaque characteristics are suggested to play a potentially important role as risk factors for stroke. MRI is well suited for evaluating carotid plaques; it is widely available, noninvasive, provides excellent soft tissue contrast, multiplanar imaging capability. In our study, we didn’t find a statistically significant relationship between degree of stenosis and plaque morphology but evaluation of patients with MRI provided additional information. More studies with larger patient groups are needed.

Congenital fusion defects of the neural tube and the related structures are classified as spinal dysraphism. Meningomyelocele is a defect which is the most common form of spinal dysraphism and occurs at an approximate rate of 1 in 800-1000 live births. In untreated meningomyelocele patients, mortality rate is 65-70% within the first 6 months. Between 2006 January and 2009 January, 10 (6 female and 4 male) newborns with a meningomyelocele defect large enough that could not repaired primarily were included the our study. In the nondelayed group which were consisted of five newborns whose diameter of the meningomyelocele defect were less than 50%, flaps were advanced to the midline and the defect was closed. In delayed group, we preferred to take advantages of the delaying phenomenon in five newborns whose diameter of the meningomyelocele defect were more than 50% of the mid-axillary distance to prevent disrupting circulation of the flaps. After 1 week, defects were closed following repair of the neural defects and advancement of the delayed flaps. The monitoring of the patients during the delay period revealed no local and central nervous system infection symptoms. In conclusion, we propose that delayed bipedicle flaps as an alternative method for the repair of large meningomyelocele defects due to their simple and reliable nature which also causes less hemorrhage, and we use them on selected patients in our clinic.

Purpose: Interval appendectomy of appendicular masses is still a controversial subject, but recent studies have adopted the view that apendectomy is unnecessary after conservative treatment. The aim of our study is to determine the necessity of interval appendectomy after a successful conservative treatment of the patients who have appendicular masses and have not applied appendectomy.
Materials And Methods: Between January 2000-December 2010, data of the 18 patients who have diagnosed with appendicular mass were analyzed. Age, sex, duration of symptoms, operation findings, the intervention, early complications and follow-up data were examined.
Results: A total of 18 patients, 8 female and 10 male were referred to our emergency service with clinical findings of acute appendicitis. The patients who have diagnosed appendicular masses with physical examination and radiological findings have interned to the hospital and conservative treatment started. We applied to patients combined dual antibiotic treatment. After discharge they have followed by policlinic follow-up. One of the patients has been operated because of unregressed clinical findings. One of them have been operated in another center because of recurrence 3 months later. During the mean 6 years (6 months to 10 years) follow-up no recurrence occured in 16 patients (88.8%).
Conclusion: Interval apendectomy is not necessary for the patients who has succesfully treated conservatively for appendicular masses and has not had recurrent symptoms.

Aim: To evaluate efficacy and morbidity of the treatment in total 533 patients underwent percutaneous nephrolithotomy (PCNL).
Material and Methods: Between November 2004 and December 2011, the records of 533 patients with renal calculi who underwent PCNL were reviewed retrospectively. All patients were evaluated with intravenous urography and/or computerized tomography. Patient related factors such as age, body mass index (BMI), ipsilateral history of SWL, PCNL and open surgery together with stone size and localization and degree of hydronephrosis were noted. Number and localization of access, blood transfusion requirement, success rate, length of hospitalization, intraoperative and postoperative complications and secondary procedures were reviewed.
Results: The application of 533 PNL procedures, 226 women (%47.5), 280 men (%52.5), %47.5 right side, %52.5 left side, BMI 26.38 kg/m2, mean stone volume 4196.64 mm3 were determined. Before the PNL procedures, 134 patients were used ESWL(%25.1), open nephrolithotomy in 77 patients (%14.4), PNL 29 patients (%5.4) applied. 221 patients didn’t have hydronephrosis (%41.5), 312 patients had hydronephrosis (%58.5) was detected before the PNL procedures. 407 patients underwent singleport (%76.4), 2 ports with 86 patients (%16.1), 38 patients with 3 ports (%7.1), 1 patient was 4 port input. Balloon dilatator (%81.6), sequential dilatator (%17.8) were used. The mean of operation and fluoroscopy time 125.91 min and 6.1 min were detected. Perioperative complications occured in 39 patients (%7.1). Required blood transfusion in 81 patients (%15.2).
Conclusion: PNL method acceptable complication rate in the treatment of kidney Stones, can be administered safety and effectively.

Objective: To evaluate of visual outcomes of Toris-K soft keratoconus contact lens in patients with advance keratoconus.
Methods: 56 eyes of 35 patients (16 female, 19 male) were included in this retrospective study. 13 eyes (%23,21) had a stage3 keratoconus and 43 eyes (%76,79) had a stage4 keratoconus. Mean age was 26,88±10,63 (range: 14-55). Mean corneal thickness was 482±28 micrometers (range: 398-524). Mean flat corneal meridian power was 49,50±4,25 diopter (range: 41,14-58,40). Mean steep corneal meridian power was 57,35±3,45 diopter (range: 53,13-69,40). Mean corneal power was 53,42±3,85 diopter (range: 49,52-60,90). Uncorrected visual acuity, best spectacle corrected visual acuity and contact lens corrected visual acuity were measured for all cases and compared.
Results: Mean uncorrected visual acuity was 0,19±0,16 (range: 0,01-0,6). Mean best spectacle corrected visual acuity was 0,33±0,16 (range: 0,05-0,8). Mean contact lens corrected visual acuity was 0,71±0,19 (range: 0,30-1,00). Mean gain line on Snellen chart was 3,84±1,35 (range: 1-7 line) with contact lens. Contact lens corrected visual acuity was meanly better then spectacle corrected visual
acuity (p=156x10-18, p<0,01).
Conclusion: We find out that visual outcome of Toris-K contact lens fitting, soft silicone hydrogel contacts, is successful in patient with advance keratoconus. These contacts improve distance visual acuity better than spectacles in advance keratoconus.

Aim: To evaluate the frequency and the correlation of short stature and obesity and among children aged between 2-16 ages in Yozgat city.
Material and Methods: Children admitted to University Hospital were evaluated. The height and weight of the children were analysed by health personel. Body mass index (BMI) was calculated with the formula; body weight (kg)/ Body height (m2 ). The correlation between short stature and obesity was statistically analysed by SPSS12.0.
Results: There were 763 children 386 (50.5%) boys and 377 (49.5%) girls. The mean body weight and height was 23.05±11.75 kg (9.0-89.2 kg ) and 114.4±21.0 cm (74- 185 cm), respectively. A total of 53 (6.9%) children, 24 girls, 29 boys, were under 3rd percentile for height. Mean BMI was 16.3±2.6 (3.5- 35.2). Short stature, overweight and obesity was seen in 6.9%, 11% and 7.1% children respectively. Among the children with short stature 9.4% were overweight and 7.5% were obese. There was no statistical signifant difference between children with or without short stature when compared for overweight and obesity (p>0.05).
Discussion: Both being related to feeding problems, short stature and obesity still are serious health care problems in our country. The quality of feeding should be improved and the doctors’ attention should be drawn to this issue, so that a national contribution may be acquired.

Objective: In this study, we evaluate retrospectively the results of 95 patients who underwent endoscopic dacryocystorhinostomy due to chronic dacryostenosis between June 2007 and November 2011.
Methods: Of 95 patients, 82 (86%) were adult, 13 (14%) were children. 71 (87%) of adult patients were female and 11 (13%) were male having ages between 17 and 78 (mean age: 40). 5 (26%) of pediatric group were female and 9 (64%) were male having ages between 3 and 14 (mean age: 8,7). Of 18 (19%) patients were operated bilaterally and only one of them was a child (7 years old female). At sixth postoperative month, the success rate was determined according to existence of epiphora and iatrogenic ostium.
Results: At the sixth postoperative month, the clinical results were reviewed. Of 113 endoscopic endonasal dacryocystorhinostomy operations 77 were unilateral and 18 were bilateral. Total cure accomplished in 103 (91,1%) operations and recurrence were seen in 10 (%8,9) operations.
Conclusion: Endoscopic dacryocystorhinostomy compared with external approaches have a remarkable high success rate with no visible scar formation and rapid healing time.

Cesarean scar pregnancy is a rare type of ectopic pregnancy and refers to implantation of a pregnancy within the myometrium at the site of a prior cesarean scar. Cesarean ectopic pregnancy is a potentially life-threatening condition that, if not detected early and managed aggressively, can result in uterine rupture, hemorrhage and maternal death. Many therapeutic options are available such as dilatation and curettage, local or systemically administered methotrexate, excision of trophoblastic tissues using either laparotomy or laparoscopy and uterine artery embolization. Through this paper, we aimed to present a case of cesarean scar pregnancy that was managed by dilatation, curettage and foley catheter bolloon.

Intracranial lipomas are very rare tumors an incidence of approximately % 0.1 of intracranial tumours. They usually occur near the middle line, as corporis callosi, quadrigeminal and ambient cisterns, infundibuler chiasma, cerebellopontine angle and sylvian fissure, rarely in the medulla oblongata, pons, proplexus and cortical area. We may encounter with radiological imaging of this lesions in
both emergency services and policlinics. Therefore, this lesions and caharacteristics must to be well known and must be approached correctly.
Case: We presented two cases in this report. Firstly; a 52 year old male patient admitted to emergency service because of trauma that his cranial tomography and magnetic resonance imaging revealed a corporis callosi lipoma and the latter; a 46 year old female patient admitted to our department because of headache that her cranial magnetic resonance imaging demonstrated a lipoma in the clivus. In this report, the clinic, radiological imaging, the area they occurred, process management and differential diagnosis of intracranial lipomas were overviwed.
Conclusion: The intracranial lipomas are usually asymptomatic and rare. They can detected from computer tomography and magnetic resonance imagings. The pathologies that accompany this tumours must be ascertained. Because of benign prognosis low speed of growth, the close to neurovascular structure they must not remove until compression findings are happened.

The finger flexor tendon injury may be open and closed. Closed tendon injuries are rare. The frequency of spontaneous flexor tendon rupture is also rare. The most common injury mechanism in spontaneous flexor tendon rupture is the resistance against the flexion movement of the hand. The location of tendon rupture is difficult to determine. The identification of the type and degree of flexon tendon injury with magnetic resonance imaging and ultrasound makes a significant contribution to preoperative surgical planning and approach. In this article, magnetic resonance imaging and ultrasound finding of bilateral spontaneous rupture of the 5. flexor digitorum profundus tendon are presented.

Trauma in pregnancy remains one of the major contributors to maternal and fetal morbidity and mortality. Potential complications include maternal injury or death, shock, internal hemorrhage, intrauterine fetal demise, direct fetal injury, abruptio placentae, and uterine rupture. Because the anatomic and physiologic alterations of pregnancy can alter the gravid woman’s response to injury, an understanding of these changes is critical when approaching trauma management.