Peritoneal yapýþýklýklar baþta gastrointestinal cerrahi olmak üzere kolorektal ve jinekolojik cerrahiler için önemli bir klinik sorundur. Bu yapýþýklýklar, enfeksiyon veya cerrahi travma gibi durumlarýn peritonu irrite etmesiyle oluþmakta ve periton hasarýnýn iyileþme sürecinin patolojik bir parçasý olarak kabul edilmektedir. Postoperatif peritoneal yapýþýklýklar, ilk cerrahi iþlemden yýllar sonra bile ortaya çýkabilmekte ve kronik karýn aðrýsý, infertilite, mekanik ince barsak obstrüksiyonu ve relaparotomiler sýrasýnda yaralanmaya neden olabilmektedir. Postoperatif yapýþýklýklarý önlemek için denenen ajanlarýn çoðu, adezyon oluþumunun doðal fizyopatolojik sürecinde yer alan basamaklar üzerinde deðiþiklikler yaparak etkilerini göstermektedir. Örneðin; fibrinolizi aktive etmeyi, koagülasyonu engellemeyi, inflamatuar yanýtý azaltmayý, kollajen sentezini inhibe etmeyi veya yakýn yara yüzeyleri arasýnda bir bariyer oluþturmayý amaçlarlar. Sonuçlarý her ne kadar cesaretlendirici olsa da, çoðunun çeliþkili ve sadece hayvan modellerinde denenmiþ olmasý bu ajanlarýn kullanýmý için en büyük engellerdir.
Gelecekteki klinik araþtýrmalar ve olasý geliþmelere kadar, intraperitoneal yapýþýklýklarla mücadele sýrasýnda ortaya çýkan istenmeyen morbidite ve mortaliteleri azaltmanýn en etkin yöntemi þimdilik sadece özenli ve uygun cerrahi teknik olarak görülmektedir. Bu durumun üstesinden gelmek ve açýklýða kavuþturmak için mutlaka preklinik ve klinik çalýþmalarýn artarak devam etmesi þarttýr.

Postoperative peritoneal adhesion is an important clinical challenge in gastrointestinal, colorectal, and gynecologic surgery. Adhesions are the most frequent cause of long-term complications, including chronic abdominal pain, female infertility, mechanical small bowel obstruction, and injury at reoperations. Postoperative adhesion formation is a natural consequence of peritoneal irritation by surgical tissue trauma or infection, and may be considered as the pathological part of healing following any peritoneal injury. In the search for effective methods for preventing postoperative adhesions, several clinical techniques and agents have been investigated. Strategies for reduction of adhesions
are based on their natural pathophysiological mechanisms of origin, including activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Despite initial promising results of different measures in postoperative adhesions prevention, none of them have become a standard application and achieved mostly in animal model. Until additional information and findings from future clinical investigations, only a meticulous surgical technique can be recommended to reduce morbidity and mortality rates from these undesirable and troublesome effects of surgery. In the current state of
knowledge, further pre-clinical and clinical investigations are necessary to evaluate the prevention strategies of postoperative peritoneal adhesions.

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Prediyabet, tip 2 diyabet ve normoglisemi arasýndaki ara dönem olarak tanýmlanabilir. Açlýk plazma glukozunun 100-125 mg/dl olmasý (Bozulmuþ açlýk glukozu) ya da 75 gr oral glukoz tolerans testinde 2 saat plazma glukozunun 140-199 mg/dl olmasý (Bozulmuþ glukoz toleransý) prediyabet olarak adlandýrýlýr. ADA 2010 önerilerine göre HbA1c düzeyinin %5.7–6.4 arasýnda olmasý da prediyabet kabul edilmiþtir. Prediyabetiklerin her yýl %5-10’u aþikar tip 2 diyabete dönüþmektedir. Dislipidemi, hipertansiyon ve obezite ile iliþkili olan prediyabet, kardiyovasküler hastalýk açýsýndan ciddi risk faktörüdür. Bu nedenle, prediyabetin erken tanýnmasý ve tedavisi ile tip 2 diyabet geliþimine müdahale edilebilir.

Prediabetes is the intermediate period between normoglycemia and type 2 diabetes mellitus. Fasting plasma glucose concentration between 100 and 125 mg/dl (Impaired fasting glucose) or second hour plasma glucose concentration of oral glucose tolerance test between 140-199 mg/dl (Impaired glucose tolerance) is termed as prediabetes. Also, HbA1c level between 5.7-6.4% has been accepted as prediabetes according to the recommendations of ADA in 2010. Every year 5 to 10% of prediabetic patients progress into type 2 diabetes mellitus. As associated with dislipidemia, hypertension and obesity, prediabetes is an important risk factor for developing cardiovascular diseases. So, early diagnosis and treatment for prediabetes may interfere in preventing type 2 diabetes development.

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Amaç: Çalýþmamýzda tedavilerinde oral antidiyabetiklerden insüline geçilen diyabetes mellitus (DM) tanýlý hastalarda insülinin periferik sinirler üzerindeki etkisini araþtýrmayý amaçladýk. Ayrýca daha önceki çalýþmalarda vurgulandýðý gibi F yanýtýnýn polinöropatinin saptanmasýndan ziyade glisemik kontrol ile polinöropati seyrinin takibinde bir parametre olarak kullanýlabilirmi sorusuna yanýt aradýk.
Gereç ve Yöntem: Çalýþmamýza Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Diyabet Polikliniðinde Amerikan Diyabet Cemiyeti (American Diabetes Association, ADA) kriterlerine göre DM tanýsý alan, oral antidiyabetik tedavi ile izlenmekte iken, insülin tedavi endikasyonu belirlenen 10 gönüllü diyabetik hasta alýndý. Tüm hastalarýn tedavi öncesi, tedavinin 1.ve 4. haftasýnda nörolojik muayene ile Total Nöropati Skorlamasý (TNS), serum glukoz ile HbA1c düzeyleri ve elektrofizyolojik deðerlendirmeleri yapýldý.
Bulgular: Çalýþmaya alýnan toplam 10 olgunun 7’si kadýn, 3’ü erkek idi. Yaþ ortalamasý 55±9.01 (40-69) idi. Olgularýn DM süreleri 1 ile 15 yýl arasýnda deðiþmekteydi (ort: 6.2±4.83). Olgularýn dördünde baþlangýç elektrofizyolojik deðerler normal sýnýrlar içindeydi. Beþ olguda alt ekstremitelerde duyusal lifleri, bir olguda üst ekstremitelerde duysal alt ekstremitelerde duyusal ve motor lifleri tutan polinöropati sendromu
tespit edildi. Polinöropatisi olmayan veya ýlýmlý nöropatisi olan olgularýn kontrol elektrofizyolojik incelemelerinde özellikle duyusal ileti amplitüdlerinin iyileþtiði ancak baþlangýçta belirgin polinöropatisi olan olgularýn kontrol elektrofizyolojik incelemelerinde anlamlý bir fark olmadýðý görülmüþtür.
Sonuç: Erken evre polinöropatinin aksine þiddetli polinöropati ortaya çýktýktan sonra iyi glisemik kontrol ile bir düzelme tespit edilmemektedir.

Objective: In our study, we aimed to investigate the effect of insulin treatment on peripheral nerves in patients with diabetes mellitus (DM) who under the oral antidiabetic therapy changed to insulin treatment. Additionally, we have searched for answer to the question that could F response used for as a parameter on monitoring the course of polyneuropathy with glycemic control. F response which use in the detection of polyneuropathy has been emphasized in previous studies.
Material and Method: Ten voluntary diabetic patients who received indication insulin treatment while being monitored with oral antidiabetic treatment and diagnosed according to the American Diabetes Association (ADA) criteria were included in our study. All our patients were outpatients of Þiþli Etfal Training and Research Hospital Diabetes Mellitus Clinic. All patients were evaluated for neurological examination, serum glucose and HbA1c levels, total neuropathy score (TNS) and electrophysiological evaluations before insulin treatment and in the first and fourth week of the treatment.
Results: Seven of patients were women and three of them were men. Age of patients were ranged from 40 to 69 and the mean age was 55±9.01. DM duration of patients ranged from 1 to 15 years (mean: 6.2±4.83). On the first Electrophysiologic evaluations of four patients were assessed within normal limits. We detected sensory polyneuropathy in lower extremities in five patients and a polyneuropathy
syndrome which affecting sensory fibers in the upper extremity and both sensory and motor fibers in the lower extremities in the remaining patient. We observed particularly improvement the sensory conduction amplitude in the control electrophysiological evaluation of the patients with moderate neuropathy or without polyneuropathy but there was not a significant difference in control electrophysiological evaluation of the patients with severe polyneuropathy in the initial evaluation.
Conclusion: After occurring severe polineuropathy syndrome there is not any improvement with good glicemic control whereas early stage of polyneuropathy.

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Amaç: Dislipidemi, dünyadaki bir numaralý mortalite nedeni olan koroner arter hastalýðýnýn (KAH) geliþiminde önemli yere sahiptir. Diyabet ve obezite farklý yollarla KAH geliþimine neden olmakla birlikte, dislipidemi KAH’na neden olan ortak yönlerinden biridir. Biz de ülkemizde diyabet hastalarýnda obezite ve kötü glisemik kontrolün lipid profili üzerinde nasýl bir etki yaptýðýný araþtýrdýk.
Gereç ve Yöntem: Ýstanbul Eðitim ve Araþtýrma Hastanesi Diyabet Polikliniði’ne baþvuran, bilinen diyabet yaþý 5‘i geçmeyen, son 6 ay içerisinde herhangi bir hiperlipidemi tedavisi almayan, kanýtlanmýþ iskemik kalp hastalýðý olmayan, sadece oral antidiyabetik ilaç kullanan, sigara ve alkol kullanmayan, kan lipid düzeyini etkileyecek bilinen bir endokrin bozukluðu olmayan 82’si erkek 165 hasta alýndý. Lipid düzeyleri ile HbA1c, vücut kitle indeksi (VKÝ) ve diyabet yaþý arasýndaki iliþkiler deðerlendirildi. Karþýlaþtýrmalarda student’s t, ANOVA ve Pearson korelasyon testleri kullanýldý. p<0.05 anlamlý kabul edildi.
Bulgular: VKÝ deðerleri arttýkça total kolesterol, trigliserid ve LDL kolesterol düzeylerinin de arttýðý (r=0.46 p<0.001, r=0.58 p<0.001, r=0.34 p<0.01, sýrasýyla), HDL kolesterol düzeylerinin ise düþtüðü
saptandý (r=-0.37 p<0.001). HbA1c deðeri yüksek olan hastalarda total kolesterol, trigliserid ve LDL kolesterol düzeylerinin yüksek olduðu (r=0.27 p<0.001, r=0.29 p<0.001, r=0.20 p<0.05, sýrasýyla) görüldü. Diyabet yaþý artýkça HbA1c düzeyleri arasýnda doðru bir orantý (r=0.28 p<0.001) saptanýrken, kan lipid düzeyinde anlamlý bir iliþki saptanmadý.
Sonuç: Ülkemizde yaptýðýmýz bu çalýþmada bire bir olmasa da daha önce yapýlan uluslararasý çalýþmalarla benzer sonuçlara ulaþtýk. Obez ve kötü glisemik kontrole sahip diyabet hastalarýnda lipid profili olumsuz etkilenmektedir.

Objective: Dyslipidemia play an important role in the development of coronary artery disease (CAD) which is the world’s leading cause of mortality. Diabetes mellitus and obesity can cause CAD by different ways; dyslipidemia is common in both of them, that can lead to CAD. We investigate the effect of obesity and poor glycemic control on lipid profile in diabetic patients, in our country.
Material and Method: One hundred and sixty five patients (82 male) who admitted to Istanbul Education and Research Hospital Outpatient Diabetes department, whose known diabetes age was less than 5 years, not taking any anti-lipidemic medicine in the last 6 months, not having ischemic heart disease, diabetes controlled by only oral antidiabetics, non-smoker and not drinking alcohol, don’t having any endocrine disorder with possible affect on blood lipid levels, were enrolled to the study. The relationship between lipid levels and HbA1c, body mass index (BMI) and diabetes age were assessed. Student’s t test, ANOVA and Pearson correlation tests were used for comparisons. p<0.05 was considered significant.
Results: It was determined that when BMI value increased, cholesterol, triglyceride and LDL levels increased (r=0.46 p<0.001, r=0.58 p<0.001, r=0.34 p<0.01, respectively) and HDL levels decreased (r=-0.37 p<0.001 ). In patients having high HbA1c levels, total cholesterol, triglyceride and LDL cholesterol levels were found high (r=0.27 p<0.001, r=0.29 p<0.001, r=0.20 p<0.05, respectively). A positive correlation was found between the increasing diabetes age and HbA1c levels (r=0.28, p <0.001) was determined, but no significant corelation with blood lipid levels was detected.
Conclusion: We found similar but not identical results with previous international studies, in this study done in our country. Lipid profile was adversely effected in diabetic patients having obesity and poor glycemic control.

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Amaç: Hashimoto tiroidit (HT) hastalýðý genetik ve çevresel faktörlerin katkýda bulunduðu otoimmün bir tiroid bezi hastalýðýdýr. Bazý Ýnsan Lökosit Antijenlerinin [Human Lökosit Antijen (HLA)] HT hastalýðý ile baðlantýlý olduðu saptanmýþtýr. Bu çalýþmada HT hastalýðý ile HLA-DRB1 alellerinin baðlantýsý araþtýrýlmýþtýr.
Gereç ve Yöntemler: Bu retrospektif çalýþmaya tiroidektomi yapýlan ve postoperatif HT tanýsý alan 48 hasta ve 126 saðlýklý akraba dýþý denek, kontrol grubu olarak dahil edildi. Hastalarýn genetik testleri Erciyes Üniversitesi Doku Tiplendirme Laboratuvarýnda polimeraz zincir reaksiyonu, sekans spesifik oligonükleotid proplarý (PCR-SSOP) kullanýlarak çalýþýldý.
Bulgular: Hastalýk grubunda HLA-DRB1*03 aleli anlamlý derecede yüksek bulunurken (hastalýk grubu; %12.5, kontrol grubu; %4.3, p=0.006), HLA-DRB1*01aleli kontrol grubunda HT hastalarýna göre belirgin derecede daha sýk olarak saptandý (hastalýk grubu; %1, kontrol grubu; %7.5, p=0.021).
Sonuç: Bu çalýþma ile Kayseri yöresi Türk toplumu için HT hastalýðý açýsýndan HLA-DRB1*03 alelinin yatkýnlýk, buna karþýlýk HLA-DRB1*01 alelinin ise hastalýktan koruyucu olabileceði gözlemlenmiþ oldu. Ancak çalýþmaya dahil edilen vaka sayýsýnýn çok az olmasý nedeni ile topluma yönelik genellemeler yapýlabilmesi için daha fazla denek sayýsýný içeren ileri çalýþmalara ihtiyaç vardýr.

Objective: Hashimoto’s thyroiditis (HT) is an autoimmune thyroid disease resulting from complex interactions between genetic and environmental factors. The Human Leukocyte Antigen (HLA) genes have been found to be involved in the susceptibility to HT. In this retrospective study, we aimed to investigate the associations between HLA-DRB1 alleles and patients with HT.
Material and Methods: Forty eight patients with HT were included in this study. We analyzed HLADRB1 by polymerase chain reaction with sequence specific oligonucleotide probes (PCR-SSOP), and compared them with 126 unrelated healthy controls.
Results: The HLA-DRB1*03 allele was higher in the HT patients than in the controls (p=0.006). Also, the HLA-DRB1*01 allele was lower in the HT patients than in the controls (p=0.021).
Conclusion: The susceptible and protectable alleles were found as HLA-DRB1*03 and HLA-DRB1*01 alleles respectively in patients with HT in the Kayseri Turkish population, in Turkey. Further studies with a larger cohort are required to confirm the role of HLA-DRB1 alleles in the development of HT in the Turkish population.

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Amaç: Pulmoner Emboli tanýsýnda; klinik, laboratuvar ve radyolojik bulgular önemli bir yer tutmaktadýr. Bununla birlikte,tanýda hastalarýn diðer klinik sorunlarý nedeni ile, çoðu zaman zorluklar yaþanmaktadýr. Bu çalýþmada; hastaya ait risk faktörleri, baþvuru anýndaki þikayetleri, klinik ve labaratuvar parametrelerini incelemeyi amaçladýk.
Gereç ve Yöntem: Bu çalýþmaya, 2010-2014 yýllarý arasýnda, Pulmoner Emboli nedeni ile servisimize yatýþý yapýlmýþ 27 olgu alýndý. Olgularýn, taný anýndaki risk faktörleri, semptomlarý, radyolojik görüntüsü retrospektif olarak deðerlendirildi. Hastalarýmýzýn baþvuru anýndaki, Wells (Canadian) pulmoner tromboemboli klinik tahmin skorlamasý yapýldý.
Bulgular: Olgularýn ortalama yaþý 74.56±11.63 olup, %25.9’u erkek, %74.1’i kadýndý. Olgularýn %29.6’sý sigara kullanýyordu. Wells skoru ortalama 3.57±1.7, D-dimer 2697.85±1648.26 idi. Emboliyi hazýrlayýcý faktör olarak cerrahi operasyon/ immobilizasyon (%48.1) ve derin ven trombozu tanýsýndan daha öncelikli alt taný (%55.6) ilk sýralarý aldý. En sýk görülen semptomlar sýrasýyla dispne (%59.3), çarpýntý (%44.4) iken Fizik muayenede en çok bulunan bulgu takipne (%66.7) ve raldi (%48.1) Oda havasýnda bakýlan kan gazýnda, %66,6 hipoksik hipokarbik bazik ph mevcuttu. Akciðer grafisinde en çok bulunan bulgu diafram yüksekliðiydi (%51.9). Derin ven Doppler USG olgularýn %48.1’ine yapýlýrken, yapýlmýþ olgularýn %46.15’de DVT bulgusu mevcuttu. Olgularýn 11 (%40.7)’sine Ventilasyon perfüzyon sintigrafisi yapýlýrken, yapýlmýþ olgularýn %63.63’sýnda yüksek olasýlýklý Pulmoner Emboli mevcuttu. BT anjiyo yapýlan olgularýn %48.1’inde PE bulgusu mevcuttu.
Sonuç: Çalýþmamýz sonunda olgularýn %59.3’üne ventilasyon perfüzyon sintigrafisi, %51.9’una BT Anjio, %51.9’una Derin Ven Doppler USG yapýlmadýðý görüldü. Hastalarýn ileri yaþ olmasý, eþlik eden diðer komorbiditesi yüksek sistemik hastalýklar bu tetkiklerin yapýlmasýnda sýnýrlayýcý olmaktadýr. Bu nedenle PE tanýsýnda klinik þüphenin ve olasý risklerin iyi deðerlendirilmesinin, erken taný ve tedaviye baþlanmasý açýsýndan önemli olduðunu düþünmekteyiz.

Objective: Clinical, laboratory and radiological findings play a major role for the diagnosis of Pulmonary Embolism. However, its diagnosis is usually challenging due to other clinical problems of patients. In this study; our aim is to determine the risk factors of patients, by evaluating their initial complaints, clinical and laboratory parameters.
Material and Method: In this study, we included 27 patients having the findings of pulmonary embolism applying to our clinic between the years 2010-2014. Risk factors at the diagnosis, symptoms, and radiological findings were retrospectively evaluated. Clinical prediction scores of all patients at the time of application was calculated by using Wells scoring system (Canadian score).
Results: The mean age of the patients were 74.56±11.63 and %25.9 were male whereas %74.1 were female. 29.6% of the cases were active smokers. The mean Well’s score and D-dimer values were 3.57±1.7 and 2697.85±1648.26 respectively. The factors that leads to pulmonary embolism were surgery/immobilization in 48.1% and subclinical diagnosis of DVT in 55.6%. The frequent symptoms were dyspnea (59.3%) and palpitations (44.4%) and ýn Physýcal examination the most common findings were tachypnea (66.7%) and pulmonary rales (48.1%). In the blood gases undertaken in room air alkaline PH that revealed hypoxia and hypercarbia were present. The most common pulmonary X ray fýndýng was the elevated diaphragm (51.9%). Doppler Ultrasound was done in 48.1% of the patients and DVT findings was present in 46.15%. 11 (40.7%) cases underwent a ventilation perfusion scintigraphy and out of these 63.3% findings consistent
with Pulmonary Embolism were present. In patients whom CT angiogram was done 48.1% revealed fýndýngs of Pulmonary Embolism (PE).
Conclusion: In conclusion our study showed that ventilation perfusion scintigraphy, CT angiography and Venous Doppler ýn DVT protocol were not done in 59.3%, 51.9%, 51.9% cases respectively. The elder age of the patients and systemic high risk comorbidities are thought to be the limiting factors that lead to nonapplication of the above tests. For this reason, clinical suspicion and assessment of probable risk factors is important for early diagnosis and rapid initiation of treatment for pulmonary embolism.

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Amaç: Son yýllarda mantar infeksiyonlarý, özellikle immünsüpresif tedavi alan ya da altta yatan bir risk faktörü nedeniyle hastanede yatan hastalarda baþlýca infeksiyon etkeni olarak ortaya çýkmýþtýr. Bu çalýþmada farklý klinik örneklerden izole edilen Candida türlerinin daðýlýmýnýn ve duyarlýlýklarýnýn retrospektif olarak incelenmesi ve kullanýlmýþ olan ticari kitlerin deðerlendirilmesi amaçlanmýþtýr.
Gereç ve Yöntem: Ocak 2011-Aralýk 2013 tarihleri arasýnda laboratuvarýmýza gelen hasta örneklerinden, maya mantarý soyutlanan 45’i kan, 12’si steril vücut sývýsý, 10’u idrar, üçü bronkoalveolar lavaj, biri kateter olmak üzere toplam 71 klinik örnek incelemeye alýnmýþtýr. Çalýþmaya alýnan örneklerden soyutlanan maya mantarlarý; germ tüp yöntemi, CHROMagar Candida (CHROMagar, Paris, France) ve AuxaColor (Bio-Rad SDP, Paris, France) ticari kitiyle tiplendirilmiþtir. Maya mantarlarýnýn antifungal duyarlýlýklarý Fungitest (Bio-Rad SDP, Paris, France) ticari kiti ile belirlenmiþtir.
Bulgular: AuxaColor ile deðerlendirilen toplam 71 Candida suþunun 28’i (%39) Candida albicans, 13’ü (%18.3) C. parapsilosis, 11’i (%15.5) C. glabrata, 10’u (%14.1) C. tropicalis, dördü (%5.6) C. krusei, üçü (%4.2) C. lusitaniae, birer tane ise (%1.4) C. kefyr ve C. dubliniensis olarak tanýmlanmýþtýr. Fungitest ile deðerlendirilen 47 suþtan Amfoterisin B’ye orta duyarlý olan bir C. parapsilosis suþu ve dirençli olan bir C. tropicalis Etest metodu ile incelenmiþ, minimum inhibitör konsantrasyon (MÝK) 1.5 µg/ml bulunmuþtur. Flukonazole (FLU) orta duyarlý üç C. albicans suþu Etest metodu ile deðerlendirilmiþ ikisinin MÝK deðeri 256 µg/ml olarak, biri 32 µg/ml olarak bulunmuþtur. FLU’ya dirençli olan bir adet C.albicans suþu MÝK deðeri Etest metodu ile 256 µg/ml olarak bulunmuþtur. Dirençli olan C. tropicalis suþunun MÝK deðer ise 0,38 µg/ml olarak bulunmuþtur.
Sonuç: Çalýþmamýzda fungal infeksiyonlarýn kontrolü için tür tayini ve antifungal duyarlýlýk test sonuçlarýnýn bilinmesi önemli olduðu ve antifungal ajanlara karþý gittikçe artan direnç oranlarý nedeniyle tedavi planlamasýnda duyarlýlýk testlerinin giderek daha önem kazandýðý sonucuna varýlmýþtýr. Kullandýðýmýz Auxacolor ve Fungitest’in uygulanmasýnýn ve deðerlendirilmesinýn kolay ve pratik bir test olduðu görülmüþtür. Fungitest duyarlýlýk sonuçlarý mevcut guidelinelarda ki antifungal dilüsyonlar ile uyumluluk göstermediðinden dikkatle deðerlendirilmelidir. Ayrýca orta duyarlý ve dirençli sonuçlarýn referans yöntemlerle teyit edilmesi uygun olacaktýr.

Objective: Fungi have emerged as major causes of human disease recently, especially among the immunocompromised patients and those hospitalized with serious underlying diseases. The aim of this study was to identify Candida species isolated from different cultures and determine their antifungal susceptibilities retrospectively and define of value of using commercial system.
Material and Method: Test results of yeasts that were isolated from 45 blood, 10 urine, three bronchoalveolar lavage and one catheter samples of the patients during the period January 2011-December 2013 in our laboratory were evaluated.The yeasts were identifed by germ tube test, CHROMagar Candida (CHROMagar, Paris, France) and AuxaColor (Bio-Rad SDP, Paris, France) commercial identifcation system. The antifungal susceptibility tests were performed using Fungitest (Bio-Rad SDP, Paris, France) commercial system.
Results: The distribution of 71 candida species was as follows: 28 Candida albicans (39%), 13 Candida parapsilosis (18.3%), 11 Candida glabrata (15.5%), 10 Candida tropicalis (14.1%), four Candida krusei (5.6%), three Candida lusitaniae (4.2%), one Candida kefyr (1.4%) and one Candida dubliniensis (1.4%). A intermediate C.parapsilosis strain to Amfoterisin B and a resistant C.tropicalis strain to Amfoterisin are evaluated using E-test and found resistant with a minimum inhibitor concentration (MIC) value of 1.5 µg/ml for both of them. The MIC rates of two out of three fluconazole (FLU) intermediate and one resistant C.albicans strains were evaluated using E-test and all three strains were found resistant with a MIC value of 256 µg/ml. The MIC of a FLU intermediate C.albicans strain to FLU was 32 µg/ml. The MIC of a C.tropicalis strain that was FLU resistant with Fungitest was 0,38 µg/ml and was evaluated as susceptible.
Conclusion: In our study, it is important knowledge of species and antifungal susceptibility test results for control of fungal infections and plan of treatment. We used Auxacolor and Fungitest in our study. And this tests were easy to use and to evaluate. It should be carefully evaluated of the Fungitest results which don’t accord with the actual guidelines. It would be appropriate to confirm intermediate and resistant results using reference methods.

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Amaç: Bu çalýþmanýn amacý, laparoskopik kolesistektomi ameliyatý sebebiyle kanama geliþen hastalarýn verilerini gözden geçirmek ve tecrübelerimizi paylaþmaktýr.
Gereç ve Yöntemler: Ocak 2006 - Nisan 2015 tarihleri arasýnda hastanemizde 865 hastaya laparoskopik kolesistektomi ameliyatý yapýldý. Bu ameliyat sebebiyle kanama geçiren ve kanama için ek bir ameliyata gerek duyulan 7 hasta çalýþmaya alýndý, týbbý kayýtlarý gözden geçirildi. Hastalarda yaþ, cins, ek hastalýk, kanama tespit zamaný, ikinci ameliyatta yapýlan iþlemler, kanama yeri, kanama sebepleri, kanama miktarý ve ameliyat sonrasý komplikasyonlar gözden geçirildi; kanamayý engellemek için alýnacak tedbirler tartýþýldý.
Bulgular: Hastalarýn ortalama yaþý 60 yýldý. Üç hastada ek hastalýk vardý. Tüm hastalarýn ameliyat öncesinde INR deðerleri normal sýnýrlarda idi. Ýki hastada ameliyat esnasýnda kanama belirlendi ve açýk ameliyata dönüldü. Diðer beþ hastanýn kanamasý ameliyattan 2-24 saat sonra belirlendi. Ýkinci kez ameliyata alýnan beþ hastanýn ikisine, doðrudan laparatomi, ikisine laparoskopi ile baþlayýp laparatomi, birine laparoskopi ile hemostaz yapýldý. Kanamalar, üç hastada safra kesesi yataðýndan, birer hastada sistik arterden, epigastrik port yerinden, kolon mezosundan ve belirsiz yerden olduðu görüldü. Kanama miktarý tüm hastalar için 300-3000 ml arasýnda olduðu belirlendi. Hastalarýmýzda kanamanýn tekrarý ve mortalite görülmedi.
Sonuç: Kanama, laparoskopik kolesistektomiden sonra az görülen ama ciddi bir komplikasyondur. En sýk kanama yeri safra kesesi yataðýdýr. Kanayacaðýndan þüphe edilen hastalarýn ameliyattan sonra 24 saat takibi yapýlmalýdýr.

Objective: The aim of this study is to review the data of patients who had hemorrhage due to laparoscopic cholecystectomy and to share our experience.
Material and Methods: In our hospital, 865 patients underwent laparoscopic cholecystectomy between January 2006 and April 2015. Seven patients who had hemorrhage due to this surgery and needed additional surgery were included in this study, and their medical records reviewed. Patient’s age, sex, comorbid disease, hemorrhage detection time, the interventions in the second surgery, the bleeding site, bleeding causes, bleeding volume and post-operative complications were reviewed; the measures which prevent bleeding were discussed.
Results: The mean age of the patients was 60 years. Three patients had comorbid disease. All patients had normal INR values preoperatively. Bleeding during surgery was detected in two patients and the operation was converted to open surgery. The bleeding of other five patients was detected 2-24 hours after surgery. Hemostasis was achieved immediately by laparotomy in two of the five patients, in two others by laparoscopy followed by laparotomy, and in one by laparoscopy alone. The bleedings were found from gallbladder bed in three patients, and the other four from cystic artery, epigastric port site, mesocolon and uncertain place. The amount of bleeding was determined to be between 300-3000 mL. No repeated bleeding or mortality was observed among our patients.
Conclusion: Bleeding is a rare but serious complication after laparoscopic cholecystectomy. The most frequent bleeding location is the gallbladder bed. The patients who are suspected to have bleeding must be observed for 24 hours after surgery.

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Amaç: Hastanemiz jinekoloji kliniðinde 2 yýldýr endometriyum kanseri tanýsýyla opere edilen hastalarý retrospektif inceleyerek hastalarýn cerrahi ve takip sonuçlarýný incelemek ve laparaskopik cerrahinin onkolojide güvenlilik ve etkililiðini araþtýrmak.
Gereç ve Yöntem: Kliniðimizde endometriyum kanseri nedeni ile opere edilen 31 hasta retrospektif olarak incelendi.
Bulgular: Yapýlan araþtýrmada hastalarýn yaþ ortalamasý 58.4±11.7 olarak bulundu. Tümor boyutu ortalama 2.1±1.5 cm olarak belirlendi. Hastalarýn %45.1 kadarý menopozda ve %29.0 kadarý diabetik olarak belirlendi. Hastalarýn %87’si endometrioid tip adenokanser tanýsý aldý. 2 hastada servikal invazyon ve 3 hastada lenfovasküler alan invazyonu belirlendi. Hastalarýn %93.5 kadarýna baþarý ile laparaskopi yapýldý ve toplamda sadece 1 hastada obturatör sinir kesisi meydana geldi. Regresyon analizi ile bakýldýðýnda sadece CA 125 düzeyi hastalýðýn evresi ile iliþkili bulundu.
Sonuç: Onkoloji cerrahisinde laparaskopi yeterli tecrübe varsa oldukça etkili ve güvenli bir yöntemdir. CA 125 düzeyi hastalýðýn ileri evre olmasýnda fikir verebilmektedir.

Objective: To evaluate the safety and efficacy of laparascopic surgery; and retrospective analysis of the follow up data of surgically treated endometrium cancer patients in our gynecology clinic in last 2 years
Material and Method: 31 patients who are operated for endometrium cancer were analysed retrospectively.
Results: Mean age of patients were 58.4±11.7. Mean tumor size was 2.1±1.5 cm. 45.1% of patients were post menopausal and 29.0% of patients had diabetes. 87.0% of patients were diagnosed as endometrioid type adenocarcinoma.2 patients had cervical and 3 patients had lymphovascular area invasion. Laparascopy was successfully performed in 93.5% of patients, obturator nerve injury occured in only 1 patient. CA125 level was found to be related with the stage of disease in regression analysis.
Conclusion: Laparascopy is very effective and safe method of surgery in oncology, if experience is sufficient. CA125 level might be used in prediction of advanced stage disease.

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Amaç: Retrospektif çalýþmamýzda, BI-RADS ultrasonografi ile, solid meme lezyonu bulunan olgularda, biopsi öncesi yeterli ön fikir elde edip edemeyeceðimizi deðerlendirdik.
Gereç ve Yöntem: Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi ve Okmeydaný Eðitim ve Araþtýrma Hastanesi Radyoloji Kliniði’nde Eylül 2014-Mart 2015 tarihleri arasýnda 96 hastanýn 102 solid meme lezyonu ultrasonografi BI-RADS sýnýflamasýna göre ayrýlýp tru-cut biopsi yapýldý. Histopatolojik sonuçlarý retrospektif olarak deðerlendirildi.
Bulgular: Hastalarýn ortalama yaþý 45.6 bulundu. 102 solid kitlenin 23’ü (%22.6) patoloji sonucu malign; 79’u (%77.4) benign idi. En sýk rastlanan benign tümör fibroadenom; malign tümör, invaziv duktal karsinom idi. Tüm olgularýn BI-RADS gruplarýnda malign/benign oraný hesaplandý sonuçlar literatür ile uyum gösterdi.
Sonuç: Son dönemdeki teknolojideki geliþmeler ve daha yüksek rezolüsyonlu ultrasonografi cihazlarýnýn kullanýma girmesi ile pleomorfik mikrokalsifikasyonlarýn daha sýk olarak saptanabildiði ve tanýmlanabildiði göz önüne alýnýrsa, solid meme kitlesi görülen olgularda kitlenin BI-RADS skorunu belirlemede sonografik verilerin önemli ölçüde bilgi vereceðini saptadýk.

Objective: Aim of this retrospective study is decision for biopsy indication with using ultrasonography findings.
Material and Method: 96 patients and 102 solid breast masses were evaluated and grouped as BI-RADS classification. Core needle biopsy was performed to all lesions and evaluated retrospectively.
Results: Twenty three of solid breast masses were cytologically malignant (%22.6) and 79 of them were benign (%77.4). In our study most common benign lesion was fibroadenoma and most common malignant leison was invasive ductal carcinoma. We calculated malignant/benign ratio in all BI-RADS subgroups as percent. Our findings were compatible with literature.
Conclusion: On recent days with technological developments even higher resolution ultrasonography devices are being used, researchers are able to find and define pleomorphic microclacifications respectively. Our experience shows that we can determine biopsy indication adequately with using BI-RADS ultrasonography findings.

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Amaç: Yenidoðan döneminde cerrahi giriþim uygulanan hastalarýn demografik özellikleri, tanýlarý, operasyon zamanlarý ve erken dönem komplikasyonlarýný deðerlendirmek.
Gereç ve Yöntem: Ocak 2007 ile Ocak 2011 tarihleri arasýnda cerrahi giriþim uygulanan ve yenidoðan yoðun bakým ünitesinde takip edilen hastalarýn dosyalarý retrospektif olarak incelendi. Olgular cerrahi yapýlan sisteme göre üç gruba ayrýldý; merkezi sinir sistemi, solunum sistemi ve gastrointestinal sistem.
Bulgular: YYBÜ’de Ocak 2007 ile Ocak 2011 tarihleri arasýnda 3246 hasta takip edildi. Cerrahi giriþim uygulanan 94 (%2.8) hastanýn 51’i erkek (%54.2) ve 80’ni (%85) zamanýnda doðan bebekler olup ortalama doðum aðýrlýklarý 3053±614 g idi. Olgularýn taný daðýlýmlarý; merkezi sinir sistemi, solunum sistemi toplam ve gastrointestinal sistem sýrasý ile 65, 14 ve 15 olgu idi. Ortalama cerrahi giriþim uygulanma zamaný 8.4±17.1 gün iken ortalama hastanede kalýþ süresi ise 21.7±26.7 gün idi. Olgularýn 36’sýnda (%38.2) cerrahi uygulama sonrasý 43 komplikasyon (17’si sepsis, 14’ü klinik sepsis, 6’sý menenjit, 2’si pnömotoraks, 2’si pnömoni, 2’si restenoz) geliþmiþti. 12 olgu (%12.7) kaybedildi. Kaybedilen olgularýn 6’sý diafragma hernisi nedeni ile cerrahi giriþim uygulanan olgulardý. Merkezi sinir sistemi olgularýnda
yaþamýnýn ilk 3 günü düzeltme operasyonu uygulanlarda ile ilk 3. günden sonra uygulananlara göre erken dönem komplikasyonlarý (sepsis, menenjit) anlamlý düzeyde düþüktü (p<0.001).
Sonuçlar: Yenidoðan döneminde cerrahi giriþimin en sýk nedeni merkezi sinir sistemi anomalileridir. Nöral tüp defektinde cerrahi giriþiminin ilk 3 günde yapýlmasýnýn erken dönem komplikasyonlarý anlamlý derecede azaltmaktadýr. En yüksek ölüm oraný konjenital diafragma hernisi idi.

Objective: To evaluate the demographic features, diagnosis, timing of the surgery and early complication in patients undergoing surgery in the neonatal period.
Material and Method: The files of the patients who were undergone surgery and followed up in neonatal intensive care unit between the January 2007 and January 2011 were investigated retrospectively. The cases were divided in three groups according to surgical performed system; central nervous systems, respiratory systems and gastrointestinal system.
Results: 3246 patients were followed up between the January 2007 and January 2011 in neonatal intensive care unit. 94 (2.8%) of these patients 51 male (54.2) and 80 of these were full-term (85%) were undergone surgery and their mean birth weight was 3053±614 g. The diagnosis of patients were central nervous system, respiration system, and gastrointestinal system in 65 patients, 14 patients, and 15 patients, respectively. The mean time of surgery was 8.4±17.1 days, and the mean length of hospital stay was 21.7±26.7 days. 43 complication (17 sepsis, 14 clinic sepsis, 6 meningitis, 2 pneumothorax, 2 pneumonitis, 2 restenosis) were occurred in the 36 of the all patients after the surgery. 12 (12.7%) patients were death in follow up. In six of the patients who died had undergone surgery due to diaphragmatic hernia. In central nervous system group, the early complication (e.g. sepsis, meningitis) were significantly lower in first three days compared with the patients who had corrective surgery after three days (p<0.001).
Conclusions: The most reason of surgery was central nervous system anomaly in neonatal period. The early complications (e.g. sepsis, meningitis) were significantly lower in patients who had corrective surgery in central nervous system group in first three days. The highest mortality rate was found in congenital diaphragmatic hernias.

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Amaç: Behçet Hastalýðý alevlenmelerle seyreden, çoklu organ tutulumu gösteren, kronik enflamatuvar bir hastalýktýr. Hastalýk, tekrarlayan aðýz ve genital bölge ülserleri, deri bulgularý ve üveit ile karakterizedir. Bu olgu sunumunda acil sezaryen operasyonu planlanan Behçet hastalýðýna sahip gebede anestezi yönetimini tartýþtýk.
Olgu: On dokuz yaþýnda Behçet hastalýðý tanýlý gebe hasta fetal distres geliþmesi üzerine acil sezaryen planlandý. Hastamýz bir yýl önce Behçet Hastalýðý tanýsý almýþ. Gebelik boyunca ilaçlarýný kullanmayý býrakmýþ. Sezaryen operasyonu genel anestezi altýnda gerçekleþtirildi. Hasta herhangi bir problem yaþanmadan 7.0 endotrakeal tüp ile ilk seferde entübe edildi. Anestezi oksijen, hava, sevofluran ve remifentanil ile idamesi saðlandý. Hemodinamik parametreler stabil seyretti ve herhangi bir komplikasyon yaþanmadý. Yenidoðanýn 1. ve 5. dk Apgar skoru 8 ve 10 idi.
Sonuç: Perioperatif anestezik yaklaþýmda temel problemleri, organ tutulumlarý ve havayolundaki skarlaþmaya baðlý zor entübasyon oluþturur. Kronik ilaç tedavisine baðlý olarak organ ve sistemlerde birtakým deðiþiklikler meydana gelmekte ve bu durum anestezi yönetimini daha da karmaþýk hale getirmektedir. Sezaryen gerektiren Behçet hastalýðýna sahip gebe hastalar için anestezi tekniði her hastanýn klinik durumuna göre deðerlendirilip en son anestezistin takdirine kalýr.

Objective: Behcet’s Disease is a chronic inflammatory with multiorgan involvements that it develope relapses. This disease is characterized with recurrent oral and genital ulcers, skin signs and uveitis. In this case report we discussed the anesthetic management of a pregnant patient with Behçet’s disease who underwent an emergency cesarean section.
Case: Nineteen year old pregnant patient with Behcet’s disease was scheduled for emergency caesarean delivery when fetal distress developed. She was diagnosed a year before and she did not use drugs during pregnancy. Cesarean section was performed under general anesthesia. Patient’s trackea was entubated with 7.0 endotracheal tube at the first attempt without any problems. Anesthesia was maintained with oxygen, air, sevoflurane and remifentanil. Hemodynamic parameters remained stable and there was no any complication. Apgar scores of the neonate were 8 and 10 at 1 and 5 minute respectively.
Conclusion: The main perioperative anaesthetic concerns are scarring of airway leading to difficult intubation and involvement of other organ systems. Due to the chronic drug therapy changes occur in organ systems causing more difficulty for the anaesthetic approach. The anesthetic technique for pregnant women with Behcet’s Disease requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions of each patient.

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Pompe hastalýðý nadir görülen ve enzim tedavisi olan lizozamal depo hastalýklarýndan biridir. Ýnfantil Pompe hastalýðýnda erken tedavi hastalýðýn prognozunu belirlemede çok önemlidir. Bu 2 vaka ile Pompe hastalýðýný erken tespit etmenin ve ekokardiyografik deðerlendirmenin tanýdaki önemini vurgulamak istedik. Birinci olgu 5 aylýkken bize hipotonisite ve üfürüm nedeniyle getirildi ve ekokardiyografide belirgin hipertrofik kardiyomiyopatisi vardý. Ýkinci olgu ise 2 aylýkken akciðer grafisinde kardiyomegali saptanmasý üzerine bize yönlendirilen fizik muayenede cansýz aðlama dýþýnda patolojik özelliði olmayan ekokardiyografide hipertrofik kardiyomiyopati saptanan hastaydý. Beþ aylýkken bize baþvuran birinci olgu enzim tedavisine baþlanamadan 1 ay içinde mama aspirasyonu nedeniyle kaybedilirken; 2 aylýk olan hastaya enzim tedavisi baþlandý. Tedavisine halen devam eden bu hastanýn kardiyak hipertrofisi tedavi baþladýktan 1 ay sonra gerilemeye baþladý. Bu 2 vaka ile pompe hastalýðýný erken saptamanýn prognoz açýsýndan çok önemli olduðunu ve tanýda ekokardiyografik deðerlendirmenin çok deðerli olduðunu vurgulamak istedik.

Pompe disease is a lysosomal storage disorder, which is rare and has an enzyme treatment. In infantile Pompe disease, early treatment is very important to determine the disease prognosis. The presentation of these two cases aimed to highlight the importance of early detection of Pompe disease and the diagnostic significance of echocardiographic assessment one again. One of the patients presented with hypotonicity and murmur at 5 months of age and found having apparent hypertrophic cardiomyopathy in echocardiography; and the other patient was referred to us due to the detection of cardiomegaly in chest radiography at 2 months of age, and had no pathological features except impassive crying at the physical examination and found having hypertrophic cardiomyopathy in the echocardiography. The patient of 5 months old was died due to aspiration of formula within 1 month before initiating the enzyme treatment, whereas the patient of 2 months old was initiated with the enzyme treatment. Still under treatment, the cardiac hypertrophy of this patient was started to regress 1 month after initiating the treatment. These two cases were presented to highlight that the early detection of Pompe disease is critical for prognosis and the echocardiographic assessment is very useful for diagnosis.

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Hirayama Hastalýðý, genç erkeklerde daha sýk görülen benign bir alt motor nöron hastalýðýdýr. Son derece enderdir. Distal üst ekstremitelerde güçsüzlük ve kas erimesiyle karakterizedir. Bu makalede ellerinde ve ön kolunda güçsüzlük ve kaslarýnda erime yakýnmasý olan 16 yaþýnda kýz hasta sunulmuþtur.

Hirayama Disease is a benign disease of the lower motor neurons which is encountered mostly in young adults. This disease is extremely rare and characterized by the wasting and weakness of the distal upper extremities. In this paper, we present a 16 year- old female patient with the complaint of weakness and muscle wasting of the hands and forearms.

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Amaç: Mezenþimal orjinli benign bir tümör olan lipomalar vücudun pek çok yerinde izlenmektedir. Ancak parotis bezinde özellikle de derin lobunda oldukça nadir bildirilmiþ olup diðer parotis kitlelerinden ayrýlmasý gerekmektedir. Bu olgu sunumuyla, parotis lipomasý ile diðer parotis kitlelerinin ayýrt edici tanýsýný yapmayý ve MR görüntüleme bulgularýný tartýþmayý hedefledik.
Olgu: Boynunda iki yýldýr var olan aðrýsýz þiþlik nedeniyle gelen erkek olgunun MR görüntüleme bulgularý sunulmuþtur.
Sonuç: Parotis bezinde lezyon saptandýðý zaman tedavisini planlamak için eksternal ve internal tümörlerin ayýrt edilmesi, fasial sinirle tümör kitlesinin iliþkisi varsa ortaya konulmasý, tümör kitlesinin malign ya da benign olmasýnýn ayýrt edilmesi oldukça önemlidir. Lipomlar için tanýda görüntüleme yöntemleri oldukça deðerlidir.

Object: Lipomas, which are bening tumors originating from Mesenchyme, are seen in several locations of the body. But they are very rarely reported in parotid gland, especially in deep lobe of parotid gland, and they should be differentiated during diagnosis from other parotid tumors. We aimed to discuss MR imaging findings and make differential diagnosis of parotis lipomas from other parotis tumors.
Case: MR imaging findings of a male patient who applied because of a painless swelling which has been for last two years in his neck.
Results: In cases with parotid gland lesions, in order to plan treatment, it is very important to differentiate external and internal tumors, determine the possible relationship of tumors with facial nerves, and to differentiate bening or malign status of tumors. Imaging methods for diagnosis of lipomas are very valuable.

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