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.

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.

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.

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.

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.

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.

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.

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.

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.

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.