Son yýllarda tüm dünyada ve ülkemizde preterm doðumlar artmaktadýr. Yenidoðan yoðun bakým alanýndaki geliþmelere baðlý olarak preterm bebeklerde mortalitesi azalýrken morbidite artmaktadýr. Geliþimsel sorunlar en sýk belirlenen morbiditelerdir. Artan morbiditenin azaltýlabilmesi amacýyla kullanýlan geliþimsel yöntemlere gereksinim duyulmaktadýr. Derlememizde geliþimsel sorunlarýn azaltýlmasýna yönelik “yenidoðan yoðun bakým ünitesinde uygulanabilecek geliþimsel bakým yöntemleri” anlatýlmaktadýr.

The incidence of preterm births have increased worldwide and in our country in recent years. Related to advances in neonatal intensive care, the mortality of the preterm births decreases but the morbidity increases. Developmental problems comprise the main portion of the morbidity. Strategies and new approaches are needed to decrease the morbidity. This review is about the approaches of developmental care used in neonatal intensive care units to support the development of preterm babies.

Amaç: Fizik muayene bulgularý ile birlikte manyetik rezonans (MR) görüntüleme sonuçlarýnýn artroskopik cerrahi yapýlmasý kararý üzerine olan etkilerini belirlemek.
Yöntem: Kliniðimizde diz artroskopisi yapýlan hastalarýn ameliyat öncesi fizik muayene bulgularý ile MR tetkiki sonuçlarý referans artroskopi alýnarak retrospektif olarak istatistiksel deðerlendirilmesi yapýldý.
Bulgular: Çalýþmaya katýlan hastalrýn yaþ ortalamasý 47,2 (22,73) olarak belirlendi. Çalýþmadaki hastalarýn 25’i kadýn, 20’si erkek, 27sol dize, 18 sað dize artroskopik cerrahi yapýldý. Medial menisküs yýrtýðý olan hastalarda Mc murray testinin duyarlýlýðý %69,8 medial eklem çizgisi hassasiyetinin duyarlýlýðý %97,7 MR görüntüleme yönteminin duyarlýlýðý %93 olarak belirlenmiþtir. Lateral menisküs yýrtýðý olan hastalarda Mc murray testinin duyarlýlýðý %71,4 lateral eklem çizgisi hassasiyetinin duyarlýlýðý %100 MR görüntüleme yönteminin duyarlýlýðý %85,7 olarak belirlenmiþtir. Medial ve lateral menisküs yýrtýklarýnda ayrým yapýlmaksýzýn Mc murray testinin duyarlýlýðý %68,9 eklem çýzgýsý hassasiyetinin duyarlýlýðý %97,8 Mr görüntüleme yönteminin duyarlýlýðý %93,3 olarak belirlenmiþtir.
Sonuç: Dikkatli yapýlan bir fizik muayenenin menisküs patolojilerini belirlemede en etkin taný yöntemi olduðunu düþündürmektedir ve gereksiz yere MR tetkiki istemi oranlarýný azaltabileceðini düþünmekteyiz.

Objective: To determine the effects of physical examination findings with the results of manyetik rezonans imaging (MRI) on the decision for arthroscopic surgery.
Methods: Preoperative physical examination findings and MRI results of the patients undergoing knee arthroscopy in our clinic were evaluated statistically by reference of arthroscopy retrospectively.
Results: The mean age of patients in the study is 47.2 (22.73), respectively. 25 of the patients were female, 20 of them were male. Arthroscopic surgery was performed for 27 left knee and 18 right knee. Mc Murray test sensitivity in patients with medial meniscus tear is 69.8%. The medial joint line tenderness sensitivity is 97.7% in the patients with medial meniscus tear. Sensitivity of MRI is determined as 93% in the group with medial meniscus tear. Mc Murray test sensitivity in patients with lateral meniscal tear is 71.4%. The lateral joint line tenderness sensitivity is 100% in the patients with lateral meniscus tear. Sensitivity of MRI is determined as 85.7% in the group with lateral meniscus tear. Mc Murray test sensitivity is 68.9%, joint line tenderness sensitivity is 97.8% and sensitivity of MRI is determined as 93.3% without discrimination on the medial and lateral meniscal tear.
Conclusion: A careful physical examination is the most effective diagnostic method to determine meniscal pathologies. We think that careful physical examination could reduce the rates of unnecessary MRI exams.

Giriþ ve Amaç: Postoperatif bulantý kusma (POBK) hastanede kalýþ süresini, hastalýðýn düzelmesini ve derlenme zamanýný uzatýr. Ayrýca, kraniyotomi sonrasý kafa içi basýnç artýþýna sebep olarak kanama riskini arttýrmaktadýr. Çalýþmamýzda intrakranial giriþim yapýlacak steroid tedavisi altýndaki hastalarda steroidin tek baþýna veya granisetron ve ondansetron ile kombine kullanýmýnýn POBK üzerine etkinliðini karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Nöroþirurji Kliniðinde supratentoryal kitle nedeniyle opere olacak olgular üzerinde yapýldý. ASA I-II, 18-70 yaþ arasý 90 olgu çalýþmaya dahil edildi. Çalýþmamýz prospektif, randomize ve çift kör olarak planlandý. Postoperatif 24 saatlik sürede her 6 saatte tüm olgulara intravenöz olarak 4 mg deksametazon uygulandý. Tüm olgulara, genel anestezi uygulandý. Ameliyat bitiminde, duramater kapatýlýrken,3 gruba ayrýlan olgularda; Grup 1’e serum fizyolojik,Grup 2’ye 8 mg ondansetron, Grup 3’e mg granisetron uygulandý.Operasyon ve anestezi süreleri, postoperatif 0, 2, 4, 6, 8, 10, 12, 16, 24. saatlerde bulantý için Verbal Destriktif Skala deðerleri, kusma varlýðý, antiemetik tüketimi, yan etkiler kaydedildi.
Bulgular: Grup 1, Grup 2 ve Grup 3 ün 0.-10.Saatler arasý bulantý þiddeti daðýlýmlarý arasýnda istatistiksel olarak anlamlý farklýlýk gözlenmiþtir (p=0,0001). Grup 1 de bulantý varlýðý Grup 2 ve grup 3 den istatistiksel olarak anlamlý derecede yüksek bulunmuþtur. Grup 1, Grup 2 ve Grup 3 ün 12-24.Saatler arasý bulantý þiddeti daðýlýmlarý arasýnda istatistiksel olarak anlamlý farklýlýk gözlenmemiþtir. Kontrol grubunda ilk 6 saatteki, ondansetron grubunda ilk 4 saatteki, granisetron grubunda 1.saatteki bulantý varlýðý diðer zamanlara göre istatiksel olarak anlamlý derecede yüksek bulunmuþtur. Grup 1, Grup 2 ve Grup 3 ün 0.-10. Saatler arasý kusma varlýðý daðýlýmlarý arasýnda istatistiksel olarak anlamlý farklýlýk gözlenmiþtir (p=0,0001). Grup 1 de kusma varlýðý Grup 2 ve grup 3 den istatistiksel olarak anlamlý derecede yüksek bulunmuþtur.Grup 1, Grup 2 ve Grup 3 ün 12.-24. Saatler arasý kusma varlýðý daðýlýmlarý arasýnda istatistiksel olarak anlamlý farklýlýk gözlenmemiþtir. Kontrol grubunda ilk 4 saatteki, ondansetron grubunda ilk 2 saatteki kusma varlýðý diðer saatlere göre istatistiksel olarak anlamlý derecede yüksekti. Granisetron grubunda hiç kusma görülmedi. Grup 1, Grup 2 ve Grup 3’ ün antiemetik ihtiyacý varlýðý daðýlýmlarý arasýnda istatistiksel olarak anlamlý farklýlýk gözlenmiþtir (p=0,02). Grup 1 de antiemetik ihtiyacý varlýðý Grup 2 ve grup 3 den istatistiksel olarak anlamlý derecede yüksek bulunmuþtur. Gruplarýn hiçbirinde yan etki ile karþýlaþýlmamýþtýr.
Sonuç: Supratentorial kitle nedeniyle opere olan olgularda deksametazonun tek baþýna antiemetik etkinliðinin yeterli olmadýðý, ondansetron ve granisetron ile kombine kullanýldýðýnda POBK’un önlenmesinde etkili olduðunu tespit ettik. Granisetron alan hasta grubunda daha az bulantý-kusma görülmesine raðmen ondansetron ve granisetron POBK açýsýndan benzer etkinlik göstermiþtir.

Objective: Postoperative nausea and vomiting (PONV) delays patient discharge and increases recovery room stays and recovery time. Furthermore, it increases the bleeding risk by causing increased intracranial pressure after craniotomy. The aim of this study was to compare the efficacy of steroids or steroids combined with ondansetron and granisetron in patients undergoing intracranial surgery.
Methods: The study was conducted on the patients undergoing supratentorial tumor surgery in the neurosurgery unit. 90 patients, classified as ASA physical status I and II, aged between 17-70 were included in this study. The study was planned as a prospective, randomized, double-blinded study. All the patients were medicated with 4 mg dexamethasone intravenously every 6 hours for the postoperative 24 hours. All patients had general anesthesia. Dura mater was turned off at the end of the surgery, and the patients were divided into 3 groups. Group 1 was treated with saline, Group 2 was treated with 8 mg ondansetron, and Group 3 was treated with 8 mg granisetron. Durations of operation and anesthesia, verbal destructive scale values for nausea at the postoperative 0th, 2nd, 4th, 6th, 8th, 12th, 16th, 24th hours, existence of vomiting, use of antiemetics, and side effects were collected.
Results: The nausea score distributions of Group 1, Group 2 and Group 3 between 0th to 10th hour were significantly different (p=0.0001). Nausea scores in Group 1 were significantly higher than Groups 2 and 3, whereas the difference between Group 1, Group 2 and Group 3 was found statistically insignificant between 12th to 24th hours. The nausea score distributions of the control group for the first 6 hours, ondansetron group for the first 4 hours and granisetron group for the first hour were significantly higher when compared to the other times. The existence of vomiting in Group 1, Group 2 and Group 3 was significantly different between 0th to 10th hour (p=0.0001). The
existence of vomiting in Group 1 was significantly higher than Group 2 and Group 3. But there was no significant difference between the groups in terms of existence of vomiting between 12th to 24th hours. The existence of vomiting in control group for the first 4 hours and in the ondansetron group for the first 2 hours were significantly higher than the other times, whereas no vomiting was observed in granisetron group. The distribution of the need for antiemetic use between Group 1, Group 2 and Group 3 was found to be significantly different (p=0.02). The need for antiemetic use in Group 1 was significantly higher from that of Groups 2 and 3. No side effects were observed in any group.
Discussion: The results of our study showed that the antiemetic efficacy of dexamethasone alone was not enough for patients underwent supratentorial tumor surgery but it was effective for prevention of PONV when combined with ondansetron and granisetron. Although less nausea and vomiting has been observed in patients medicated with granisetron, the efficacy of ondansetron and granisetron was similar for preventing PONV.

Amaç: Doðumdan sonraki ilk karþýlaþmada anne veya babanýn, bebeðe karþý gösterdiði davranýþlar ilk ebeveynlik davranýþý olarak kabul edilmektedir. Araþtýrma, annelerin doðum sonu dönemde ebeveynlik davranýþlarýnýn deðerlendirilmesi amacýyla yapýlmýþtýr.
Yöntem: Tanýmlayýcý nitelikte olan araþtýrma; Kadýn-Doðum Hastanesinde Ocak 2011-Mayýs 2011 tarihleri arasýnda vajinal doðum yapan, saðlýklý bebeðe sahip olan 234 anne ile tamamlanmýþtýr. Veriler; anket formu ve Britton ve arkadaþlarý (2001) tarafýndan geliþtirilen, Çalýþýr ve arkadaþlarý (2009) tarafýndan geçerliliði yapýlmýþ “Doðum Sonrasý Ebeveynlik Davranýþý Ölçeði” (DSEDÖ) ile toplanmýþtýr. Doðumdan sonra anne ve bebeðin karþýlaþtýðý ilk 10 dakika süresince gözlemci, annenin bebeðine karþý gösterdiði davranýþlarý gözlemleyerek, var olan davranýþa (+), olmayan davranýþa (-) iþareti koyarak kaydetmiþtir. Altý maddeli ölçeðin, her bir maddesi için davranýþ gözlenmiþse bir (1) puan, gözlenmemiþse sýfýr (0) puan olarak deðerlendirilir. Ölçekten alýnan toplam puanýn yüksek olmasý ebeveynin bebeðine karþý olumlu ebeveynlik davranýþýna sahip olduðunu göstermektedir. Annenin doðal davranýþýný gözleyebilmek için önce DSEDÖ, sonra anket formu gözlemci tarafýndan doldurulmuþtur. Her anket formu ve DSEDÖ için yaklaþýk 15 dakikalýk süre kullanýlmýþtýr. Araþtýrmaya baþlamadan önce etik kurul kararý ve kurumdan izin alýnmýþtýr. Doðuma gelen gebelere açýklama yapýlarak ve doðumdan sonra gözlemin herhangi bir zamanda yapýlacaðý bildirilerek katýlmak isteyenlerin onamlarý alýnmýþtýr. Verilerin deðerlendirilmesinde; yüzdelik daðýlým, varyans analizi ve t testi kullanýlmýþtýr.
Bulgular: Annelerin %66.7’sinin 20-29 yaþ grubunda olduðu, %77.8’inin isteyerek gebe kaldýðý belirlenmiþtir. Annelerin %9’u “0” puan alýrken, %17.5’i “6” puan almýþlardýr. Annelerin toplam puan ortalamasý 3.20±1.95 olarak bulunmuþtur. Annelerin; aile tipine, eðitim durumlarýna, eþlerin eðitim durumlarýna ve gelir düzeylerine göre (p<0.001), gebeliði isteme durumlarýna göre DSEDÖ puan ortalamalarý arasýnda anlamlý bir iliþki bulunduðu belirlenmiþtir (p<0.05).
Sonuçlar: Annelerin, ebeveynlik davranýþý puan ortalamalarýnýn orta düzeyde olduðu, aile tipi, eðitim, gelir düzeyleri ve gebeliðin istenmesinin puan ortalamalarýný etkilediði saptanmýþtýr.

Aim: In the first meeting after labor, attitudes of mother and father towards the infant are accepted as the first parenthood attitudes. This study was carried out with the aim of evaluating parenthood attitudes of mothers in post-partum period.
Method: The study, descriptive one, was carried on 234 mothers having healthy babies and giving vaginal birth at Women Labor Hospital between the dates Jan 2011 and May 2011. The data were collected by means of survey form and The Scale of Parenthood Attitude After Labor (SPAAL) validated by Çalýþýr et al (2009) and developed by Brittion et al (2001). During the first ten minutes when mother and father met after the labor, the observer followed the attitude of the mother towards her baby, and recorded as (+) for existing attitude, as (-) for unavailable attitude. In the scale consisting of six articles, if an attitude is observed for each article, it is given one point (1), if it isn’t observed, it is evaluated as (0) point. The fact that total score taken from the scale become high indicates that parents had positive parenthood attitude towars their infant. In order to observe natural attitude of mother, firstly, the Scale of Parenthood Attitude After Labor was filled, and then survey form was filled by observer. About 15 minutes were used for both survey forms. Before starting to the study, the decision of ethic board and permission of organization were taken. Explanations fort he pregnants coming for the labor were made, and was reported that observations after labor would be made at any time, and approval was taken from those who won’t to participate in. In the
evaluation of the data, variance analysis and t-test were used.
Findings: It was determined that 66.7% of the mothers were in 20-29 age group, and that 77.8% of the mothers became pregnant villingly. While 9% of mother took “0” poin, 17.5% took “six” (6) point. It was found out that total score average of the mothers was 3.20±1.95. It was also determined that, according to type of life, education level, educational level of the spouses (p<0.001), and villingness about pregnancy, there was a significant relationship between score averages of The Scale of Parenthood Attitude After Labor (p<0.05).
Results: It was found out that score averages of parenthood attitude of mothers were in moderate level, and that type of family, education, revenue levels and villingness about pregnancy affected score averages.

Giriþ ve Amaç: Manyetik rezonans görüntüleme (MRG)’de gürültü varlýðý, iþlem sýrasýnda hareketsizliðin gerekmesi, dar alana girme zorluðu, özellikle 8 yaþ altý çocuklarda sedasyon uygulamasýný gerekli kýlmaktadýr. Çalýþmamýzda, MRG yapýlan çocuklarda tiyopental ve midozolam-ketamin sedasyonunu karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Etik kurul onayý alýndýktan sonra, MRG yapýlan, 0-8 yaþ arasý, ASA I-II 40 olgu rastgele çalýþmaya dahil edildi. Grup 1’e Midazolam iv 0.1 mg/kg + Ketamin iv 2 mg/kg indüksiyon dozunun ardýndan, idamede ek doz ketamin 0.5 mg/kg uygulandý. Grup 2’ye Tiopental iv 3 mg/kg indüksiyon dozunun ardýndan, idamede gereðinde ek doz 1mg/kg tiyopental uygulandý. Sedasyon düzeyini belirlemede University of Michigan Sedation Scale (UMSS) kullanýldý. UMSS 3 ve üzeri olmasý yeterli sedasyon düzeyi olarak kabul edilip hastalar, MRG’ye verildi. Demografik veriler, indüksiyon, iþlem, derlenme ve toplam sedasyon süreleri, MRG kalitesi, toplam anestezik ilaç miktarý, baþlangýçtan itibaren her 5 dakikada bir sistolik ve diyastolik arter basýncý, kalp tepe atýmý ve satürasyon deðerleri, komplikasyonlar kaydedildi.
Bulgular: Gruplarýn yaþ ve aðýrlýk daðýlýmlarý arasýnda istatistiksel olarak anlamlý fark bulunmamýþtýr. Grup 1’in indüksiyon süreleri, toplam sedasyon süreleri ve derlenme süreleri ortalamalarý Grup 2’den istatiksel olarak anlamlý oranda uzundur (p=0,001, p=0,035, p=0,038). Her iki grup karþýlaþtýrýldýðýnda KTA, SKB, DKB ve SpO2 daðýlýmlarý arasýnda tüm zamanlarda istatiksel anlamlý farklýlýk tespit edilmemiþtir. Aile memnuniyeti açýsýndan deðerlendirildiðinde, midazolam -ketamin grubunda 19 kiþi çok memnun, 1 kiþi ortaderece memnun olarak, tiyopental uygulanan grupta ise 18 kiþi çok memnun, 2 kiþi orta derecede memnun olarak belirtti. Çekim kalitisinin deðerlendirilmesinde de gruplar arasýnda anlamlý farklýlýk tespit edilmemiþtir. Gruplarýn ikisinde de yan etki ile karþýlaþýlmamýþtýr.
Sonuç: Tiyopental MRG’de midozolam ve ketamin kombinasyonuna alternatif olarak güvenle kullanýlabilir. Çekim kalitesinin iyi olmasý, anestezi indüksiyon süresi ve derlenme süresinin kýsa olmasý, tiyopentali MRG’de daha etkin bir anestezik ajan haline getirmektedir.

Introduction and Aim: Children especially under age 8 cannot lie still enough for magnetic resonance imaging (MRI) or are afraid of noise and narrow spaces so sedation is necessary for high quality imaging. The aim of this study was to compare Midazolam - Ketamine combination and Thiopental sedation for children undergoing MRI.
Materials and Methods: Forty randomly selected patients undergoing MRI classified as ASA physical status I and II aged between 0-8 were included in this study after receiving institutional approval from Ethics Committee. The patients were divided into two groups. Group 1 received Midazolam iv 0.1 mg kg + Ketamine iv 2 mg kg followed by an additional dose of Ketamine 0.5 mg kg. Group 2 received Thiopental iv 3 mg kg followed by an additional dose of Thiopental 1 mg kg when needed. University of Michigan Sedation Scale (UMSS) was applied. UMSS score 3 and higher were accepted for effective sedation and the patients underwent MRI. Demographic data induction process recovery and total sedation times MRI quality total anesthetic dose amount systolic and diastolic blood pressure at every 5 minutes from the beginning peak heart rate and saturation values and complications were recorded.
Results: There was no significant difference in terms of age and weight between the two groups. The average induction time total sedation time and recovery time of Group 1 was significantly longer than that of Group 2 (p=0.001, p=0.035, p=0.038). There were no significant differences in PHR SBP DBP and SpO2 distributions at all times. Evaluations of the families of Midazolam – Ketamine group’s patients were recorded as 19 very satisfied 1 satisfied while evaluations of the families of Thiopental group’s patients were recorded as 18 very satisfied 2 satisfied. There was no significant difference between the two groups in terms of imaging quality. No side effects or complications were observed for both groups.
Discussion: Thiopental was found to be a safe alternative to Midozolam – Ketamine combination in MRI. High image quality anesthesia induction time and short recovery time make Thiopental a more effective anesthetic agent for MRI.

Giriþ: Ýnme sonrasýnda geliþen depresyon %20-60 oranýnda bildirilmektedir ancak patogenezi henüz netlik kazanmamýþ konulardan birisidir. Çalýþmamýzda inmeli olgularda depresyon ve anksiyete düzeyini ortaya koymayý ve yaþ faktörünün tabloya etkisini incelemeyi amaçladýk.
Hastalar ve Yöntem: Seksen üç inme hastasýnýn tanýmlayýcý özellikleri kaydedildi. Hastalarýn baðýmlýlýk düzeyi Fonksiyonel Baðýmsýzlýk Ölçeði (FBÖ) ile, depresyon düzeyi Beck Depresyon Ölçeði (BDÖ) ile, anksiyete düzeyi Beck Anksiyete Ölçeði (BAÖ) ile deðerlendirildi. Kognitif fonksiyonlarý deðerlendirme amacýyla Mini Mental Test (MMT) kullanýldý. Elde edilen verilere yaþýn etkisini ortaya koyabilmek için hastalar 65 yaþ ve üzeri geriyatrik (GER) grup ve 65 yaþ altý geriyatrik olmayan (NGER) grup olmak üzere ikiye ayrýlarak istatistiksel karþýlaþtýrmalar yapýldý.
Bulgular; GER grubunda 16’sý kadýn (%36,4), 28’i erkek (%63,6) olmak üzere toplam 44 hasta, NGER grubunda 18’i kadýn (%46,2), 21’i erkek (%53,8) olmak üzere toplam 39 hasta deðerlendirildi. Yaþ ortalamasý GER grubunda 70,3±6,1, NGER grubunda 55,6±6,4 idi. GER grubunda ortalama FBÖ 65,8±22,5, NGER grubunda ise 77,8±22,1 idi. GER grubunda %20,5 (9) hafif, %47,7 (21) orta, %2,3 (1) þiddetli düzeyde depresyon izlendi. NGER grubunda ise %30,8 (12) hafif, %30,8 (12) orta düzeyde depresyon bulgularý izlendi. Gruplar arasý karþýlaþtýrmada geriyatrik grubun fonksiyonel baðýmsýzlýk ve kognitif fonksiyon düzeyleri daha geride bulunurken daha ciddi düzeyde depresyon ve anksiyete bulgularý gösterdiði izlendi.
Sonuç: Ýnme sonrasý geliþen depresyon yaþam kalitesini ve rehabilitasyon sürecini olumsuz yönde etkileyebilecek sýklýðý hiç de az olmayan önemli bir komorbid hastalýktýr. Özellikle geriyatrik hastalarda sýklýðýnýn daha da fazla olabileceði akýlda tutulmalýdýr ve erken dönemde tanýmlanarak tedavisine baþlanmalýdýr.

Introduction: Post stroke depression is the one of the issues not yet well established on pathogenesis and reported 20-60% after stroke. We aimed to reveal the level of anxiety and depression in stroke patients and aimed to investigate the effect of the age factor table in our study.
Patients and Method: Descriptive characteristics of eighty-three stroke patients were recorded. The patients were evaluate with the Functional Independence Measure (FIM) for level of dependency, the Beck Depression Inventory (BDI) for the depression levels, the Beck Anxiety Inventory (BAI) for the anxiety levels, the Mini Mental Test (MMT) for evaluate the cognitive functions. To elucidate the effect of age, patients were divided two groups as geriatric group (GER) and non- geriatric group (NGER) and then statistical comparisons were done.
Results: Sixteen women (36.4%) and 28 men (63.6%) for a total of 44 patients in were evaluated GER group, 18 women (46.2%) and 21 males (53,8%) for a total of 39 patients were evaluated in NGER group. The mean age of GER group was 70.3±6.1 and NGER group was 55.6±6.4. The mean FIM of GER group was 65.8±22.5 and NGER group was 77.8±22.1. In GER group 20.5% mild, 47.7% moderate and 2.3% severe depression was observed. In NGER group 30.8% mild and 30.8% moderate depression was observed. Significantly lower levels of functional independence and cognitive function were observed and depression and anxiety were more serious levels in geriatric patients.
Conclusion: The process of post-stroke depression is not an uncommon comorbid disease which may adversely affect the quality of life and rehabilitation. That should be kept in mind especially in geriatric patients and early treatment should be initiated.

Amaç: Rektum kanseri nedeniyle ameliyat ettiðimiz hastalarda prognostik faktörlerin yaþam süresi üzerine etkilerinin incelenmesi.
Yöntem: Ocak 2004-Aralýk 2010 yýllarý arasýnda Þiþli Etfal Eðitim ve Araþtýrma Hastanesi 1.Genel
Cerrahi Kliniðinde rektum kanseri nedeniyle opere edilen 112 hastadan küratif rezeksiyon uygulanan 80 hastanýn klinik kayýtlarý retrospektif olarak incelendi. Yaþ, cinsiyet, vücut kitle indeksi, uygulanan ameliyat þekli, tümör lokalizasyonu, tümör boyutu, tümörün makroskopik tipi, tümörün evresi (TNM Sýnýflamasý), histolojik tip ve diferansiasyon derecesi, çevresel cerrahi sýnýr pozitifiði (ÇCS), vasküler invazyon, perinöral invazyon, lenf bezi tutulumu, preoperatif neoadjuvan tedavi, postoperatif adjuvan tedavi, ameliyat öncesi tümör belirteçleri; CEA (N: 0,0-3,0), CA19-9 (N: 0-35U/ML), hemoglobin, albumin düzeyleri prognostik parametre olarak belirlenip 5 yýllýk saðkalýma olan etkileri deðerlendirildi.
Bulgular: Hastalarýn 42’si erkek, 38’i kadýn ve yaþ ortalamalarý 57,8±11.0 (20-79yaþ) idi. Hastalarýn verileri univaryans analizle incelendiðinde; Yaygýn rektum tutulumu olanlar, tümör boyutunun 5 cm’den büyük olmasý, evre III-IV tümörü olanlar, çevresel cerrahi sýnýrda tümör olanlar, perinöral ve vasküler invazyonu olanlar, lenf bezi pozitif saptananlar, ameliyat öncesi CEA düzeyi yüksek olanlar ile WHO sýnýflamasýna göre Malign Melanom ve Skuamoz hücreli karsinom olanlarýn daha kýsa süreli yaþadýðý belirlendi. Bu faktörler Lojistik regresyon analizi ile incelendiðinde baðýmsýz prognostik faktörler olduðu saptandý.
Sonuç: Çalýþmamýzda yaygýn rektum tutulumu,tümör boyutu, tümörün evresi, perinöral ve vasküler invazyonu, pozitif lenf nodu sayýsý, CEA düzeyi, çevresel cerrahi sýnýr pozitifliði ve tümörün histolojik tipi baðýmsýz prognostik faktörler olarak bulunmuþtur. Ancak saðkalým üzerinde bu parametrelerin etkilerini daha net ortaya koyabilmemiz için vaka serimizin ve erken evre hastalarýmýzýn sayýsýnýn artmasýna ve cerrahi tekniðin standardizasyonuna ihtiyaç vardýr.

Objective: In this study we investigate the effects of the prognostic factors on the patients’ life expectancy whom underwent surgery for rectal cancer.
Methods: Between January 2004-December 2010, 112 patients were operated for rectal cancer at Þiþli Etfal Traning and Reserach Hospital, First General Surgery Clinic. 80 patients underwent curative resection. Their clinical records were retrospectively reviewed. Age, gender, body mass index, operation type, tumor location, tumor size, macroscopic type, tumor stage (TNM classification), histological type and degree of differentiation, circumferential resection margin (CRM), vascular invasion, perineural invasion, lymph node involvement, preoperative neoadjuvant therapy, postoperative adjuvant therapy, preoperative tumor markers, CEA (N: 0,0-3, 0), CA19-9 (N: 0-35U / ML), hemoglobin, serum albumin levels were identified as prognostic parameters. Their effects of 5-year survival were evaluated.
Results: There were 42 males and 38 females, mean age 57.8±11.0 years (age 20-79, Patient data were analyzed by univariate analysis. Patients who had extensive involvement of the rectum, tumor size larger than 5 cm, stage III-IV tumors, CRM positive, perineural and vascular invasion, lymph node positive, with high preoperative CEA levels according to the WHO classification and Malignant Melanoma or squamous cell carcinoma were short survival times. These factors were found to be independent prognostic factors were investigated by logistic regression analysis.
Conclusion: In our study, extensive involvement of the rectum, tumor size, tumor stage, perineural and vascular invasion, number of positive lymph nodes, CEA levels, positive CRM and tumor histological type were found to be independent prognostic factors. However, the effects of these parameters on survival should be more clearly. Therefore, it needs to increase the number of our patients and also the early stage patients and standardization of the surgical technique is required.

Amaç: Özellikle yoðun bakým hastalarýnda oluþan metabolik yanýt sonucu artmýþ protein ve enerji malnutrisyonu, yoðun bakýmda kalýþ süresinin uzamasýna, morbidite ve mortalitede artýþa neden olmaktadýr. Hekimlerin nütrisyonun temel kavramlarýna ve uygulama yöntemlerine vakýf olmasý önem arzettiði için, çalýþmamýzda bir yýllýk beslenme profilimizi deðerlendirmeyi amaçladýk.
Gereç ve Yöntemler: Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Anesteziyoloji ve Reanimasyon Kliniði’nde 2008 yýlýnda yatmýþ olan olgularýn kayýtlarý geriye dönük incelendi. Demografik veriler, beslenme þekli, beslenme baþlangýç saati, hedef kaloriye ulaþma zamaný, beslenmeye baðlý komplikasyonlar ve yatýþ süresi kaydedildi. Veriler Ortalama±Standard Sapma (Ort±SS) olarak sunuldu.
Bulgular: Toplam 152 olgunun yaþ ortalamasý 49.5±24.2 yýl, erkek/kadýn oraný %60.5/39.5’dir, yatýþ süresi ortalama 13.1±24.9 gündür. Beslenme ortalama 13.7±16.0’ýncý saatte baþlanmýþtýr, hedef kaloriye ortalama 53.52±53.04 saatte ulaþýlmýþtýr. Olgularýn %31.6’sý enteral, %30.9’u parenteral, %13.8’i enteral+parenteral, %11.8’i oral, %2’si oral+parenteral yoldan beslenmiþtir. %9.9’u beslenme uygulanmadan kýsa süre içinde taburcu edilmiþ ya da kaybedilmiþtir. Parenteral beslenenlerin %14.8’inde periferik yol, %85.2’sinde santral yol tercih edilmiþtir; enteral beslenme %91.3 sýklýðýnda nazogastrik sonda, %8.7 sýklýðýnda gastrostomi yoluyla olmuþtur. Gastrik rezidüel volüm>200ml %1.3 sýklýðýnda saptanmýþtýr. Kusma, aspirasyon ve ishal sýrasýyla %0.1, %0.7, %6.6 olarak saptanmýþtýr. Parenteral beslenmede ise %0.7 sýklýðýnda pnömotoraks, %1.3 sýklýðýnda kateter enfeksyonu, %2.6 sýklýðýnda týkanma ve %19.7 sýklýðýnda hiperglisemi görülmüþtür.
Sonuçlar: Mümkün olan en erken dönemde beslenme parametrelerinin deðerlendirilip, hedef kalori belirlenerek uygun yolla beslenmenin baþlamasý gerektiði kanaatindeyiz.

Objective: Increased protein and energy malnutrition due to metabolic response in Intensive Care Unit (ICU) patients is causing ICU stay prolongation, increased morbidity and mortality. Because doctors should be aware of basic knowledge and practice, we aimed to evaluate our nutrition profile for one year period.
Methods: We examened records of patients who were admitted to the Anesthesiology and Reanimation Clinic of Sisli Etfal Training and Research Hospital in the year 2008 retrospectively. Demographic variables, feding type, time to start feding, time to reach target calory, complications related to feding and admission duration were recorded. Variables were presented as Mean±Standard Deviation (Mean±SD).
Results: Average age of 152 patients was 49.5±24.2 years, male/female ratio was 60.5/39.5%, admission duration was 13.1±24.9 days. Feeding was started at 13.7±16th hour, target calory was reached at 53.52±53.04 hours. 31.6% of patients were feeded enteral, 30.9% parenteral, 13.8% enteral+parenteral, 11.8% oral, 2% oral+parenteral. Without nutrition 9.9% were discharged. In the parenteral feeded patients peripheric venous access was used in 14.8%, central access in 85.2%; enteral feding was performed by naso-gastric-tube in 91.3%, and in 8.7% it was performed by gastrostomy. The frequency of gastric residual volume>200ml was 1.3%. Vomiting, aspiration and diarrhea frequency was as follows: 0.1%, 0.7% and 6.6%. Pneumothorax frequency was 0.7%, catheter infection 1.3%, obstruction 2.6% and hyperglycemia 19.7%.
Conclusions: Nutrition parameters should be evaluated as soon as possible and appropriate feeding should be started after target calory calculation.

Ganglion kistleri ayak, el ve el bileðinde görülen en sýk yumuþak doku tümörleridir. Omuz ekleminden kaynaklanan ganglion kisti ise sýk görülmez. Sað omuzda aðrý þikayeti ile baþvuran, yapýlan incelemelerde atipik yerleþimli ganglion kisti tanýsýyla ameliyat edilen ve histopatolojik tanýsý ganglion kisti olan kýrkbeþ yaþýndaki erkek hasta cerrahi sonucu ile birlikte sunuldu. Ameliyat sonrasý takiplerinde hastanýn þikayetlerinin düzeldiði görüldü.

Although ganglion cysts are most common soft tissue tumors of foot, hand and wrist, they are rarely seen in shoulder girdle. In this manuscript it is aimed to present a patient who was admitted with shoulder pain due to atypically located ganglion cyct. The symptoms were relieved after excision of lesion.

Kalça kýrýðý sonrasý uygulanan parsiyel protezlere baðlý çýkýklar, karþýlaþýlabilecek komplikasyonlar arasýndadýr. Bu çýkýklar femoral baþýn bir bütün þeklinde doðal asetabulumdan ayrýlmasý þeklinde görülür. Bizim olgumuzda ise intertrokanterik femur kýrýðý nedeniyle 2002 yýlýnda kalkar destekli Leinbach tipi parsiyel protez uygulamasý sonrasý femoral baþ ile stem arasýnda çýkýk meydana gelmiþtir. Parsiyel protezin baþ kýsmý asetabulumda kalmýþ, femoral stem ise posterosuperior yönde çýkmýþtýr. Bu yazýda baþ boyun replasmanlý parsiyel protezlerde baþ ve boyun uyumsuzluðu olduðunda atipik protez çýkýklarý geliþebileceði vurgulanmak istenmiþtir.

Dislocation of hemiarthroplasty after hip fracture surgery is a rare complication and mostly occurs as a total luxation of head from acetabulum. In our case, dislocation occured between head of prosthesis and femoral stem after operation with Leinbach type hemiarthroplasty due to intertrochanteric femur fracture. Although head of prosthesis stayed in acetabulum, femoral stem luxated posterosuperiorly. This study aims to emphesize the risk of atypic dislocation in case of incongruency of head and femoral stem of hemiarthroplasty.