Çocuklarda toplum kökenli pnömoni (TKP) özellikle geliþmekte olan ülkelerde önemli bir morbidite ve mortalite nedenidir. Tüm dünyada 5 yaþ altý çocuklarda ölüm nedenlerinin baþýnda gelir. TKP taný ve tedavisine yönelik rehberlerin morbidite ve mortaliteyi azalttýðý gösterilmiþtir. Rehberler taný ve tedavide tek yaklaþým deðildir. Pediatrik TKP’nin klinik seyri çok farklýlýklar gösterdiði gibi ayný patojen farklý klinik tabloya neden olabilir. Rehberler hastayý takip eden klinisyenin deðerlendirmesinin yerini alamaz. Bu çalýþmada çocuklarda TKP’nin taný ve tedavisi Amerikan çocuk enfeksiyon hastalýklarý derneðinin yayýnladýðý rehber ýþýðýnda tartýþýlmaktadýr.

Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality in children, especially in developing countries. Worldwide, CAP is the leading cause of death in children younger than five years. Guidelines for the management CAP have been demonstrated to decrease morbidity and mortality rates. They do not represent the only approach to diagnosis and therapy; there is considerable variation among children in the clinical course of pediatric CAP, even with infection caused by the same pathogen. It does not replace the need for the application of clinical judgment to each individual presentation. In this study we aim to discuss the diagnosis and management of CAP in children based on clinical practice guidelines by the pediatric society and the infectious diseases society of America.

Amaç: Normal over yanýtlý hastalarda in vitro fertilizasyon (IVF) sýrasýnda GnRH-agonist ve GnRH-antagonist tedavinin embriyo kalitesine ve insan koryonik gonadotropin (hCG) günü bakýlan E2 ve PRL düzeylerine olan etkisine baðlý olarak gebelik sonuçlarýna etkisi deðerlendirilmiþtir.
Gereç ve Yöntemler: Kontrollü ovaryan hiperstimülasyonda GnRH agonist (n=44) veya GnRH (n=71) antagonist ile down regülasyonu yapýlarak oosit toplanmasý, intrastoplazmik sperm injeksiyonu (ICSI) ve embriyo transferi yapýlan 18-40 yaþ arasý 115 hastada prospektif olarak çalýþýlmýþtýr. hCG yapýlma günü ve bazal serum E2 ve PRL düzeyleri ölçülmüþtür. Demografik bilgiler, over cevabý, endometriyal kalýnlýk, embriyo geliþimi, ve IVF sonuçlarý her iki grup arasýnda karþýlaþtýrýlmýþtýr.
Bulgular: Tedavi protokolleri sonucunda elde edilen oosit sayýsý, matür olan oosit sayýsý ve fertilize olan oosit sayýsý istatiksel olarak farklý deðildir. hCG günü ultrasonografik olarak bakýlan endometriyal kalýnlýk ve endometriyal görünüm, serum E2 (1818±1064 pg/ml vs 1592±860 pg/ml, sýrasýyla, p>0.05) ve PRL (34.2±20.1 ng/ml vs, 30.3±15.4 ng/ml, sýrasýyla, p>0.05) düzeyleri iki grup arasýnda istatiksel olarak farklý deðildir. GnRH-agonist ve GnRH-antagonist tedavi sikluslarý sonucunda fertilizasyon oraný (60.3% ve 60.9%, sýrasýyla, p>0.05), implantasyon oraný (20.5% ve 23.5%, sýrasýyla, p>0.05), gebelik oraný (27.3% ve 21.1%, sýrasýyla, p>0.05) istatiksel olarak farklý deðildir. Gebelik oranlarý için hCG günü bakýlan E2 ve PRL AUC düzeyleri için yapýlan ROC eðim analizi sonuçlarý IVF/ICSI sikluslarýnda gebelik
oluþumunu tahmin etmede kullanýlamayacaðý görülmüþtür (AUC 0.505, 95% CI: 0.372–0.638; AUC 0.412, 95% CI: 0.286-0.537, sýrasýyla ).
Sonuçlar: GnRH-agonist veya GnRH-antagonist tedavi protokolü uygulanan normal over yanýtlý hastalarda bu tedavi farklýlýðýnýn embriyo kalitesi üzerine etkisi olmadýðý ve gebelik sonuçlarýný etkilemediði görülmüþtür. GnRH-agonist ve antagonist sikluslarda hCG günü bakýlan E2 ve PRL ortalama kan düzeyleri farklý bulunmamýþtýr. Ayrýca hCG günü bakýlan E2 ve PRL düzeylerinin gebelik oluþumunu tahmin etmede kullanýlmasýnýn anlamlý olmadýðý görülmüþtür.

Objective: In patients who have normal ovarian response in vitro fertilization (IVF) during GnRH-agonist and GnRHantagonist treatment on embryo quality and E2 and prolactine levels on human chorionic gonadotropine day; pregnancy outcomes were evaluated.
Material and Methods: Analyse of 115 women aged 18–40 years who underwen to varian hyperstimulation in fresh cycles down regulated either with GnRH agonist (n=44) or GnRH antagonist (n=71) followed by oocyte pickup, intracytoplasmic sperm injection (ICSI) and embryo transfer are prospectively analyzed. PRL and E2 values performed basal and on the day of hCG injection. Demographic data, ovarian responses, endometrial thickness, development of embryo and IVF result among groups were compared.
Results: Treatment protocols of the number of oocyte sobtained as a result, the number of oocytes and thenumber of mature oocytes that fertilized and not statistically different. Endometrial thickness and endometrial appearance day of hCG, which is viewed as ultrasound, serum E2 (1818±1064 pg/mL vs 1592±860 pg/ml, respectively, p>0.05) and PRL (34.2±20.1 ng/mL vs 30.3±15.4 ng/ml, respectively, p>0.05) were not statistically different between the two groups. GnRH-agonist and GnRH-antagonist result of treatment cycles with fertilization rate (60.3% and 60.9%, respectively, p>0.05), implantation rate (20.5% and 23.5%, respectively, p>0.05), pregnancy rate (27.3% and 21.1%,
respectively, p>0.05) was not statistically different. Pregnancy rates for the day of hCG viewed E2 and PRL for AUC levels ROC curve analysis results of IVF / ICSI was observed cycles can not be used to predict the occurrence of pregnancy (AUC 0.505, 95% CI: 0372-0638; AUC 0.412, 95% CI: 0.286 to 0.537, respectively).
Conclusions: GnRH-agonist or GnRH-antagonist protocol in patients with normal ovarian response had no effect on embryo quality and diversity of this treatment has been shown to affect pregnancy outcomes. GnRH agonists and antagonists on day of hCG in cycles E2 and PRL mean blood levels viewed were not significantly different. Inaddition, the day of hCG viewed E2 and PRL showed no significant use in predicting the occurrence of pregnancy.

Amaç: Çalýþmada primer amacýmýz tubaovaryan apse tanýlý hastalarda apse boyutunun klinik ve laboratuar sonuclarýna etkisi ve cerrahi tedavide laparoskopi yönteminin etki ve güvenililirliðini deðerlendirmek.
Gereç ve Yöntem: Kliniðimizde son 18 aylýk dönemdeki tubaovaryan apse (TOA) tanýsýyla medikal tedaviye yanýt vermeyen 42 adet laparoskopi yapýlan hasta retrospektif incelendi.
Bulgular: Yapýlan deðerlendirmede hastalarýn ortalama yaþý 38.7 olarak belirlendi. Bu hastalarýn %16.6’sý menopoz sonrasý dönemde iken, %14.2’sinde RÝA mevcuttu. Ayrýca apse boyutu 7 cm üzerinde olan grupta 38 derece ustu ateþli hasta oraný, C-reaktif protein (CRP), eritrosit sedimentasyon hýzý (ESH) ve lökosit sayýsý anlamlý olarak yüksek bulundu. Yapýlan 42 laparoskopi operasyonunda sadece 1 hastada termal ureter hasarý oldu ve ikincil operasyon hiçbir hastaya gerekmedi.
Sonuç: Yeterli cerrahi tecrübe olan kliniklerde TOA cerrahi tedavisinde laparoskopi oldukça güvenli ve etkili bir tedavi olarak görünmektedir.

Objective: Our primary objective in this study was to evaluate whether the size of the abscess affects clinical or laboratory results; also to evaluate efficacy and safety of laparascopy in surgical treatment.
Material and Method: 42 patients diagnosed as having tuboovarian abscess (TOA) who did not respond to medical treatment and underwent laparascopic surgery in last 18 monhts in our clinic were retrospectively analysed.
Results: Mean age of patients was 38.7 years. 16.6% of those were postmenopausal and 14.2% had intrauterine device. Fever above 38 degrees celcius, c-reactive protein (CRP), erithrocyte sedimentation rate, leukocyte count were significantly higher in the group of patients who had abscesses over 7 centimeters. Only one patient had thermal urether injury, none needed secondary operation.
Conclusion: Laparascopy is a very efficient and safe way in surgical treatment of tuboovarian abscess in surgically-experienced centers.

Amaç: Gebelik haftasý ≥35 hafta olan bebeklerde taburcu edilme zamanýnýn hiperbilirubinemi nedeniyle yeniden hastaneye yatýþ üzerine etkisini araþtýrmak.
Gereç ve Yöntem: Hastanemiz Yenidoðan Kliniðinde, Ocak 2010 – Haziran 2011 tarihleri arasýnda, gebelik süresi ≥35 hafta olan ve sarýlýk nedeniyle yatýrýlarak tedavi edilen tüm bebekler çalýþmaya alýndý. Hastalarda sarýlýðýn etiyolojisi, kliniði, laboratuvar özellikleri ve uygulanan tedaviler kaydedildi. Anne bebek çiftinin taburcu edilme zamaný ile bilirubin deðerleri karþýlaþtýrýldý.
Bulgular: Çalýþma süresince kriterlere uyan 222 bebek deðerlendirildi. Hiperbilirubinemi etyolojisi incelemesinde en sýk saptanan nedenler; ABO uyuþmazlýðý 66 (%29,7), Rh uyuþmazlýðý 19 (%8,6) ve patolojik oranda tartý kaybý 19 (%8,5) olarak sýralandý. Bebeklerin 90’ýnda (%40,6) herhangi bir etyolojik neden bulunamadý. Patolojik tartý kaybýnýn total serum bilirubin (TSB) üzerine anlamlý etkisi olduðu bulundu (p: 0,014). ABO uygunsuzluðu ve TSB deðerleri arasýnda anlamlý negatif korelasyon saptandý (p<0,001), bununla birlikte ABO uygunsuzluðu olan bebeklerin getiriliþ günlerinin anlamlý olarak daha kýsa olduðu bulundu (p<0,001). Taburculuk öncesi sarýlýðý olan bebeklerin hastaneye geliþ günlerinin anlamlý olarak daha kýsa olduðu (p<0,001) ve TSB deðerlerinin anlamlý olarak daha düþük olduðu saptandý (p<0,001). Doðum sonrasý taburculuk zamaný belli olan 184 bebeðin taburculuk saati ortalamasý 32,9±20 saat (5-120 saat) olarak saptandý. Doðum sonrasý hastaneden taburculuk saatinin TSB deðerlerine anlamlý etkisi saptanmadý. Ortalama taburculuk süresi hastanemizde, diðer devlet hastanelerinde ve özel hastanelerde sýrasýyla 37,7±22 saat, 34,6±19,8 saat ve 25,1±14,7 saat idi. Ortalama kontrole çaðrýlma zamaný hastanemizde, diðer devlet hastanelerinde ve özel hastanelerde sýrasýyla 4±2,1 gün, 5±3,2 gün ve 5,3±3,6 gün saptandý. Hastanemizde doðan bebeklerin doðum sonrasý taburculuk saatlerinin özel hastanede doðan bebeklere göre anlamlý olarak uzun olduðu (p: 0,001) ve hastanemizde doðan bebeklerin kontrole çaðýrýlma günlerinin özel hastanede doðanlara göre anlamlý olarak kýsa olduðu saptandý (p: 0,019).
Sonuç: Çalýþmamýzda doðum sonrasý taburculuk saatinin geliþ hiperbilirubinemi düzeyi üzerine olumsuz bir etkisi saptanmadý. Patolojik tartý kaybý ve ABO uygunsuzluðunun hiperbilirubinemi geliþimi için risk faktörleri olduðu belirlendi. Hastanemizde, özel hastanelere göre taburcu edilme zamanýnýn daha geç ve kontrole çaðrýlma zamanýnýn daha erken olduðu belirlendi.

Objective: The purpose of the study is to investigate the effect of discharge time on rehospitalisation of babies with gestational age ≥35 weeks from hyperbilirubinemia.
Material and Method: Between January 2010 to June 2011, all babies included to study who were ≥35 weeks and treated for hyperbilirubinemia in our newborn clinic. Etiology, clinical and laboratory features and given therapies were recorded. Bilirubin levels compared according to postpartum discarge time of mother-baby couple.
Results: Two hundred and twenty two babies who met criteria were assessed. Mostly detected reasons during hyperbilirubinemia etiology investigations were; ABO incompatibility in 66 babies (29,7%), Rh incompatibility in 19 babies (8,6%) and pathologic weight loss in 19 babies (8,5%). There were no etiologic reason found in 90 (40,6%) babies. It was detected that pathologic weight loss had significant effect on total serum bilirubin (TSB) levels (p=0,014). Negative correlation between ABO incompatibility and TSB levels was detected (p<0,001), but babies with ABO incompatibility had significantly shorter duration of hospital admission (p<0,001). Mean discharge time of 184 babies who had known postnatal discharge time was detected as 32,9±20 hours (5-120 hours). There was no significant effect of postnatal discharge time detected on TSB levels. Mean discharge times at our hospital, state hospital and special hospital were found 37,7±22 hours,
34,6±19,8 hours and 25,1±14,7 hours, respectively. The follow up examination time at our hospital, state hospital and special hospital were found 4±2,1 days, 5±3,2 days and 5,3±3,6 days, respectively. Babies born in our hospital had significantly longer postnatal discharge time (p.0,001) and shorter duration for follow up examination (p: 0,019) against special hospitals.
Conclusion: In our study, it was detected that postnatal discharge time of mother baby couple had no negative effect on admission bilirubinemia levels. Pathologic weight loss and ABO incompatibility were detected as risk factors for development of hyperbilirubinemia. We found that postnatal discharge time is longer and duration for follow up is shorter in our hospital according to special hospitals.

Amaç: Yenidoðan bebeklerde sarýlýk tedavisinde verilen saðlýk bakým hizmeti hakkýnda, hemþirelerin uygulama düzeyinin deðerlendirilmesi.
Gereç ve Yöntem: Çalýþma verileri Ýstanbul ilinde iki eðitim ve araþtýrma hastanesi yenidoðan bölümlerinde görevli olan ve çalýþmayý kabul eden hemþirelerden elde edildi. Araþtýrmacýlar tarafýndan deneyimler ve literatür bilgileri doðrultusunda çalýþmanýn anket formu oluþturuldu, etik kurul onayý alýndý. Ankette bireyin genel çalýþma özellikleri ile birlikte; sarýlýðýn erken taný, tedavi ve izlemi ile ilgili bilgi düzeyleri deðerlendirildi. Eðitim durumunun ve çalýþma sürelerinin deðiþkenler üzerine olan etkileri incelendi. Veriler yüzdelik ve ki-kare testleri ile deðerlendirildi.
Bulgular: Çalýþma, ankete katýlmayý kabul eden 87 yenidoðan hemþiresi ile tamamlandý. Hemþirelerin %51.7’si lisans mezunu idi. Sarýlýk ile ilgili eðitim alma oraný %57.5 sýklýðýndaydý. Ankette sarýlýk geliþimi ile ilgili risk faktörlerinin %79.3, uygun þekilde sarýlýðýn tespit edilmesinin %58.6, patolojik sarýlýk tanýmýnýn %73.1, sarýlýðýn klinik bulgularýnýn %61.3, fototerapi etkinliðini artýrma yöntemlerinin %79.6, fototerapi hemþirelik bakým esaslarýnýn %52.9, fototerapi yan etkilerinin %42.6 ve fototerapi esnasýndaki uygun beslenme modelinin %65.6 oranlarýnda doðru bilindiði belirlendi. Yüksek lisans mezunlarýnýn anne sütü sarýlýðý sendromunu doðru tanýmlamada (p: 0.05) ve erken anne sütü sarýlýðýný bilmede (p: 0.018) daha baþarýlý olduklarý saptandý. Yenidoðan bölümünde beþ yýldan fazla çalýþanlarda fototerapinin yan etkilerini bilme (p: 0.039) oranlarý daha yüksekti.
Sonuç: Hemþirelerin sarýlýðýn klinik bulgularýný, sarýlýk geliþimindeki risk faktörlerini, fototerapinin etkinliðini artýrma yöntemlerini ve fototerapi esnasýnda beslenme yöntemlerini önemli bir oranda doðru olarak bildiði saptandý. Yüksek lisans eðitimi alan veya 5 yýldan daha uzun süre yenidoðan bölümünde çalýþan hemþirelerin uygulama bilgilerinin daha yüksek oranda doðru olduðu belirlendi.

Objective: To evaluate the application level of nurses about health care service given at jaundice treatment on newborn babies.
Material and Method: Study data was obtained from nurses who work in neonatal units of two training and research hospitals of Ýstanbul and agreed to participate the study. For this study a questionnaire form established by investigators under the supervision of experties and under the consideration of literature knowledge and approval from ethical committee received. In questionnaire, with general working characteristics of individual, also knowledge level about early diagnosis, treatment and follow up of jaundice evaluated. The impact of educational status and working period on the variables was analysed. Data were analyzed with percentage and chi-square methods.
Results: The study performed with 87 nurses who accepted the questionnaire. Fifty one point seven percent of nurses were university graduates. The receive education rate about jaundice was 57.5%. In questionnaire, the percentage of right knowledge for risk factors about development of jaundice was 79.3%, detection of jaundice properly was 58.6%, the definition of pathologic jaundice was 73.1%, clinical findings of jaundice was 61.3%, the methods for increasing the effectiveness of phototherapy was 79.6%, principles of nursing care for
phototherapy was 52.9%, side effects of phototherapy was 42.6 % and proper feeding method during phototherapy was 65.6%. Master graduates were detected more succesfull in correct definition of breast feeding jaundice syndrome (p: 0.05) and knowing early breast feeding jaundice (p: 0.018). The percentage of knowing the side effects of phototherapy was higher in nurses working more than 5 years in neonatal units (p: 0.039).
Conclusion: It was detected that the nurses had true knowledge with important proportion about clinical features and risk factors in development of jaundice, methods for increasing the effectiveness of phototherapy and feeding methods during phototherapy. The application knowledge was determined higher correct proportion in nurses who were master graduates or working period more than 5 years in newborn units.

Amaç: Bu araþtýrma, esansiyel hipertansiyonlu bireylerin öfke düzeyleri ve öfke ifade tarzlarýný belirleme amacýyla tanýmlayýcý olarak yapýlmýþtýr.
Gereç ve Yöntem: Tanýmlayýcý olarak yapýlan bu araþtýrmanýn evrenini Eylül 2010–Ocak 2012 tarihleri arasýnda Üniversite Hastanesi Kardiyoloji polikliniðine baþvuran esansiyel hipertansiyon tanýsý almýþ hastalar oluþturmuþtur. Örneklemini ise, en az üç aydýr esansiyel hipertansiyon tanýsý almýþ, biliþsel iþlevleri etkileyecek rahatsýzlýk veya kronik hastalýðý olmayan, 18 yaþ ve üzerindeki, araþtýrmaya gönüllü olarak katýlmayý kabul eden 220 hasta oluþturmuþtur. Veriler; ‘‘Tanýtýcý Soru Formu’’ ve ‘‘Sürekli Öfke - Öfke Tarz Ölçeði’’ ile
toplanmýþtýr.
Bulgular: Araþtýrmaya katýlan hastalarýn; %55.9’u erkek, %38.2’si 66-76 arasý yaþ grubunda, %84.5’i evli ve %40.9’u okur yazar deðildir. Hastalarýn %40.9’unun hipertansiyon süresinin 1-5 yýl arasýnda olduðu görülmüþtür. Hastalarýn %56.8’inin birden fazla antihipertansif ilaç kullandýðý, %35’inin tek ilaç kullandýðý, %55.9’unun hipertansiyon kontrollerini düzenli yaptýrdýðý, %66.4’ünün ise hipertansiyon eðitimi almadýðý tespit edilmiþtir. Hastalarýn sürekli öfke ve öfke ifade tarzý ölçeðinden aldýklarý en yüksek ortalama puanlarýnýn sürekli öfke alt boyutundan (24.11±6.71) ve en düþük ortalama puanýn ise öfke dýþa alt boyutundan (16.43±5.60) olduðu bulunmuþtur. Esansiyel hipertansiyon hastalarýnýn sürekli öfke ve öfke ifade tarzlarýnda meslek, medeni durum, kullanýlan ilaç sayýsý, hipertansiyon kontrollerini yaptýrma ve hipertansiyon eðitimi alma durumunun etkili faktörler olduðu saptanmýþtýr.
Sonuç: Esansiyel hipertansiyon tanýsý alan hastalarýn sürekli öfke düzeylerinin yüksek olmasýna raðmen öfke kontrolünün de yüksek olduðu bulunmuþtur. Bu sonuçlar doðrultusunda; esansiyel hipertansiyon hastalýðý olan bireylere öfke ifadesi ve kontrolü konusunda, hipertansiyon farkýndalýðýný ve bilincini arttýracak eðitimin saðlýk çalýþanlarý tarafýndan verilmesi önerilmektedir.

Objective: This study was conducted descriptively to determine the anger levels and anger expressions in individuals with essential hypertension.
Material and Method: The study population of this descriptive study consisted of patients with a diagnosis of essential hypertension admitted to Firat University Hospital, Cardiology Outpatient Clinic between September 2010 and January 2012. And, the sample of the study consisted of 220 patients who were 18 years or older and diagnosed with essential hypertension at least in the last three months, had no chronic diseases and disorders that affect cognitive functioning, and who agreed to participate voluntarily in the study. Data were collected with “Introductory Information Questionnaire” and “Trait Anger and Anger Expression Scale”.
Results: Of the patients included in the study, 55.9% was male, 38.2% was in the 66-76 age group, 84.5% was married, and 40.9% was illiterate. Duration of the hypertension was found to be between 1 and 5 years in 40.9% of the patients. It was found that 56.8% of the patients was using multiple antihypertensive drugs, 35% was using one drug only, 55.9% was going to the regular hypertension checks, and 66.4% has not received any training on hypertension. The highest mean score of the patients taken in the trait anger and anger expression scale was in the Trait Anger subscale (24.11±6.71), and the lowest mean score taken was in the Anger-Out subscale (16.43±5.60). The profession, marital status, number of medications received, regular hypertension checks and hypertension training were found to be effective factors in trait anger and anger expression of patients with essential hypertension.
Conclusion: Anger management of patients diagnosed with essential hypertension was found to be high, despite their high levels of trait anger. In line with these results, it is recommended to provide training by health professionals on anger expression and control in order to increase hypertension awareness in individuals with essential hypertension.

Amaç: Her saðlýk çalýþaný, saðlýk hizmetleri sektörünün önemli bir parçasýdýr. Herhangi bir alandaki olumsuzluk saðlýk çalýþanlarýný etkilediði
gibi, sektörün diðer çalýþanlarýný da etkilemektedir. Teknolojinin geliþmesi, saðlýk sektöründe daha ileri ve üst düzey hizmet ihtiyacý yaratmýþ ve çalýþan gücünün vasýflý olmasýný zorunlu hale getirmiþtir. Bu vasýflý insan gücünün de verimli olmasý için kurumdan memnun olmasý ve kurumsal baðlýlýk düzeyinin de yüksek olmasý gerekmektedir. Çünkü memnun olan personel daha üretken ve mesleðine daha baðlý olmaktadýr. Bu çalýþmanýn amacý, Ýstanbul Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi’nin çeþitli birimlerde görev yapan Veri Hazýrlama ve Kontrol Ýþletmenlerinin mesleðinden, çalýþma koþullarýndan ve kurumdan memnun olma durumlarýný belirlemek ve kurumdan ayrýlýp ayrýlmama yönündeki düþüncelerini saptayýp iyileþtirme faaliyetlerinde kuruma rehberlik etmektir.
Gereç ve Yöntem: Bu çalýþma kapsamýnda, Ýstanbul Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi’nde çeþitli birimlerde görev yapan
Veri Hazýrlama ve Kontrol Ýþletmenlerinin iþinden, çalýþma koþullarýndan ve çalýþtýðý kurumdan memnun olma durumlarýný belirlemek ve
kurumdan ayrýlýp ayrýlmama düþüncelerini sorgulamak amaçlý anket sorularý hazýrlanmýþ ve kurum Etik Kurul onayý alýndýktan sonra 201 çalýþana uygulanmýþtýr. Uygulanan anket verileri bilgisayara ortamýna aktarýldýktan sonra tanýmlayýcý analizler ve hipotezlere yönelik istatistiksel analiz için SPSS 15.0 for Windows programý kullanýlmýþtýr. Tanýmlayýcý istatistikler; kategorik deðiþkenler için sayý ve yüzde, sayýsal deðiþkenler için ortalama, standart sapma olarak verilmiþtir. Kategorik deðiþkenlerin gruplar arasýndaki oranlarý Ki Kare Analizi ile test edilmiþtir. Koþullarýn saðlanamadýðý durumda Monte Carlo simülasyonu uygulanmýþtýr. Ýstatistiksel alfa anlamlýlýk seviyesi p<0.05 olarak kabul edilmiþtir.
Bulgular: Çalýþanlar %41.8’i Þiþli Hamidiye Etfal’de çalýþmaktan memnun olduðunu belirtmiþtir. %44.8 kýsmen memnun olduðunu, %13.4’ü
memnun olmadýðýný belirtmiþtir. Kýsmen memnun olan ve memnun olmayanlarýn en büyük gerekçesi %59.5 oranla aldýðý maaþýn yetersiz
olmasýný gerekçe göstermiþtir. Çalýþanlarýn %42.3’ü, kurumdan ayrýlmayý düþünüyor musunuz? sorusuna hayýr cevabý vermiþtir. %21.4’ü
evet, %36.3’ü kýsmen cevabý vermiþtir. Ayrýlmayý düþünen grubun %62.1 oranla gerekçesini aldýðý maaþýn düþük olmasý olarak belirtilmiþtir.
Çalýþanlarýn yaþ gruplarý ile kurumdan ayrýlmayý düþünme durumlarý arasýnda p=0.015<0.05 oranýnda anlamlý iliþki bulunmuþtur. Kurumdan
ayrýlmayý düþünmeyenlerde %22.4 oranla Þiþli Etfal’li olmayý sevdiklerini belirtmiþlerdir.
Sonuç: Çalýþma sonunda;
• Çalýþanlarýn kurumun fiziki koþullarýndan çok memnun olmadýðý,
• Çalýþma arkadaþlarý ile iletiþimlerinin iyi olduðu,
• Görev daðýlýmda adil olunduðunu dair inancýn düþük olduðu,
• Kurum içi iletiþimin düþük olduðu ve kuruma baðlýlýk düzeyinin düþük olduðu
• Kurumda performans deðerlendirme ölçütlerinin uygulandýðýna dair inancýn düþük olduðu, Yöneticilerle iliþkilerinin düþük düzeyde olduðu,
• Kurumda algýladýklarý sosyal olanaklarýn düþük olduðu,
• Eðitim faaliyetleri ve Kalite çalýþmalarý konusunda yeterince aktif ve katýlýmcý olmadýklarý sonucuna ulaþýlmýþtýr.
Veri Hazýrlama ve Kontrol Ýþletmenlerinin, kurumdan ayrýlmayý düþünmelerinin en büyük nedeni ise aldýklarýn ücretin yetersiz olduðunu
düþünmeleridir. Veri Hazýrlama ve Kontrol Ýþletmenlerinin memnuniyet arttýrýp kuruma baðlamak amaçlý çözümler geliþtirilmelidir. Bunun
için mesleki memnuniyet düzeylerini olumsuz etkileyen faktörlere karþý önlem alýnmalý, sosyal imkânlarý arttýrýlmalý, beklentilerine yönelik
yönetim stratejileri geliþtirilmelidir.

Objective: All health care workers, are important parts of the health care sector.As negative effects in any other field affect health professionals, also affects other employees in the sector. The development of technology in the health sector has created the recuirements
for more advanced and high level of service and has made employee strength, mandatory to be qualified. These skilled people has to be
satisfied with the institutions to be efficient in power and the institutional commitment levels should be high. Because more pleased staffs
are more productive and professional. The purpose of this study is to check satisfaction and working conditions of various units serving in
Data Processing and Control Operators in Istanbul Sisli Hamidiye Etfal Education and Research Hospital, and detect their thoughts about
to leave their procession in organization and guide to the instution about redevelopment acitivities.
Material and Method: In this study we purpose to survey about satisfaction and working conditions of various units serving in Data
Processing and Control Operators in Istanbul Sisli Hamidiye Etfal Education and Research Hospital, and detect their thoughts about to
leave their procession and the questions were prepared and receive approval from Ethics Committee has been applied to 201 employees.
After applied survey data being transferred to the computer, for statistical analysis about descriptive analysis and hypothesis, SPSS 15.0
for Windows program was used. Descriptive statistics; number and percentages for categorical variables, the average for numeric variables
are given as the standard deviation. Percentages of categorical variables among groups was tested by chi square analysis. In cases where requirements are not met Monte Carlo simulation is applied. Statistical significance level of alpha has been accepted as p<0.05
Results: The employees stated that of their 41.8% enjoyed working in the Sisli Hamidiye Etfal. 44.8% were partially satisfied, 13.4% were not satisfied. The common argument of the partially satisfied and dissatisfied was unsatisfactory money for life. (59.5%) 42.3% of employees about leaving the organization has ‘no ‘ answer to the question. 21.4% yes, 36.3%. maybe. The group who were thinking about to leave their job, the common motivation (62.1) was the low salary rates Between the age grups and the situation about thought of leaving the organization, there was percent significant relationship (p=0.015<0.05 percent). The thinking about to stay in the instution, 22.4% of
the employee stated that they liked to be from Þiþli Etfal.
Conclusion: At the end of the study;
• The employees of institutions were not satisfied with the physical conditions,
• Have good communication with work colleagues,
• The belief about justice in the task distribution was low.
• The communication in the instution was poor and the loyalty to the instution was not enough.
• The belief that the implementation of the performance evaluation criteria in the institution is low, it was the low level of relations with the Director,
•Social opportunities, of the instution were not enough.
•They were not sufficiently active in training activities and quality studies and concluded they were not participants.
Data Processing and Control operators’ the biggest reason for thinking of leaving the organization was that the salary rates insufficient for life. Because of it, the satisfaction of this employee must be higher. The measures to be taken against factors that negatively affect their professional satisfaction, social services should be increased, management strategies should be developed to expectations.

Pitriyazis likenoides et varioliformis akuta (PLEVA), ani baþlayan, etyolojisi tam olarak bilinmeyen yaygýn papüloskuamöz lezyonlar ile karakterize bir deri hastalýðýdýr. Burada özellikle fleksural alanlarda yoðunlaþan, yer yer nekrotik krutlu yaygýn papüloskuamöz lezyonlar ile birlikte, ateþ, halsizlik ve kas aðrýlarý olan 31 yaþýnda nörofibromatozisli bir PLEVA olgusu sunulmaktadýr.

Pityriasis lichenoides et varioliformis acuta (PLEVA), is a sudden onset skin disease characterized by diffuse papulosquamous lesions with unknown etiology. Here, we report a 31-year-old patient with neurofibromatosis who had generalised papulosquamous lesions especially on flexural areas, accompanying fever, malaise and muscle pain.

Amaç: Kritik valvüler aort darlýðý en sýk fetal kardiyak giriþim gerektiren doðumsal kalp hastalýðýdýr. Bu olgu, ülkemizde fetal kardiyak cerrahinin önemine vurgu yapmak amacý ile sunulmuþtur.
Olgu: Olgumuz 18 yaþýndaki annenin ilk gebeliðinden 29. Gestasyonel haftada 1600 gram doðan kýz bebek. Prenatal 24. Gestasyonel haftada kritik valvüler aortik stenoz saptanýp doðumda resüsite edilip entübe edildi. Akciðer grafisinde aðýr respiratuar distres sendromu bulgularý olmasý üzerine solunum destek cihazýna baðlanarak iki doz sürfaktan verildi. Dopamin ve alprostadil infüzyonu baþlandý. Postnatal ekokardiyografik incelemede sol ventrikül yetmezliðinin eþlik ettiði kritik aort darlýðý tanýsý teyid edildi. Postnatal 5. saatte balon aortik valvüloplasti iþlemi yapýldý. Yaþamsal bulgularýnda kýsmi düzelme gözlenen hasta iþlemden sonraki 4. saate yoðun bakýmda kaybedildi.
Sonuç: Ülkemizde fetal kardiyak giriþimlerin yapýlabileceði merkez sayýsýnýn yeterli düzeye çýkarýlmasý gerektiði kanýsýndayýz.

Objective: Critical valvular aortic stenosis is the most common congenital heart disease which requires fetal cardiac intervention. This case is presented to emphasize the significance of prenatal intervention in our country.
Case: Our case is a female infant with a birthweight of 1600 g at 29th gestational weeks from the first pregnancy of an 18 years old mother. At prenatal 24th gestational weeks critical valvuler aortic stenosis detected and resuscitated and entubated at birth. At chest roentgenogram there was findings of respiratory distress syndrome, so mechanical ventilation support applied and 2 doses of surfactant therapy given. Dopamine and alprostadil infusion was started. Critical aortic stenosis diagnosis with accompanying left ventricular failure was confirmed following postnatal echocardiographic examination. Aortic valvuloplasty preocedure was applied at the postnatal fifth hour. The patient observed to have partial improvement in vital findings following balloon valvuloplasty but was lost four hours after the intervention.
Conclusion: We believe that the number of centers where cardiac interventions will implent must be increase to a satisfactory level.

Aktinomikozis aktinomiçes tarafýndan oluþturulan bir enfeksiyondur. Abdominal enfeksiyonlar genellikle mukozal bütünlüðün bozulduðu durumlarda oluþmaktadýr. Bu olgu sunumunda, akut apandisit tanýsý almýþ cerrahi sonrasý tanýsý konulan aktinomikoz olgusu ve aktinomikoz hakkýnda genel bilgiler kýsaca sunulmaktadýr.

Actinomycosis is an uncommon suppurative infection. The Actinomyces species can cause opportunistic infections due to the disruption of the mucosal surface. We report a case initially presented as acute appendicitis and definitely diagnosed as actinomycosis after surgery and short summary of the general knowledge on actinomycosis.

Johanson-Blizzard Sendromu (JBS) nadir görülen otozomal resesif kalýtýmlý multisistemik bir hastalýktýr. En karakteristik fenotipik özelliði ekzokrin pankreas yetersizliðidir. Bundan baþka sýklýk sýrasýna göre; burun kanadý hipo-aplazisine baðlý küçük gaga benzeri burun, dental anomaliler, kafa derisinde orta hat defektleri, sensörinöral tip iþitme kaybý, büyüme geliþme geriliði, psikomotor retardasyon, hipotiroidi, kadiyovasküler ve genitoüriner sistem anomalilerine de rastlanmaktadýr. En sýk görüler oftalmolojik manifestasyon kutaneolakrimal fistüldür. Sendroma eþlik eden nazolakrimal malformasyonlar bir hayli sýk iken intraoküler malformasyonlara neredeyse hiç rastlanmamasý sendromun bir yüzey ektodermal displazi oluþu hipotezini desteklemektedir. Gözlerde sulanma nedeniyle kliniðimize refere edilen JBS’lu erkek bir bebeðe bilateral punktum dilatasyonu ve nazolakrimal probing uygulanmýþ ve JBS sendromunun ender görülmesi nedeniyle bu vakanýn sunulmasý amaçlanmýþtýr.

Johanson-Blizzard Syndrome (JBS) is a rare, autosomal recessive disease with multi-system involvement and characteristic exocrine pancreatic insufficiency. Other typical clinical features of JBS are the following (with decreasing frequency); hypoplasia/aplasia of the alae nasi (beak like small nose), dental anomalies, congenital scalp defects, sensorineural hearing loss, growth retardation, psychomotor retardation, hypothyroidism, cardiovascular and genitourinary anomalies. The most common ophthalmologic manifestation is lacrimal cutaneous fistula. The syndrome is often accompanied with nasolacrimal malformations however, intraocular malformations are almost never coincide with syndrome, supports the hypothesis that syndrome is a surface ectodermal dysplasia. We performed bilateral dilatation of puncta and nasolacrimal probing to a male infant with JBS who had been referred to our clinic with constant and excessive tearing of both eyes. Due to the rare incidence of the syndrome we aimed to report this case.

Jarcho-Levin Sendromu kýsa torax, kosta ve vertebralarýn yapýsal ve sayýsal anomalileri ile karakterize nadir bir sendromdur. Spondilotorasik ve spondilokostal dizostoz olarak adlandýrýlan iki gruba ayrýlan bu sendroma diðer sistemlere ait anomalilerde eþlik edebilmektedir. Bu yazýda Jarcho-Levin Sendromu tanýsý alan bir yenidoðan olgusu ciddi nörolojik tutulumu ve eþlik eden anomalileri nedeniyle sunulmuþtur.

Jarcho-Levin Syndrome is a rare syndrome, characterized by short thorax, numerical and structural abnormalities of costae and vertebrae. This syndrome, divided into spondylothoracic and spondylocostal subgroups, can be accompanied by other system abnormalities. Herein, we present a newborn diagnosed with Jarcho-Levin syndrome with serious neurological symptoms and accompanied abnormalities.