Yenidoðan yoðun bakým hizmetleri içerisinde solunum yetersizliði nedeni ile mekanik ventilasyon desteði gereken bebeklerin bakýmý önemli bir yer tutmaktadýr. Solunum desteði alan bu bebeklerin bakýmýnda aðrý kontrolü, aspirasyon yöntemi, fizyoterapi ve ideal vücut ýsýsýnýn saðlanmasý ana ilkeleri oluþturmaktadýr. Uygun þekilde bakýmýn saðlanmasý yenidoðan bebeklerin morbidite ve mortalite oranlarýný önemli oranda azaltacaktýr. Mekanik ventilasyon uygulanan bir bebeðin bakýmýndaki en önemli prensibin, minimum dokunma ve maksimum gözlem olduðu unutulmamalýdýr. Bu yazýda, mekanik ventilasyon uygulanan bebeklerin bakýmýndaki önemli noktalara deðinilecektir.

The care of infants with respiratory failure who required mechanical ventilation holds an important place in the neonatal intensive care units. In the care of these infants; pain control, aspiration method, physiotherapy and providing ideal body temperature constitutes the main principles. To provide proper care will significantly reduce morbidity and mortality of newborn infants. The ‘minimum touch and maximum observation’ principle should be noted as the most important principle in the care of baby with mechanical ventilation. In this article, the important points will be referred in the care of infants with mechanical ventilation.

Amaç: Endometriyum kanseri olgularýnda preoperatif yükselmiþ CA-125 düzeylerinin klinik ve patolojik kötü prognostik faktörlerle iliþkisi araþtýrýldý.
Gereç ve Yöntem: Nisan 2007 ve Nisan 2012 tarihleri arasýnda, Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum Kliniði’nde, endometriyum kanseri tanýsýyla opere olan 100 hastada preoperatif CA-125 düzeyi ile klinikopatolojik parametreler arasýndaki iliþki deðerlendirildi. Tüm olgularýn, yaþ ortalamasý, menopoz durumu, vücut kitle indeksi, preoperatif CA-125 düzeyleri, tümör tipleri, histolojik gradeleri, cerrahi-klinik evreleri, batýn sývýsý pozitifliði, lenfovasküler invazyon varlýðý, myometriyum invazyon ve derecesi, omentum metastazý ve tümör çapý deðerlendirildi. CA-125 kesme deðeri olarak 35 IU/ ml deðeri ile karþýlaþtýrýldý.
Bulgular: Endometriyum kanserli hastalarda preoperatif yapýlan CA 125 ölçümü 35 kesme deðeri için; omentum tutulumu, yarýdan fazla myometriyal invazyon, batýn yýkama sývýsý pozitifliði, 2 cm. üzeri tümörü belirlemede, lenfovasküler invazyon ve lenf düðümü pozitifliðini belirlemede istatiski olarak anlamlý olarak bulunmuþtur.
Sonuç: Endometriyum kanserli hastalarda preoperatif serum CA-125 deðerleri kötü prognostik faktörleri ortaya koymada önemli bir test aracý gibi gözükmektedir. Ancak tek baþýna baðýmsýz prognostik faktör olarak kullanýlmasý uygun görünmemektedir.

Objective: In this study the relationship of preoperative high CA-125 levels with clinical and pathological prognostic factors were investigated in endometrium cancer patients.
Material and Method: The relationship between preoperative CA-125 levels and clinicopathological parameters was investigated on 100 patients who operated for endometrium cancer between April 2007-April 2012 in Department of Obstetric and gynecology at Þiþli Etfal Research and Training Hospital. Average age, menopausal status, body mass index, preoperative CA-125 levels, tumor types, histologic grades, surgical-clinical stage, positive peritoneal fluid cytology, presence of lymphovascular invasion, myometrium invasion and its degree, omentum metastasis, and tumor diameter and grade were evaluated. For CA-125 cut off point was accepted as evaluated 35 IU/mL.
Results: Cut-off point of CA-125 results of endometrium cancer patients were significantly associated with omentum metastasis, invasion to more than half of the myometrium, positive peritoneal fluid cytology and tumor size larger than 2 cm, lymphovascular invasion and positive lymph nodes.
Conclusion: For patients with endometrium cancer, preoperative CA-125 measurement (for cut off point 35) can be utilized as an important factor determining poor prognostic factors. However, it is not suitable to be used as an independent prognostic factor alone.

Amaç: Histerosalpingografi uterus ve tubal faktörün araþtýrýlmasýnda infertil hastalar için birinci basamak prosedürdür. Bu prosedürde oluþan aðrý hasta konforunu ve iþlem baþarýsýný negatif yönde etkilemektedir. Biz çalýþmamýzda lidokain spreyin servikal bölgeye uygulanmasýnýn histerosalpingografi çekimi sýrasýnda aðrý üzerine olan etkisini araþtýrdýk.
Gereç ve Yöntem: Çalýþmamýz için etik kurul onamý alýndýktan sonra eylül 2011 – kasým 2011 tarihleri arasýnda, Zeynep Kamil Eðitim ve Araþtýrma Hastanesi Kadýn Doðum Kliniðine infertilite araþtýrýlmasý nedeniyle HSG çekimi için baþvuran toplam 100 hasta dahil edildi. Çalýþmanýn istatistiksel deðerlendirmesinde SPSS 19.0 paket programý kullanýldý.
Bulgular: Dismenore, disparöni ve geçirilmiþ cerrahi öyküsü gibi pelvik aðrý yapacak nedenler açýsýndan plasebo ve lidokain grubu deðerlendirildiðinde gruplar arasýnda istatiksel olarak anlamlý bir farklýlýk bulunmadý. Tenekulum ve enstrümantasyon iþleminden hemen sonraki Vizuel Analog Skala puaný lidokain spray uygulanan hasta grubunda 1.2±0.8, kontrol grubunda ise 2.5±1.2 olarak saptandý (p<0.05). Lidokain uygulanan hasta grubunun Vizuel Analog Skala puaný anlamlý ölçüde düþük saptandý. Gruplar arasýnda iþlemden 30 dakika sonraki Vizuel Analog Skala puanlarý açýsýndan da istatiksel olarak anlamlý farklýlýk saptanmadý. Vizuel Analog Skala puanlarý genel olarak her iki grupta incelendiðinde en aðrýlý basamaðýn 2. Enjenksiyon sýrasýnda olduðu saptandý.
Sonuç: Servikal bölgeye verilen topikal anestezi sadece enstrumantasyon sýrasýnda oluþan aðrýyý azaltýr. Uterus ve tubal distansiyona baðlý oluþan viseral aðrýda etkisiz kalmaktadýr. Bu konuyla ilgili randomize kontrollü çalþmalara ihtiyaç vardýr.

Objective: Hysterosalpingography is a procedure to investigate the shape of the uterine cavity and the fallopian tubes especially in the infertile women. As hysterosalpingography is a painful procedure, pain affects negatively the success of the procedure and the comfort of the patient. Purpose of this research is to determine the effect of the lidocaine spray application to the cervix on the pain.
Material and Method: This study was performed including the patients who had hyserosalpingography procedure for investigation of infertility at Zeynep Kamil Gynecology - Obstetrics and Pediatrics hospital between 2011 september and 2011 november. Statistical analysis was performed using the SPSS 19 program.
Results: When we compare placebo and lidocaine group in terms of pelvic pain reasons such as dysmenorrhea, dyspareunia and history of previous surgery, there was no statistically significant differences. Vizuel Analog Scala score of the instrument application at the placebo group was 2.5±1.2, at the lidocaine it was 1.2±0.8. There was statistically significant difference (p<0.05). There was no statistically significant difference between the groups in terms of VAS score at the 30 minutes after the procedure. When we compare Visual Analog Scale scores between the groups, we found that the most painful step was second injection.
Conclusion: Topical anesthesia applied to the cervix only affects to reduce the pain during instrument application. Topical anesthesia is unsufficeint to reduce the visceral pain caused by distension of uterus and tubes.

Amaç: Bu çalýþmanýn amacý kemik fraktürü olan ve olmayan yaþlý kadýnlarýn kemik mineral yoðunluklarýnýn karþýlaþtýrýlmasýdýr.
Gereç ve Yöntem: Hastanemizde Ocak 2010 – Haziran 2012 tarihleri arasýnda kemik mineral yoðunluðu (KMY) ölçümü yapýlmýþ 65 yaþ ve üzeri kadýn hastalarýn dosyalarý retrospektif olarak demografik özellikleri ve KMY deðerleri bakýmýndan deðerlendirildi. Yaþ, vücut kitle indeksi (VKÝ), menopoz süresi, ek sistemik hastalýklar, osteoporoz varlýðý ve KMY deðerleri kemik fraktürü olan ve olmayan hastalar arasýnda karþýlaþtýrýldý.
Bulgular: Çalýþmaya alýnan 102 hastanýn 17’sinde (%16.3) kemik fraktürü saptandý. Kemik fraktürü olan ve olmayan hastalar arasýnda yaþ, VKÝ, menopoz süreleri ve ek sistemik hastalýk varlýðý açýsýndan fark saptanmadý (p>0.05). Benzer þekilde her iki grup arasýnda osteoporoz sýklýðý, lomber vertebra ve femur total KMY ve T skorlarý açýsýndan anlamlý fark saptandý (p>0.05).
Sonuç: Geriatrik dönem kadýnlarda kemik fraktür riski yalnýzca KMY ile iliþkili olmayýp kemiðin içerik ve yapýsý gibi özelliklere ve bu yaþlarda sýkça görülen düþme ile de iliþkili olabileceði akýlda tutulmalýdýr.

Objective: The aim of this study was to compare the bone mineral density in elderly women with and without bone fracture.
Material and Method: The records of the ≥ 65 years women patients who had been performed bone mineral density (BMD) measurements in our hospital between January 2010 and June 2012 were evaluated according to their demographic features and BMD measurements retrospectively. Age, body mass index (BMI), menopause period, systemic disease, presence of osteoporosis and BMD were compared between patients with and without bone fracture.
Results: Bone fracture was determined in 17 (16.3%) of 102 patient admitted in our study. There was no significant difference between patients with and without bone fracture for age, BMI, menopause period and systemic diseases (p>0.05). Similarly, there was no significant difference between two groups for the presence of osteoporosis, total BMD values and T scores of lomber spine and femur (p>0.05).
Conclusion: Risk of bone fracture in geriatric women is not only associated with BMD. We should keep in mind that the risk may be associated with features such as content and structure of the bone and fall common seen in these ages.

Amaç: Omuz distosisi (OD) tüm vajinal doðumlarýn %0.2-3’ünü etkileyen, nadir olmayan ve öngörülemeyen bir komplikasyondur. Tek merkezde 5 yýlda gerçekleþen omuz distosisi vakalarýnýn mevcut risk faktörleri ve perinatal sonuçlarý deðerlendirilmiþtir.
Gereç ve Yöntem: Çalýþma, refere bir merkez olarak hizmet veren Zeynep Kamil Kadýn ve Çocuk Hastalýklarý Eðitim ve Araþtýrma Hastanesi’nde 1998-2013 yýllarý arasýndaki omuz distosisi vakalarýnýn retrospektif taranmasý ile gerçekleþtirildi. Tekiz sefalik geliþli vaginal doðumlarda omuzlarýn doðumu esnasýnda ek müdahalelere gerek duyulan vakalar omuz distosisi olarak tanýmlandý. Hastalarýn kayýt altýna alýnmýþ olan maternal demografik özellikleri, intrapartum özellikleri ve neonatal sonuçlarý bilgisayar veritabanýnda analiz edildi.
Bulgular: Son 5 yýllýk dönemde toplam vaginal doðum sayýsý 31497 olarak gerçekleþmiþtir. Bu dönemdeki omuz distosisi insidansý %0.1 (n: 33) olarak deðerlendirildi. Hastalarýn %21’inde (n=7) gestasyonel diabetus mellitus (GDM) mevcuttur. Çalýþmaya alýnan hastalarýn sadece %21’i (n=7) nullipardýr. OD geliþen bebeklerin %39’unda (n: 13) brakial pleksus yaralanmasý (BPY) bulgularý görülmüþtür. OD olan bebeklerin sadece birinde (%3) fetusun ultrasonografik tahmini fetal aðýrlýk (EFW) ölçümü 4000 gr üstünde deðerlendirilmiþ (4050 gr). Fakat OD olan yenidoðanlarýn %39’unun (n: 13) doðum aðýrlýðý 4000 gr ve üzerinde ölçülmüþtür. Bebeklerin 3’ü (%9) doðum sonrasý yeni doðan yoðun bakým servisinde takip edilmiþ. Yenidoðan bebekler, OD nedeniyle komplikasyon geliþen (n=18, %54) ve geliþmeyen (n=15, %46) olarak iki gruba ayrýlmýþtýr. Brakial pleksus yaralanmasý, epizyotomi ve manevralarýn birlikte uygulandýðý hastalarda sadece epizyotomi ve sadece manevra uygulananlara kýyasla daha fazla izlenmiþtir (p: 0.046).
Sonuç: Omuz distosisinin kabul edilen risk faktörlerine göre tam anlamýyla öngörülebilir olmadýðý kabul edilmektedir. Fakat yenidoðan ve anne komplikasyonlarý açýsýndan uygun doðum eðitimleri düzenlenerek olasý riskler minimuma indirgenebilir.

Objective: SD (shoulder dystocia) is an uncommon and unpredictable event complicating 0.2–3% of all vaginal deliveries. We sought to examine the current risk factors and perinatal outcomes of all cases of shoulder dystocia in a single institution over a five years period.
Material and Method: This is a retrospective study carried out at a large tertiary referral center serving a single urban population over a 5 years period from 1998-2013. Shoulder dystocia was defined as failure to deliver the shoulders at the first attempt in singleton cephalic vaginal deliveries. Details of maternal demographics, intrapartum characteristics and neonatal outcomes were recorded prospectively on a computerized database for analysis.
Results: Last five years, total number of vaginal birth was 31,497 and the incidance of shoulder dystocia was %0.1 (n=33) in this period. In the shoulder dystocia cases %21 (n=7) of them had gestational diabetes mellitus and only 21% of the patients (n=7) were nulliparous. In %39 (n: 13) of newborns who had sshoulder dystocia were observed signs of brachial plexus injury like moro reflex loss. Newborns who had shoulder dystocia, %39 (n: 13) had 4000 gr and above birthweight but only one of the newborns (%3) who had shoulder dystocia had antenatal ultrasonographic measurement of estimated fetal weight over 4000 grams (4050 gr). 3(%9) of newborns needed to be followed up in neonatal intensive care unit. Newborns who had shoulder dystocia were divided into two groups: babies with (n=18, %54) or without (n=15, %46) complication because of shoulder dystocia. Brachial plexus palsy was significantly more common among episiotomy + maneuver, compared with maneuver-only and episiotomy-only (p: 0.046).
Conclusion: We consider this robust and significant data relating to contemporary antecedents and outcomes of SD. As a complication which carries a significant risk of persistent neurological injury for the infant and consequent medicolegal implications for the clinician, continuous audit and high levels of awareness and training for all birth attendants should now be standard practice.

Amaç: Ortopedik giriþimlerde sýklýkla spinal anestezi tercih edilir. Spinal anestezide, operasyonun tolere edilebilmesi için sedasyon uygulanýr. Kullanýlan sedatif ajan hýzlý baþlangýç ve uyanma saðlamalý, minimal yan etkiye sahip olmalýdýr. Çalýþmamýzda; Ortopedik giriþimler esnasýnda, spinal anestezi uygulanan olgularda sedasyon amaçlý remifentanil ve deksmedetomidin infüzyonunun sedasyon kalitesini, hemodinamik ve solunumsal etkilerini karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Ortopedi Kliniklerinde spinal anestezi ile alt ekstremite operasyonu planlanan, ASA I- III, 20-60 yaþ arasýnda, 90 olgu çalýþmaya dahil edildi. Çalýþma prospetif, rastgele, kontrollü olarak planlandý. L4-L5 mesafesinden, 2 ml %0.5 hiperbarik bupivakain verilerek tek tearaflý spinal anestezi saðlandý. Grup1’e 20 ml/ 10 dakika yükleme dozunu takiben 15 ml/saat %0.9 NaCl infüzyonu, Grup 2’ye, 0.5 mcg/kg (20 ml) 10 dakika yükleme dozunu takiben 0.2 mcg/kg/saat deksmedetomidine infüzyonu, Grup 3’e 0,5 mcg/kg (20 ml) 10 dakika yükleme dozunu takiben 0.1 mcg/kg/dakika remifentanil infüzyonu uygulandý. Olgularýn spinal blok öncesi (BÖ), blok sonrasý (BS) ve sedasyon uygulamasýný takiben 1., 5., 10., 15., 20. dakikalarda ve operasyon bitimine kadar 10 dakika aralarla ortalama arter basýncý (OAB), kalp tepe atýmý (KTA), solunum sayýsý (SS), periferik oksijen satürasyonlarý (SPO2), sedasyon skorlarý ve bulantý, kusma, bradikardi, hipotansiyon, desatürasyon, solunum depresyonu gibi yan etkileri kaydedildi.
Bulgular: Gruplarýn yaþ, cinsiyet, kilo, boy ortalamalarý ve operasyon süreleri daðýlýmlarý arasýnda istatistiksel olarak anlamlý farklýlýk gözlenmemiþtir. Grup 3 KTA ölçümleri ortalamalarý açýsýndan Grup 1 ve 2’den istatiksel olarak anlamlý düþüþ göstermiþtir (p<0.05). OAB ölçümleri tüm gruplarda spinal anestezi sonrasý 1.dk’dan itibaren tüm zamanlarda, sedasyon öncesine göre istatiksel anlamlý düþüþ göstermiþtir (p<0.05). Gruplar arasýnda solunum sayýlarý ve SPO2 açýsýndan istatiksel fark bulunmamýþtýr. Ramsay Sedasyon Skoru ölçümleri Grup 3’te sedasyon sonrasý 1. dakikada sedasyon öncesine göre istatiksel anlamlý yükseliþ göstermiþtir (p<0.05). Grup 1 ve 2’de RSS’de sedasyon öncesine göre sedasyon sonrasýnda istatiksel anlamlý farklýlýk görülmemiþtir. Üç grup arasýnda RSS ölçümlerinde istatiksel farklýlýk yoktur. Üç grubun komplikasyon daðýlýmlarý arasýnda istatiksel farklýlýk görülmemiþtir.
Sonuç: Spinal anestezi uygulamasýnda sedasyon amacýyla kullanýlan remifentanilin daha stabil hemodinami saðladýðýný, remifentanil ve deksmedetomidinin benzer sedatif etki gösterdiðini, düþük yan etkiye sahip olduklarýný tespit ettik. Deksmedetomidin ve remifentanilin sedasyon skorlarý kontrol grubuyla benzer olmakla birlikte klinik olarak etkin sedasyon saðlamaktadýrlar. Deksmedetomidin ve remifentanil rejyonel anestezi uygulamalarýnda sedasyon amacýyla düþük dozlarda güvenle kullanýlabilir.

Objective: In orthopedic procedures spinal anesthesia is often the preferred method. When performing a spinal anesthesia, sedation is also applied in order to tolerate the operation. Sedative agent that used needs provide rapid onset and recovery, should have minimal side effects. Our study aimed to compare the sedation quality, the hemodynamic and respiratory effects of remifentanil and dexmedetomidine infusion for sedation in patients undergoing spinal anesthesia during orthopedic procedures.
Material and Method: For study 90 subjects (ASAI-III) who underwent lower extremity surgery under spinal anesthesia were included. The age ranged between 20 and 60 years. This study is a prospective, randomized, controlled study. For spinal anesthesia, between L4-L5 distance, 2 ml of 0.5% hyperbaric bupivacaine was administerd and unilateral spinal anesthesia was achieved. In group 1, 20 ml / 10-minute loading dose followed by 15 ml/h infusion of 0.9% NaCl solution. In group 2, 0.5 mcg/kg (20 ml) 10-minute loading dose followed by 0.2 mcg/ kg/h dexmedetomidine infusion. In group 3, 0.5 mcg/kg (20 ml) 10-minute loading dose followed by 0.1 mcg/ kg/h remifentanil infusion. Of the cases, before the spinal block (BB), after the block (AB), at the 1st, 5th, 10th, 15th, 20th minute of sedation and 10-minute intervals until the end of operation; mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SPO2), sedation and nausea, vomiting, bradycardia, hypotension, desaturation, respiratory depression such side effects have been recorded.
Results: The age, sex, weight, height averages and duration of operation did not significantly differed between groups. In group 3 HR was observed significantly lower than group 1 and 2 (p<0.05). At all times MAP measurements significantly decreased in all groups when compared with before sedation measurements (p<0.05). There was no significant difference between the groups in terms of respiratory rate and SPO2. When the Ramsay Sedation Scores (RSS) were compared; in group 3, a significant increase was observed at 1th minute of sedation when compared with before sedation scores (p<0.05). In group 2 and 3 no significant difference was observed between
before sedation and after sedation scores. There was also no significant difference between RSS scores and complication distrubition between groups.
Conclusion: Remifentanil used for sedation, during spinal anesthesia, provides more stable hemodynamics. Remifentanil and dexmedetomidine showed similar sedative effects, with a low incidence of side effects. Although dexmedetomidine and remifentanil sedation scores were similar to the control group, they provide a clinically effective sedation. Low doses of dexmedetomidine and remifentanil can be used safely for sedation during regional anesthesia.

Amaç: Hastanemizdeki yenidoðanlar arasýnda dýþ genital anomali sýklýðýnýn belirlenmesi.
Gereç ve Yöntem: Ocak 2010 - Aralýk 2010 tarihleri arasýnda Þiþli Hamidiye Etfal Hastanesi’nde doðan 3437 yenidoðan olgu dýþ genital anomali açýsýndan incelendi. Kliteromegali, inguinal/labial alanda kitle, hipospadias, mikropenis, ambigus genitalya ve inmemiþ testis varlýðý kaydedildi.
Bulgular: Bu çalýþmada 20 (6/1000) yenidoðan olguda dýþ genital anomali tespit edildi. Olgularýn tümü yaþamýnýn ilk 3 gününde muayene edildi. Tespit edilen morfolojik anormallikler: Ýnmemiþ testis (kriptorþidizm) (12/20), izole hipospadias (5/20), kliteromegali (1/20), epispadias (1/20) ve ambigus genitale (1/20) idi. Kriptorþidizm sýklýðýmýz %0.34, hipospadias sýklýðýmýz ise %0.23 olarak saptandý. Olgularýn 4’ü prematüre idi. Ýki olguda kongenital adrenal hiperplazi saptandý.
Sonuç: Dýþ genital anomaliler en sýk rastlanýlan kongenital anomaliler grubunda yer alýr. Genital anomalilerin uygun olarak erken taný ve tedavisi, týbbi, psikolojik ve sosyal sorunlarý en aza indirmek için büyük önem taþýmaktadýr. Çalýþmamýzda, yenidoðan döneminde dikkatli bir genital morfolojik inceleme sonucu fark edilen minör anomalilerin, cinsel geliþim bozukluðunun bir klinik bulgusu olabileceðini vurgulamak istedik.

Objective: To determine the prevalance of external genital abnormalities among neonates in our hospital.
Material and Method: A total 3437 neonates delivered at Þiþli Hamidiye Etfal Hospital between January 2010- December 2010 were examined at birth for external genital abnormalities. The presence of cliteromegali, inguinal / labial mass, hypospadias, micropenis, and undescended testicles and ambigus genitalia were examined.
Results: The study identified 20 (6/1000) neonates with external genital abnormalities. All of them were examined within 3 days of life. Morphological abnormalities comprised: undescended testes (cryptorchidsm)(12/20), isolate hypospadias (5/20), cliteromegali (1/20), epispadias (1/20) and ambiguous genitale (1/20). The incidence of hypospadias and cryptorchidism were found 0.34%, 0.23%, respectively. Prematurity occured in 4/20 cases. Congenital adrenal hyperplasia were detected in two cases.
Conclusions: External genital anomalies are among the most common congenital anomalies. Proper early diagnosis and management of genital abnormalities are of great importance to minimize medical, psychological and social complications. Our result reinforce the importance of a careful examination of genital morphology in neonatal period towards the recognition of minor defects that can be clinical features of a disorder of sex devolpoment.

Amaç: Over kanseri taramasýnda kullanýlan tümör belirteçlerinden CA12-5, CA 15-3, CA 19-9, CEA, AFP ve ß-HCG’nin adneksiyal kitlelerin malign-benign ayýrýmýndaki yeri, patolojik tanýsý ve tümör evresi ile korelasyonu deðerlendirildi.
Gereç ve Yöntem: Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Kadýn Hastalýklarý ve Doðum Kliniði’nde Ocak 2006- Aðustos 2011 tarihleri arasýnda adneksiyal kitle ön tanýsý ile opere edilen 277 olgu retrospektif olarak incelendi.
Bulgular: Tümör belirteçlerinin taný testi olarak gücü ROC eðrisi yöntemi ile incelendi. ROC eðrisi altýnda kalan alan, CA 12-5 için 0.872, CA15-3 için 0.739, CA 19-9 için 0.522, CEA için 0.614, AFP için 0.433 ve ß-HCG için 0.635 birim kare olarak bulundu.
Sonuç: Benign-malign ayýrýmý için yapýlan istatiksel deðerlendirmede CA 12-5 ve CA 15-3 dýþýndaki markýrlar anlamlý bulunmadý. Her markýrýn maligniteyi ayýrt etme gücü istatistiksel olarak ROC eðrisi yöntemi ile analiz edildi. Analiz sonucunda CA 12-5 en deðerli markýr olarak bulundu. CA 15-3’ün ayýrt ediciliðinin kabul edilebilir düzeyde olduðu, diðer testlerin ise anlamsýz olduðu görüldü. Sadece CA 12-5’in tümör evresi ile korelasyon gösteriyordu.

Objective: The place of CA 12-5, CA 15-3, CA 19-9, CEA, AFP and ß HCG, which are tumor markers used in screening over carcinoma, in differentiating benign or malign adnexial masses, and the correlation of these markers with the pathological diagnosis and stage of the tumor were evaluated.
Material and Method: Two hundred seventy seven patients who were operated with the diagnosis of adnexial mass at Þiþli Etfal Training and Research Hospital Gynecology and Obstetrics Clinic between January 2006 and August 2011 were analyzed retrospectively.
Results: Efficiency levels of tumor markers as diagnostic tests were studied by ROC curve method. The area under the ROC curve was calculated as 0.872 unit frames for CA 12-5, 0.739 for CA 15-3, 0.522 for CA 19-9, 0.614 for CEA, 0.433 for AFP and 0.635 for ß HCG.
Conclusion: Markers other than CA 12-5 and CA 15-3 could not found significant in the statistical evaluation for the discrimination of benign and malignant. The discriminative power of each tests were analyzed by statistical ROC curve method. At the analysis, CA 12-5 was found as the most valuable marker. While the discriminative value of CA 15-3 was found acceptable, other tests were found invaluable. Only CA 12-5 had showed a correlation with the tumor stage.

Amaç: Üreter orta ve üst bölümünde görülen 1.5-2 cm arasý impakte taþlarýn tedavisinde en etkin tedavi yönteminin araþtýrýlmasýný amaçladýk.
Gereç ve Yöntem: 2000-2013 yýllarý arasýnda üreter orta ve üst bölümünde 1.5-2.0 cm boyutunda impakte taþý olan ve kliniðimizde opere edilen 75 hasta çalýþmaya alýndý. Hastalar demografik verileri, taþ hacimleri, hastanede kalma süreleri, taþsýzlýk ve komplikasyon oranlarý açýsýndan karþýlaþtýrýldý. Ýstatistiksel analiz için Pearson ki-kare, Mann Whitney-U ve student-t testi kullanýldý. Anlamlýlýk sýnýr deðeri p<0.05 olarak kabul edildi.
Bulgular: Yetmiþbeþ hastaya altmýþüçü üreteroskopi ve yirmidördü üreterolitotomi olmak üzere toplam 87 ünite tedavi uygulandý. Üreteroskopi semi- rijid üreteroskopla yapýldý. Üreterolitotomilerin 11’i açýk, 13’ü laparoskopik yapýldý. Taþ hacimleri arasýnda anlamlý bir fark yoktu (503-395 mm3 p=0.172). Hastanede kalma süreleri iki grup arasýnda benzerdi (3.4-4.1 gün p=0.086). Taþsýzlýk oranlarý karþýlaþtýrýldýðýnda üreterolitotomi grubunda %96, üreteroskopi grubunda %46 olarak bulundu.
Üreterolitotomi, üreteroskopiden anlamlý olarak daha baþarýlý bulundu (p=0.01). Üreterolitotomi grubunda sadece bir hastada komplikasyon geliþirken (%4); üreteroskopi grubunda bir hastada total avulsiyon, iki hastada açýða geçmeyi gerektiren perforasyon geliþti (%6.3).
Sonuç: Üreter üst ve orta bölümü taþlarýnýn tedavisinde semi- rijid üreteroskopinin düþük baþarýsý ve yüksek majör komplikasyon oraný düþünülerek, fleksible üreteroskopi imkaný da yoksa, üreteroskopi yapmadan, laparoskopik veya açýk üreterolitotomi düþünülebilir.

Objective: We aimed to research the most effective treatment method of the middle and upper ureteral impacted stones of which is 1.5-2 cm diameter size.
Material and Method: Between 2000 and 2013, 75 patients who had impacted stone size of between 1.5-2cm at the middle and upper part of the ureter were examined. Patients had been analysed in terms of their demographical characteristics, stone size, hospitalization time, stone- free and complication rates. For statistical analysis Pearson’s chi-square, Mann Whitney-U and student-t tests has applied. The significance level is determined as p<0.05.
Results: Sixty five ureteroscopy and twenty four ureterolithotomy, a total of 87 treatment method had been given to 75 patients. Ureteroscopy had been applied by semi rigid ureteroscope. Eleven of twenty four patients ureterolithotomy were open surgery and 13 were laparoscopic ureterolithotomy. Stone size wasn’t greater in the group which has received ureterolithotomy examination compared to group received ureteoscopy examination (503-395 mm3 p=0.172). The hospitalization times was similar for each group (3.4-4.1 days p=0.086). The stone- free rate was 96% for ureterolithotomy group and 46% for ureteroscopy group. Ureterolithotomy has been found more successful then ureteroscopy (p=0.01). Although ureterolithotomy group has only one complications (4%), 1 patient in ureteroscopy group faced with total avulsion and 2 patients were faced ureteral perforation (6.3%).
Conclusion: Due to the failure of semi rigid ureteroscope and the high major possibility of complication even if there is not a flexible ureteroscope option, laparoscopic ureterolithotomy or open surgery can be applied instead of ureteroscopy for the treatment of stones which is seen at the upper and middle part of the ureter.

Amaç: Bu araþtýrma, erken postpartum dönemde olan annelerde emzirme ile doðum sonu depresyon arasýndaki iliþkinin saptanmasý amacýyla yapýlmýþtýr.
Gereç ve Yöntem: Tanýmlayýcý ve iliþki arayýcý tipte olan araþtýrma 1 Þubat2013-30 Nisan 2013 tarihleri arasýnda Erzurum il merkezinde bulunan Kadýn-Doðum hastanesinde yapýlmýþtýr. Veriler Tanýtýcý Bilgi Formu, LATCH Emzirme Tanýlama Ölçeði ve Edinburgh Doðum Sonrasý Depresyon Ölçeði ile toplanmýþtýr. Verilerin deðerlendirilmesinde tek yönlü varyans analizi, t testi, Kruskal-Wallis, Mann-Whitney U ve korelasyon analizi kullanýlmýþtýr.
Bulgular: Annelerin; yaþý, eðitim düzeyi ve gebelik sayýsý ile LATCH puan ortalamalarý arasýnda istatistiksel açýdan anlamlý fark olduðu (p<0.05), EDSDÖ puan ortalamalarý ile annelerin gelir düzeyi, gebelik sayýsý ve gebeliði isteme durumu arasýnda istatistiksel olarak anlamlý fark olduðu belirlenmiþtir (p<0.05). Bulgulara göre LATCH ve EDSDÖ puan ortalamalarý arasýnda bir iliþki olmadýðý saptanmýþtýr
Sonuç: Araþtýrma sonucunda annelerin; emzirme baþarýlarýnýn orta düzeyde olduðu, dörtte birinin depresyon açýsýndan risk altýnda olduðu ve depresyon ile emzirme arasýnda bir iliþki olmadýðý belirlenmiþtir.

Objective: The objective of this study was to determine the relationship between breast feeding and postnatal depression in mothers in the early postpartum period.
Material and Method: This descriptive and correlational study was conducted at the maternity hospitalin the city center of Erzurum between 1 February 2013 and 30 April 2013. The data were collected using the Introductory Information Form, LATCH Breastfeeding Assessment Tool and Edinburgh Postnatal Depression Scale. One way analysis of variance, t test, Kruskal-Wallis, Mann-Whitney U and correlation analysis were used to assess the data.
Results: It was determined that there was a statistically significant difference between the age, educational level and pregnancy number of mothers and LATCH mean scores (p<0.05), and a statistically significant difference between the EPDS mean scores and income level, pregnancy number and pregnancy intention of mothers (p<0.05). According to these results, no relationship was determined between LATCH and EPDS mean scores.
Conclusion: As a result of the study, it was determined that mothers had a moderate-level success of breast feeding, one fourth of them were under risk in terms of depression and there was no relationship
between the depression and breast feeding.

Amaç: Evde bakým hizmeti alan yaþlýlarda genel yaþlý popülasyondan daha sýk beslenme yetersizliði gözlenmektedir. Çalýþmada evde saðlýk hizmeti alan yaþlý hastalarýn beslenme durumlarýnýn deðerlendirilmesi ve beslenme durumunun laboratuvar parametreleri üzerine iliþkisinin irdelenmesi amaçlanmýþtýr.
Gereç ve Yöntem: Çalýþma Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi Evde Saðlýk Hizmetleri Birimi’ne baþvuran, 65 yaþ ve üzerinde 178 hasta üzerinde yürütüldü. Türkçe geçerliliði kanýtlanmýþ Mini Nütrisyonel Deðerlendirme (MNA) formu çalýþma yürütücüsü tarafýndan hasta baþýnda uygulandý. Rutin biyokimyasal testler hasta dosyalarý taranarak incelendi. Ýstatistiksel analizler için NCSS 2007&PASS 2008 Statistical Software programý kullanýldý. Sonuçlar %95’lik güven aralýðýnda, anlamlýlýk p<0.05 düzeyinde deðerlendirildi.
Bulgular: Çalýþmaya katýlan olgularýn yaþ ortalamasý 81.19±8.22 yýldýr. Çalýþmaya katýlanlarýn %32’si erkek, %68’i kadýndýr. MNA toplam deðerlerine göre olgularýn %33.1’i malnütre; %39.3’ü malnütrisyon riski altýnda ve %27.5’i ise normal olarak saptanmýþtýr. MNA toplam sýnýflamasýna göre total protein, albümin, demir, TDBK, ferritin, vitamin B12, folik asit, CRP, hemoglobin ve lenfosit düzeylerinin daðýlýmlarý istatistiksel olarak anlamlý farklýlýk göstermektedir. Malnütrisyonlu olgularda; hemoglobin, demir, TDBK, vitamin B12, folik asit ve lenfosit oraný düþüklüðü, ferritin ve CRP düzeyi yüksekliði diðerlerinden anlamlý düzeyde farklýdýr. Malnütrisyon riski altýnda bulunanlarýn demir ve albümin oranlarý normal olgulara göre anlamlý düzeyde düþüktür; CRP oranlarý ise normal olgulardan anlamlý yüksektir.
Sonuç: Evde saðlýk hizmeti ihtiyacý olan yaþlý hastalar, özellikle kronik mental veya fiziksel hastalýklara sahip olduklarý zaman yetersiz beslenmeye yatkýndýr. Malnütrisyon taný konulup tedavi edilmediðinde diðer hastalýklarýn tedavisini güçleþtirmekte, morbidite ve mortaliteyi arttýrmaktadýr. Bu nedenle evde saðlýk hizmeti ihtiyacý olan yaþlý hastalarýn hepsi mutlaka erkenden taranmalý ve uygun hastalar tedavi edilmelidir.

Objective: Malnutrition and undernutrition are common phenomena in elderly. Prevalence of malnutrition is even higher in older people admitted to home health care services. Our aim was to evaluate the nutrioional status and its effect on biochemical parameters of the elderly people admitted to home health care services.
Material and Method: Our study was performed in 178 participants admitted to the home health care services. Validated Mini Nutritional Assessment (MNA) form was used and biochemical tests were performed. For statistical analyses NCSS 2007& PASS 2008 Statistical Software was used and p<0.05 was considered as statistically significant.
Results: Main age of the participants is 81.19±8.22 years and 32% of participants were male, 68% were women. According to MNA 33.1% were malnourished, 39.3% were under malnutrition risk and 27.5% were in normal nutritional status. Hemoglobin, total iron, total iron binding capacity (TIBC), vitamin B12, folic acid and lymphocyte levels were significantly lower, ferritin and C-reactive protein levels were significantly higher in malnutrition group. Total iron and albumin levels were significantly lower and CRP levels were significantly higher in undernutrition group compared to subjects with normal nutritional status.
Conclusion: Elderly people given home care are under greater risk of malnutrition. If not appropriately managed, malnutrion is associated with higher morbidity and mortality. Therefore it is essential to closely monitor the nutritional stutional status of the elderly people who are admitted to home health care services.

Amaç: Peroneal sinir felci alt ekstremitede sýk görülen periferik sinir lezyonlarýndan biridir. Bu yazýda, mekanik, travma ve postural nedenlerle peroneal sinir yaralanmasý geliþen sekiz olgunun özellikleri ve cerrahi tedavi sonuçlarý incelendi.
Gereç ve Yöntem: Nisan 2011- Kasým 2013 tarihleri arasýnda peroneal sinir yaralanmasýna baðlý düþük ayak nedeniyle kliniðimize baþvuran sekiz hasta tedavi edildi. Hastalarýn hepsinde taný koyma ve yaralanma düzeyinin belirlenmesi amacýyla elektromiyografi (EMG) ve sinir ileti hýzý çalýþmalarý yapýldý. Motor deðerlendirmede hastalarýn saðlam taraflarý ile karþýlaþtýrma yapýldý.
Bulgular: Hastalarýn altýsý erkek ikisi bayan olup ortalama yaþ 41.9±4.2 (aralýk: 23-72) idi. Hastalarýn birinde ayak bileði burkulmasý, ikisinde dizleri üzerine çömelip saatlerce çalýþma, iki hastada uzun çizme veya bot giyme, iki hastada bacak bacak üstüne atýp saatlerce bekleme ve bir hastada trafik kazasý sonrasý diz eklemi düzeyinde travma öyküsü vardý. Semptom ve bulgularýn süresi ortalama 3.8 ay (aralýk: 3-6 ay) idi. Hastalara yapýlan EMG’de ana peroneal sinirde fibula baþý düzeyinde iletim hýzýnda ciddi yavaþlama ve amplitüd bloðu görüldü. Tüm hastalar fibula baþý hizasýnda peroneal sinir dekompresyonu yapmak suretiyle tedavi edildi.
Sonuç: Peroneal sinir genellikle fibula baþý veya boyun kýsmýnda sýkýþýr. Konservatif tedavilere yanýt vermeyen olgularda sinirin fibula baþý seviyesinde serbestleþtirilmesi ile genellikle tatminkar sonuçlar edilir.

Objective: Peroneal nerve paralysis is one of the peripheral nerve lesions often seen in the lower limb. In this paper, characteristics and surgical treatment results of eight cases in whom peroneal nerve injury developed due to mechanical, traumatic and postural reasons were investigated.
Material and Method: Between April 2011 and November 2013, eight patients who referred to our clinic due to lower leg related to peroneal nerve injury were treated. In order to diagnose the illness and determine the level of injury, electromyography (EMG) and neural transmission speed study were carried out on all patients. During motor assessment, strong sides of patients were compared.
Results: Six of the patients were men and 2 of them were women, and average age was 41.9±4.2 (range: 23-72). One of the patients had an ankle sprain history, two of them had a history of long term practice by falling on their knees, in two a history of wearing top boots or wellies, in other two patients a history of waiting for hours by crossing their legs, and one patient had a trauma history on knee-joint level after a traffic accident. Average duration of symptoms and findings were 3.8 months (range: 3-6 months) A very serious slowness in the transmission speed and an amplitude block were seen in main peroneal nerve and at a level of fibular head during the EMG done to the patients. All the patients were treated at the level of fibular head by doing peroneal nerve decompression.
Conclusion: Peroneal nerve is usually pinched in fibular head or neck side. In the cases not responding to conservative treatments, satisfactory results are generally obtained by freeing of nerve at fibular head level.

Longitudinal ekstensif transvers miyelit, merkezi sinir sisteminin spinal kordu etkileyen inflamatuar demiyelinizan hastalýðýdýr. Nöromiyelitis optika (NMO) sendromunun bir spektrumu olabilir. NMO artmýþ disabilite ve morbidite ile iliþkili relapslarla giden bir sendromdur. Burada özgeçmiþinde bir kez paraparezi ve bir kez de quadriparezi öyküsü olan ve yeni baþlayan subakut sol hemiparezi kliniði ile baþvuran 61 yaþýnda kadýn hasta sunuldu. Servikal manyetik rezonans görüntüleme tetkikinde tüm servikal segment boyunca uzanan lezyon görüldü. Etiyoloji araþtýrmasýnda serum anti-aquaporin 4 antikor pozitifliði saptandý. Bu olgu sunumu ile tüm transvers miyelit hastalarýnda anti-aquaporin 4 antikor seviyesi ölçümünün önemi vurgulanmaktadýr.

Longitudinally extensive transverse myelitis is an inflammatory demyelinating disease of the central nervous system which affects the spinal cord. It may be a spectrum of neuromyelitis optica (NMO) syndrome. NMO is a relapsing disease which is usually associated with increased disability and morbidity. Here we report a 61 year-old woman with subacute left hemiparesis, who had paraparesis and quadriparesis, each once in the past. Magnetic resonance imaging revealed lesion areas throughout all the cervical segments. During etiological research, anti-aquaporin 4 antibody was found positive. With this case report, we aimed to emphasize the importance of measurement of anti-aquaporin 4 levels in patients with transverse myelitis.

Vena cava tümörü, nadir görülen ve cerrahisi özellik arz eden bir durumdur. 55 yaþýnda kadýn hasta batýn içi kitle ön tanýsý ile kliniðimize yönlendirildi. Preoperatif hazýrlýk sonrasýnda vena cava tümörü tespit edilen hasta opere edildi. Hastaya total kitle eksizyonu ile birlikte parsiyel vena cava rezeksiyonu uygulandý ve vena cava sentetik damar grefti ile tamir edildi. Kitlenin patolojik incelenmesinde iðsi hücreli sarkomatöz malign tümor görülerek, orta derecede diferansiye leiomyosarkom olarak yorumlandý. Nadir görülen bu klinik durum literatür bilgileri ile birlikte irdelendi.

Vena cava tumor is a rare tumor and its surgical procedure is unique. A women patient, 55 years old, referred to our hospital becouse of intraabdominal mass. After preoperative preperation, the patient was operated for vena cava tumor. Total tumor excision and partially vena cava resection were performed and vena cava was repaired with synthetic vasculer graft patch. In pathological examination of mass, spindle cell sarcomatous malignant tumor was detected and it was interpreted as moderately differentiated leiyomyosarcoma. A rare clinical condition of this case was discussed together with literature.

Turner sendromu sýk rastlanýlan kromozom anomalilerinden biri olup, canlý doðan kýz çocuklarýnýn 1/4000-8000’inde görülmektedir. Bu makalede el-ayak sýrtý ödemi nedeniyle baþvuran ve 45 X0 karyotipi gösteren 10 günlük kýz çocuðu sunuldu. Turner sendromu ile ilgili literatür gözden geçirildi.

Turner’s syndrome (TS) is one of the most common chromosomal abnormalities with an estimated frequency among female live birth of 1/4000-8000. In this article, we presented a 10 day-old girl who admitted with carpal-pedal edema, with 45, X0 karyotype. The literature about Turner’s syndrome was reviewed.

Rektumun diffüz kavernöz hemanjiomu (RDKH) nadir rastlanan benign vasküler bir lezyon olup, genellikle genç yetiþkinlerde görülür. Aðrýsýz, tekrarlayan rektal kanama ile ortaya çýkar. Olgu bildirimizde RDKH hikayesi olan 5 yaþýnda bir erkek çocuk hastayý tanýmladýk. Hastanýn tanýsý doðum esnasýnda konulmuþtu. Kesin taný kolonoskopik inceleme sýrasýnda gerçekleþtirilen biyopsi ile yapýlmýþtý. Hastaya yapýlan manyetik rezonans görüntüleme (MRG) ile hem tümöre ait karakteristik sinyal intensite özellikleri ortaya kondu, hem de lezyonun kesin yeri ve uzanýmý saptandý. Tümör son MRG tetkiki ile kýyaslama yapýldýðýnda minimal boyut artýþý göstermekteydi. Hasta þu anda medikal tedavi görmekte ve MRG ile takip edilmektedir. RDKH ile nadiren karþýlaþýlýr ve internal hemoroidler, inflamatuar barsak hastalýklarý, karsinoma ve çeþitli diðer patolojik durumlarý taklit edebildiðinden sýklýkla yanlýþ taný konulur. Sonuç olarak nadir görülmesine karþýn, özellikle genç hastalarda aðrýsýz, tekrarlayan rektal kanamalarýn ayýrýcý tanýsýnda RDKH’nin göz önünde bulundurulmasý gerektiðini vurgulayabiliriz.

Diffuse cavernous hemangioma of the rectum (DCHR) is a rare benign vascular lesion usually seen in young adults. The presenting symptom is painless recurrent rectal bleeding. Herein, we report a 5 yearold male patient with a history of DCHR. He had been diagnosed with DCHR at his birth. The definite diagnosis was made on the basis of biopsy wich was performed during colonoscopic examination. The patient underwent magnetic resonance imaging (MRI) examination which revealed characteristic signal intensity features of the tumor and also determined the exact location and extent of the lesion. The tumor had only minimally progressed in size compared to the last MRI examination. Currently, the patient is on medical treatment and being followed up by MRI. DCHRs are rarely encountered and often misdiagnosed because they can mimic internal hemorrhoids, inflammatory bowel disease, carcinoma and various other pathological conditions. In conclusion, we can emphasize that despite its rarity, DCHR should be considered in the differential diagnosis of young patients presenting with painless recurrent rectal bleeding.