Amaç: Ýskemik inme, çeþitli etiyolojik nedenleri olan bir hastalýktýr. Ýnme etiyolojik tanýsýný belirlemeye yönelik iliþkisi keþfedilmiþ pek çok belirteçten biri de D – Dimer’dir (DD). Bu çalýþmada DD seviyeleri ile inme alt gruplarýnýn ayýrýcý tanýsý, inme aðýrlýðý ve prognoz arasýndaki iliþkinin incelenmesi hedeflenmiþtir.
Gereç ve Yöntem: Çalýþmaya Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Nöroloji Kliniðine ilk 24 saat içinde baþvuran ilk kez inme geçiren hastalar prospektif olarak alýndý. Tüm hastalarýn ilk 24 saat içinde ve 8–10 gün arasýnda olmak üzere iki kez DD düzeylerine bakýldý. Hastalarla eþit yaþ ve cinsiyet daðýlýmýndaki saðlýklý bireyler kontrol grubu olarak alýndý ve bir kez DD düzeylerine bakýldý. Hastalar etiyolojik olarak TOAST kriterlerine göre sýnýflandý. Akut dönemde National Ýnsitutes of Health Stroke Scale (NIHSS) ile inme aðýrlýðý, daha sonraki izlemlerde ise Modifiye Rankin skalasý (mRS) ve Barthell skalasý ile prognozlarý deðerlendirildi.
Bulgular: Bu çalýþmaya 15’i kadýn, 40 iskemik inmeli hasta ve 12’si kadýn olmak üzere 20 saðlýklý kontrol hastasý dahil edildi. Çalýþmamýzda akut dönemde iskemik inmeli hastalarda saðlýklý kontrollere göre DD seviyelerinde anlamlý yükseklik saptanmýþ olmasýna karþýn(p=0,018 p=0,019), kardiyoembolik inmesi olanlar ve atriyal fibrilasyonu olanlar diðer gruplarla karþýlaþtýrýldýðýnda anlamlý farklýlýklar bulunamamýþtýr (p=0,333 p=0,519 ve p=0,490 p=0,251). Ýnme aðýrlýðý ve prognoz ile iliþkisine bakýldýðýnda ise yüksek DD seviyeleri dizabilite ile iliþkili olarak bulunmuþtur.
Sonuç: DD iskemik inmenin erken döneminde kullanýþlý olabilecek bir belirteçtir. Her ne kadar DD seviyelerini etkileyen çok sayýda faktör varsa da, DD düzeyindeki yükselmenin progresif inmenin bir göstergesi olabileceðini ve prognoza dair bilgiler sunabileceðini söylemek mümkün gibi görülmektedir.

Background: Objective-Ischemic stroke is a disease with a variety of etiological factors. D-dimer (DD) is one of markers established in the etiological diagnosis of stroke. In this study, differential diagnosis of the subgroups of stroke and the relationship between the severity of stroke and the prognosis is investigated in association with the DD levels.
Material and Metod: In this study, the patients who had a stroke and applied to the Clinic of Neurology at Þiþli Etfal Education and Resarch Hospital in 24 hours has been included prospectively. All patients’ plasma D-dimer levels has been measured for two times firstly in 24 hours and the second between 8.-10. days. The etiological subgroups were determined according to TOAST criterias. The stroke severity has been evaluated in acute periode by National Ýnsitutes of Health Stroke Scale (NIHSS), the prognosis has been evaluated subsequent periode by Modifiye Rankin scala (mRS) and Barthell scala.
Results: In this study 40 patients with stroke including 15 women and 20 healthy control patients including 12 women were included. In our study, the level of DD in ischemic stroke patients in the early period is found to be higher compared with the healthy controls(p=0,018 p=0,019). But DD levels are not significantly higher in the atrial fibrillation and cardioembolic stroke patients compared with the other groups (p=0,490 p=0,251 and p=0,333 p=0,519). When the relationship between the severity of the stroke and the prognosis is investigated, high DD levels are found to be associated with disabilities.
Conclusion: DD is an applicable biomarker in the early period of ischemic stroke. Although there are many factors that affect the level of DD, DD levels may be an indicator of progressive stroke and can provide information about prognosis seems to be able to say.

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Giriþ ve Amaç: Teknolojik geliþmeler sayesinde, hastalara taný ve tedavi amacýyla ameliyathane dýþý ortamlarda invaziv ve non-invaziv uygulamalara baþlanmýþtýr. Bu durum ameliyathane dýþý anestezi (ADA) ekiplerinin kurulmasýna neden olmuþtur. Biz, bu çalýþmada, ADA ekibimizin deneyimlerini sunmayý amaçladýk.
Gereç ve Yöntem: Ekim 2010-Nisan 2012 tarihleri arasýndaki ADA uygulamalarýmýzý retrospektif inceledik. ADA uyguladýðýmýz 3583 olgunun cinsiyeti, yaþý, ASA’sý, yapýlan giriþimleri, uygulanan anestezi ilaçlarý ve komplikasyonlarý kaydedildi.
Bulgular: Olgularýn cinsiyet daðýlýmý E/K 1671/1912, yaþ ortalamalarý 48.52±28.4, yaþ daðýlýmý 20 günlük - 91 yaþ arasýndaydý. ASA sýnýflamasý ASA I 1958, ASA II 1296, ASA III 318, ASA IV 11 þeklindeydi. 1837 olguya kolonoskopi, 536 olguya gastroskopi, 131 olguya ERCP uygulandý. 811 olguya MR, 62 olguya BT çekimi yapýldý. 234 seans EKT uygulamasý, 106 seans RT uygulamasý yapýldý. Anjiografi ünitesinde 40 olguya anevrizma embolizasyonu uygulandý. Anjiografi ünitesinde 9 olguya venöz sampling, 43 olguya karotis stent uygulamasý yapýldý. Ayrýca 63 olguya giriþimsel radyolojide farklý uygulamalar yapýldý. Olgularýn 1960’ýnda propofol+alfentanil,740’ýnde propofol, 544’ünde propofol+fentanil, 115’inde ketofol, 65’inde midozolam+ketamin, 83’ünde dexmetedomidin sedasyonu uygulandý. 234 EKT seansýnýn 90’ýnda etomidate+süksinilkolin, 144’ünde propofol+süksinilkolin uygulandý. 40 embolizasyon olgusuna genel anestezi
verildi. Geçirilmiþ serebrovasküler hastalýk, hipertansiyon öyküsü olan olguda kolonoskopi iþlemi esnasýnda intrakraniyal kanama geliþmesi dýþýnda majör bir komplikasyonla karþýlaþýlmadý. 12 olguda solunum depresyonu, 41 olguda bradikardi, 144 olguda desatürasyon, 19 olguda derlenme süresinin uzamasý, 8 olguda kusma gibi minör komplikasyonlarla karþýlaþýldý.
Sonuç: ADA uygulamalarý her alanda ve her yaþ grubunda sýklýkla kullanýlan bir yöntemdir. Ameliyathaneden uzak olma, yetersiz donaným ve monitör, çalýþma alanýndaki hareket kýsýtlýlýðý ADA uygulamalarýný zorlayýcý kýlmakta, beceri ve deneyim gerektirmektedir. Uygun donaným, ilaçlar ve yeterli koþullarda deneyimli bir anestezist ADA uygulamalarýndaki baþarýnýn sýrrýdýr. Ameliyathane dýþý anestezi uygulamalarý hasta güvenliðini ve memnuniyetini artýrýp, huzursuzluk ve aðrýyý azaltmakta, hekim konforunu arttýrmaktadýr.

Introduction And Aim: Thanks to technological developments, invasive and non-invasive diagnostic and therapeutic procedures have been done at the outside of the operating room. In this manner, to provide anesthesia at the outside of the operating room, anesthesia teams have been found. In this study, we aimed to report our anesthesia teams’ experiences.
Materials And Methods: We reviewed the procedures that was experienced at outside the operating room from October 2010 to April 2012 retrospectively. 3583 Patients who required anesthesia at the outside of the operating room included the study, and their sexes, ages, ASA status, procedures, and anesthesia complications were recorded.
Results: Patients’ sex ratio male/female 1671/1912; ranged in age from 20 day to 91 years; with the mean age 48,52±28,4. ASA status were, ASA I 1958, ASA II 1296, ASA III 318, ASA IV 11. Anesthesia procedures were for 1837 colonoscopy, 536 gastroscopy, 131 ERCP endoscopic retrograde cholangiopancreatography, 811 MRI magnetic resonance imaging, 62 CTI computerized tomography imaging, 234 ECT electroconvulsive therapy, 106 RT radiotherapy, 40 angiographic aneurysm embolization, 9 angiographic venous sampling, 43 carotis stent, and 63 other radiologic interventions. For sedation; 1960 Patient received propofol + alfentanil, 740 only propofol, 544 propofol + fentanyl, 115 ketofol, 65 midazolam+ketamin 83 dexmedetomidine. For electroconvulsive therapies, 90 patient received etomidate + succinyl choline, 144 propofol + succinyl choline. 40 patient received general anesthesia for embolisation procedures. There are no major complication occured except one patient experienced intracranial hemorrhage during colonoscopy. In minor complications; 12 patient experienced respiratory depression, 41 bradycardia, 144 oxygen desaturaion, 191 prolonged recovery from anesthesia, 8 vomiting.
Conclusion: Anesthesia procedures at the outside of the operating room are frequently used in all medical interventions and at all ages. Remote locations from operating room, inadequate equipment and monitors,not enough space in the working environment, providing anesthesia outside the operating room is challenging and requires expertise and skill. The secret of success in anesthesia in remote locations is the skilled anesthesiologist with the appropriate equipment and drugs, along with adequate backup facilities. Anesthesia procedures at the outside of the operating room are guarding the patients safety and welfare, minimising physical discomfort and pain, providing physicians’ comfort.

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Giriþ ve Amaç: Perkütan trakeotomi(PT) uygulamasý, kýsa sürede yatak baþýnda uygulanabilme ve daha az kanama gibi avantajlarý, ayrýca uzamýþ yapay solunum gereksinimi, “weaning”in kolaylaþtýrýlmasý, acil hava yolu saðlanmasý gibi endikasyonlarla yoðun bakým ünitelerinde sýklýkla tercih edilir. Cerrahi trakeostomiye alternatif yöntemdir. Bu çalýþmada ki amacýmýz YBÜ’mizde son 4 yýlda açýlan trakeotomileri uygulama günü, uygulama zamaný ve uygulama sonrasý komplikasyonlarý açýsýndan analiz etmektir.
Yöntem: 01.01.2007 ve 31.12.2010 tarihleri arasýnda YBÜ’mizde tedavi edilen 603 olgudan perkutan trakeotomi uygulanan 132 olgu analiz edildi. Perkütan trakeotomi uygulamasý griggs tekniðiyle birekip tarafýndan gerçekleþtirildi. Demografik verileri, uygulama günü, toplam mekanik ventilasyon günü, uygulama zamaný ve uygulama sonrasý komplikasyonlarý kayýt edildi.
Bulgular: Son 4 yýlda YBÜ’mizde takip ve tedavi edilen 603 olgudan 132’sine perkütan trakeotomi pratiði bu periotta uygulandý. Kadýn-Erkek oraný 62/70, olgularýn yaþ ortalamasý 58.65±17.22 yýl, olgularýn ortalama hastanede yatýþ süresi 38.77±28.74 gün, trakeotomi pratiði öncesi ortalama entübasyon süresi 8.20±5.44 gün, toplam mekanik ventilasyon süresi 26.85±21.70 gün ve ortalama operasyon uygulama zamaný 6.1±2.1 dakikaydý. 86 olgu komorbiditelerinden dolayý YBÜ’mizde öldü. 46 olgu ilgili servislere transfer edildi. Toplam komplikasyonlar (8 olgu) kayýt edildi.
Sonuç: YBÜ’de uzamýþ mekanik ventilasyon ihtiyacý, weaning’i kolaylaþtýrmasý, acil hava yolu saðlamasý gibi endikasyonlarla uygulanan peruktan trakeotomi basit, düþük komplikasyon oranýna sahip ve minimal giriþimsel uygulamadýr.

Introduction and Objective: Percutaneous tracheotomy practice is usually preferred at ICU for the advantages of able to be applied in a short time and at the bedside and it causes less bleeding. It is the alternative of surgical tracheotomy. The aim of this study is to analyze tracheotomies that were opened in our ICU in last 4 years, within the terms of practice day, practicing duration and post practice complications.
Method: 132 percutaneous tracheotomy practiced cases of 603 cases that were treated in ourreanimation unit between 01.01.2007 and 31.12.2010 were analyzed. Percutaneous tracheotomy practices were conducted via Griggs technique by a team. Demographic information, practice day, total mechanical ventilation days, practicing duration and post practice complications were recorded.
Findings: 603 cases were followed up and treated in ICU in last 4 years. 132 Percutaneous tracheotomy practices were applied in this period. It is figured out that women-man ratio was 62/70, the mean of age of the cases was 58.65±17.22 years, the mean hospitalization time of cases was 38.77±28.74 days, the mean intubation time before tracheotomy practice was 8.20±5.44 days, total mechanical ventilation days 26.85±21.70 and the mean practicing duration of operation was 6.1±2.1 minutes. 86 cases were deceased due to the comorbidities at ICU. 46 cases were transferred to the related services. Total complication (8 cases) were encountered.
Result: Percutaneous tracheotomy which was practiced for indications such as need for mechanical ventilation for long time, easing weaning, providing urgent airway in ICU; is simple, has low complication ratio and is minimally invasive practice.

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Amaç: Hastanemiz yenidoðan kliniðinde yatýrýlarak izlenen ve izlem sýrasýnda kaybedilen bebeklerin demografik özelliklerinin sunulmasý amaçlanmýþtýr.
Gereç ve Yöntem: Yenidoðan Kliniðimizde beþ yýllýk süre içerisinde (1 Ocak 2007–31 Aralýk 2011), kaybedilen bebeklerin kayýtlarý retrospektif olarak incelenerek; neonatal mortalite oranlarý, perinatalmaternal risk faktörleri ve ölüm nedenleri belirlendi.
Bulgular: Çalýþma süresince kliniðimize yatan hasta sayýsý 5491 iken bu bebeklerin 167’si kaybedildi ve mortalite oraný %3,04 olarak saptandý. Kaybedilen bebeklerin %15,6’sý ilk 24 saat içerisinde, %74,9’u ise ilk 7 gün içerisinde kaybedilmiþti. Kaybedilen bebeklerin %46,8’i kýz, %53,2’si erkek idi. Akraba evliliði sýklýðý %28,1 ve anne yaþý <19yaþ olma oraný %2,3 ve >35 yaþ olma oraný %14,3 olarak belirlendi. Kaybedilen bebeklerin %61,6’sý 37 gebelik haftasýnýn altýnda, %29,9’u 28 gebelik haftasý ve altýnda doðmuþtu. Doðum aðýrlýðýna göre ise %37,1’i 1000 g altýnda ve %64,6’sý 2500 g altýnda idi. En sýk saptanan yenidoðan ölüm nedenleri; respiratuar distres sendromu ve immatürite %24,6, neonatal sepsis %14,9 ve konjenital anomaliler %10,2 olarak belirlendi. Diðer nedenler ise sýrasýyla; perinatal asfiksi %9, diðer solunum problemleri (pnömotoraks, mekonyum aspirasyon sendromu, konjenital diyafragma hernisi v.b) %9, siyanotik konjenital kalp hastalýðý %8,4, metabolik hastalýklar %7,7, intraventriküler kanama %7,7, nekrotizan enterokolit %3,6 ve diðer nedenler %4,9 olarak belirlendi.
Sonuç: Yenidoðan bebeklerin ölüm nedenleri arasýnda immatürite ve konjenital anomaliler günü- müzde önemli bir sýklýkta yer almaktadýr. Bebeklerin önlenebilir ölüm nedenlerinin saptanarak bunlarý azaltmaya yönelik çabalar yenidoðan bebeklerin ölüm oranlarýný azaltmada belirli oranda faydalý olacaktýr.

Aim: This study was aimed to present the demographic information about neonates who were hospitalized and followed in our neonatal clinic and who died during follow-up.
Material and Methods: In this study, records of neonates who died in our Neonatal Clinic in five years (from 1 January 2007 to 31 December 2011) were evaluated retrospectively. Neonatal mortality rates, perinatal-maternal risk factors and causes of mortality were determined.
Results: During the five years, 5491 patients admitted in our clinic and 167 of them died. The mortality rate was 3,04%. The rate of neonates who died in the first 24 hours was 15,6%, whereas 74,9% of them died in the first 7 days of life. The gender distribution of infant deaths was found 46.8% female and 53.2% male. The rate of consanguineous marriage was 28,1%. The rate of mothers <19 years of age was 2,3%; whereas >35 years of age was 14,3%. The rate of neonates who were born <37 weeks of gestational age was 61.6%, whereas 29,9% of them were <28 weeks of gestational age; 37,1% of them were <1000 g of birth weight and 64,6% of them were <2500 g. The most common causes of neonatal mortality were determined as respiratory distress syndrome and prematurity (24.6%), neonatal sepsis (14.9%) and congenital anomalies (10.2%). Other causes were found perinatal asphyxia (8.9%), other respiratory problems (pneumothorax, meconium aspiration syndrome, congenital diaphragm hernia, etc.) (8.9%), cyanotic congenital heart disease (8.4%), metabolic diseases (7.7%), intraventricular hemorrhage (7.7%), necrotizing enterocolitis (3.6%) and others (4.9%).
Conclusion: Prematurity and congenital anomalies are still frequent reasons of neonatal deaths. To establish preventable mortality reasons and prevent relevant conditions can be helpful to decrease neonatal mortality rates.

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Amaç: Klinik muayene ve radyolojik olarak tanýsý konulan rotator manþet yýrtýklarýnýn tam artroskopik tamiri sonuçlarý klinik ve fonksiyonel olarak deðerlendirildi.
Hastalar ve Yöntem: Artroskopik rotator manþet yýrtýk tamiri yapýlan ve kontrolü yapýlarak fonksiyonel skorlarý bakýlan 26 hasta deðerlendirilmeye alýndý. Ortalama yaþ ortalama yaþ 52.85±8.39’du (daðýlým 38-71), ortalama takip süresi 36.6±16.6 (daðýlým 14-56) ay saptanan hastalarýn, 10’u (%38.5) erkek, 16’i (%61.5) kadýndý. Hastalar preop. direkt grafi ve MR ile radyolojik, preop ve postop constant
skoru ile klinik olarak deðerlendirildi.
Bulgular: Etkilenen omuzlarýn 18’i (%69.2) sað, 8’i (%30.2) sol tarafta idi. 3(%13.5) hastaya akromioplasti yapýldý. Çalýþmadaki 26 hastanýn %76.9’unda sadece supraspinatus yýrtýðý mevcutken, %23.1’inde infraspinatus yýrtýðý da eþlik etmekte idi. Bu hastalarýn etyolojisine bakýldýðýnda hastalarýn %11.5’inde (üç hasta) travma hikayesine rastlandý. Hastalarýmýzýn ameliyat öncesi 52.89.1 (33-64) ve ameliyat sonrasý 82.0±11.7 (56-100) constant skorlarý karþýlaþtýrýldýðýnda bütün hastalarýn constant skorlarýnda anlamlý derecede iyileþme gözlendi (p=0.000). Sekiz (%30.7) hasta mükemmel, on (%38.4) hasta iyi, yedi (%26.9) hasta orta, bir (%3.8) hasta kötü olarak deðerlendirildi.
Sonuçlar: Masif olmayan seçilmiþ olgularda yapýlan artroskopik rotator manþet tamiri; sonuçlarýnýn iyi olmasý, komplikasyonlarýnýn az olmasý nedeniyle tercih edilebilir. Beraberinde rutin olarak akromiyoplasti yada subakromiyal dekompresyon önerilmemektedir.

Purpose: Clinical and functional arthroscopic repair results of rotator cuff tears which have been diagnosed both radiographically and clinicaly have been evaluated.
Patients And Method: 26 patients treated with arthroscopic rotator cuff tear repair have been studied. Functional scores at the last follow-up were recorded. Mean age was 52.85±8.39 (range 38- 71), Mean follow up time was 36.6±16.6 (range 14-56). 10 patients were (38.5%) male and 16 (61.5%) were female. Preoperatively patients were examined radiologically with X ray and MR and clinically with constant score. Postoperative constant scores were recorded.
Results: 18 (69.2%) of the effected shoulders were on the right side and 8 (30.2%) were on the left side. 3 (13.5%) of the patients went through acromioplasty. 76.9 % of the 26 patients had only supraspinatus tear where as in 23.1% of the patients concomitant infraspinatus tear was detected. Ethiologically three (11.5%) patients had history of shoulder trauma. Preoperative mean constant score was 52.89 (33-64) and postoperative mean constant score was 82±11.7 (56-100). All patients had significant increase in constant scores (p=0.000). Eight (30.7%) patients scored excellent, 10 (38.4%) patients good, seven (26.8%) patients fair and one (3.8%) patient bad.
Conclusion: In selected cases, when the tear is not massive, arthroscopic rotator cuff repair may be the preferred treatment method becouse of its predictable good results and relatively less complication rate. Routine acromioplasty or subacromial decompression are not recommended.

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Sweet sendromu (SS); etyopatogenezi tam olarak bilinmeyen febril nötrofilik dermatozdur. Etyolojide infeksiyonlar ve maligniteler önemli rol oynar. Olgularýn olgularýn yaklaþýk %20’sine malignite eþlik etmektedir ve malignitelerin yaklaþýk %85’ini Akut miyeloblastik lösemi (AML) oluþturmaktadýr. SS’lu olgularda paterji testi pozitifliði saptanabilmekle birlikte paraneoplastik SS’lu olgularda nadir görülen bir durumdur. Burada AML M4 ve Sweet Sendromunun birlikte görüldüðü, paterji testi pozitifliðnin eþlik ettiði 80 yaþýnda bir kadýn hasta sunulmaktadýr.

Sweet’s syndrome is a skin disease, which can be described as an acute febrile neutrophilic dermatosis with unknown etiology. SS can accompany infectious diseases and malignancies. Approximately 20 percent of patients with Sweet’s syndrome have an associated malignancy. Most commonly acute myelomonocytic leukemia, account for 85% percent of the associated malignancies. Pathergy test positivitiy can be detectable in patients with SS whereas pathergy test positivity is a rare condition patient with paraneoplastic SS. We report a 80-year old woman with positive pathergy test associated SS and AML.

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Karotidini, karotis bifurkasyon bölgesinin palpasyon sýrasýnda tek taraflý hassasiyetiyle karakterize bir boyun aðrýsý sendromudur. Bu sendromun doðru teþhisi için ayýrýcý tanýnýn oldukça dikkatli yapýlmasý gerekir. Karotidini için ayýrýcý tanýda, Takayasu ve temporal arteriti gibi büyük damar vaskülitleri, arterioskleroz, tromboz, fibromuskular displazi, diseksiyon ve anevrizmanýn yaný sýra non-vasküler hastalýklar; lenfödem, siyaloadenit, tiroidit, peritonsiller abse veya boyun neoplazileri sayýlabilir. Takayasu arteriti, etiyolojisi bilinmeyen aort ve ana dallarýný tutan, nadir görülen kronik sistemik granülomatöz inflamatuar bir hastalýktýr. Karotidini, Takayasu arteriti ve diðer büyük damar vaskülitlerinin klinik bir iþareti olabilir. Bu çalýþmada, idiopatik ve Takayasu arteritli olmak üzere iki karotidini olgusunun ultrasonografik ve manyetik rezonans bulgularýný sunduk.

Carotidynia is a neck pain syndrome, characterized by unilateral tenderness to palpation over the carotid bifurcation area. The differential diagnosis for carotidynia should be done carefully for the proper identification of this syndrome. The differential diagnosis for carotidynia includes large-vessel vasculitides such as Takayasu’s and temporal arteritis, arteriosclerosis, thrombosis, fibromuscular dysplasia, dissection and aneurysm, as well as other non-vascular diseases such as lymphoedemas, sialodenitis, thyroiditis, peritonsiller abse or neck neoplasms. Takayasu’s arteritis is a rare chronic systemic granulomatous inflammatory disease that affect the aorta and its major branchs with unknown etiology. Carotidynia may be a clinical sign of Takayasu arteritis and other large vessel vasculitides. In this study, we report ultrasonographic and magnetic resonance imaging findings in two patients with idiopatic carotidynia and Takayasu arteritis as a cause of carotidynia.

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Ovaryan kitleler bazen dev boyutlara ulaþabilirler. Bu yüzden de diðer komþu organlara, büyük damarlara kompresyon uygulayýp patoloji yaratabilir, asit oluþturabilirler. Bu derece büyük kitlelerin çýkarýlmasý sýrasýnda çok fazla sývý aspire edilmesine veya dev kitlenin çýkarýlmasýna baðlý olarak ciddi hipotansiyon ve Ýnferior Vena Cava (ÝVC) sendromu oluþabilir. Burada bu þekilde olan dört olguyu
jinekolojik, patolojik, anestetik açýlardan sunmak istedik.
Olgu: 54, 35, 39 ve 42 yaþýnda olan hastalar sýrasýyla 20 kg ve 40x20cm; 14 kg ve 40x40x40 cm; 17 kg ve 45x50cm; ve 53x50 cm kitle saptanýp opere edildiler. Histopatolojik tanýlarý sýrasýyla ilk ikisi borderline müsinöz adenokarsinom, benign endometroid tümör ve son olarak müsinöz kistadenoma eþlik eden teratom þeklindeydi. Preoperatif deðerlendirmede, hastalarýn aþýrý abdominal distansiyona baðlý dispne ve taþipnesi vardý ve kan gazlarý hipoksikti. Supin hipotansiyon ve diðer major komplikasyonlarý önlemek için gerekli operatif tedbirler alýnarak uygun anestezi tekniði ile opere edildiler. Major peroperatif ve postoperatif herhangi bir komplikasyon oluþmadý.
Tartýþma: Dev kitle eksizyonlarý önemli morbidite ile beraber olabilirler. Bu genelde kitlenin büyüklüðüne ve hastanýn kötü kondisyonlarýna baðlýdýr. Eðer operasyon için gerekli tedbirler alýnmazsa dev kitleler kanama ve hipotansiyon, elektrolit bozukluklarý ile beraber belirgin morbidite ve ciddi problemlere sebep olurlar. Bu yüzden ventilatörle monitorizasyon, hemodinamik deðerlendirme, hipotermi ve koagülopati için uygun tedbirler alýnýp operasyona multidisipliner hazýrlanmalýdýrlar.

Ovarian masses sometimes can be seen as bulky masses reaching to huge amounts. Most pathologic signs can be attributed to compression effect on intraabdominal organs, vascular structures and ascites made by tumor. After removal of such huge pelvic masses, serious clinical hypotension and inferior vena cava (IVC) syndrome can be seen related to the aspiration of high levels of fluid or resection of bulky mass. Here, we present four cases of bulky ovarian masses by means of gynecologic surgery, anaesthesia and pathology.
Case: 54, 35, 39, 42 years old patients having 20 kg and 40x20cm; 14 kg and 40x40x40 cm, 17 kg and 45x50 cm and 53x50 cm adnexal masses respectively were operated. Histopathologies were found each to be the first two borderline mucinous carcinomas, third one was benign endometrioid tumor and the fourth one was mucinous cystadenoma complexed with teratom structures. On preoperative assessment, patients had dyspnea and tachypnea due to huge abdominal distention, blood gas parameters were hypoxic. To prevent supin hypotensive syndrome and other complications peroperatively, cases were evaluated by anesthesiology and the appropriate anesthesia technique was chosen, no major complications were seen in the peroperative or postoperative periods.
Discussion: Giant ovarian cyst excision may be associated with significant mortality. Most of the problems are due to the size of the cyst and to the patient‘s poor condition. Serious problems in this case mainly develop because of intraoperative blood loss and duration of the operation, postoperative hypotension and electrolyte disorders may be seen. Special attention should be paid to ventilator monitoring and hemodynamic assessment peroperatively and intraoperative fluid imbalance, hypotermia and coagulopathy regulation and the operative approach in the planning area needs to be done carefully.

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Ýmplante damar eriþim cihazlarý pek çok hematolojik ve onkolojik hastalýðýn tedavisinde kullanýlmaktadýr. Ýntravenöz tedavinin zorluðunu belirgin olarak azaltýr ve onkoloji hastalarýnýn yaþam kalitesini arttýrýrlar. Deneyimli ellerde komplikasyon oraný çok düþüktür. Bununla birlikte kullanýcýlarýn eðitilmesi, katater bakýmýnýn sýk ve uygun þekilde yapýlmasý, takýldýkdan sonra uygun þekilde kullanýlmasý gereklidir. Biz bu olguda uygunsuz kullaným sonrasý delinme ve sýzýntý geliþen port katateri komplikasyonunu sunmayý amaçladýk.

Implanted vascular access devices (ports catater) are widely used in pediatric haematology and oncology patients. They reduce the intravenous therapy difficulties and increase the quality of lives of oncologic patients. Complications are rare with experienced hands. Education of users, correct and frequent care, appropriate postoperatively use are important. Correct procedure and careful usage decrease the incidence of complications. We present a case where a perforation and leakage of ports catater occured due to improper usage.

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Dermoid kistler en yaygýn görülen periorbital tümörlerdir. Total eksize edildikten sonra en önemli konu operasyon sonrasý en iyi estetik sonucun alýnmasýdýr. Cerrahi sýrasýndaki insizyonun lokalizasyonu iyileþme sürecini etkilemektedir. Biz bu çalýþmada dermoid kist eksizyonunda üst kapak kývrýmýný kullandýðýmýz bir olguyu sunarken insizyon tekniklerini sorguladýk

Dermoid cysts are the most frequent periorbital tumors. The primary concern after total excision is an acceptable cosmetic result. Localization of incision during surgery effects the healing process and cosmetic result. In this report, we reviewed incision techniques while presenting a case in which we used upper skin crease incision for dermoid cyst excision.

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