Primer hiperparatiroidizm (pHPT) en sýk 3. endokrin hastalýktýr ve ayaktan hastalarda hiperkalseminin en sýk sebebidir. Geçmiþte hastalarýn çoðu belirgin pHPT semptom ve bulgularý ile baþvurmaktaydýlar. Otomatik kan analizörlerinin geliþmesi ve yaygýn kullanýlmasý ile günümüzde hastalarýn büyük bölümü diðer nedenlerle yapýlan rutin biyokimyasal testlerle teþhis edilmektedir. Hastalarýn çoðunluðu minimal semptomatik veya asemptomatiktir. pHPT’nin klinik prezentasyonu, asemptomatik hastalýktan renal ve iskelet komplikasyonlarýnýn gözlendiði semptomatik hastalýða kadar deðiþir. Hafif pHPT terimi 30 yýldýr birçok farklý durum için kullanýlmýþtýr. Hafif pHPT terimi net olarak, güncellenen uluslararasý kýlavuzlara göre cerrahi endikasyonu olmayan asemptomatik hastalarý belirtmek için tanýmlanmýþtýr. Normokalsemik pHPT ilk olarak 2008’de asemptomatik pHPT’nin tedavisi ile ilgili düzenlenen 3. uluslararasý çalýþtayda resmen kabul edilmiþtir. Normokalsemik pHPT klasik hiperkalsemik pHPT’nin bir varyantýdýr. Normokalsemik pHPT paratiroid hormon (PTH) artýþýna neden olabilecek sekonder bir sebep olmaksýzýn, normal iyonize ve total kalsiyum (Ca) düzeyleri ile birlikte yüksek PTH düzeyi ile karakterizedir. pHPT biyokimyasal olarak klasik pHPT (hem Ca hem PTH yüksek), nonklasik (normohormonal veya nonsuprese) pHPT (yüksek Ca, normal PTH), normokalsemik pHPT (normal Ca, yüksek PTH) olarak prezente olabilir. pHPT’nin tek küratif tedavisi cerrahidir. Paratiroidektomi bütün semptomatik hastalarda endikedir. Asemptomatik pHPT’nin tedavisi ile ilgili 4. uluslararasý çalýþtay 2013’te yapýldý. pHPT’nin cerrahi endikasyonlarý yaþ, Ca düzeyi, iskelet ve böbrek bulgularýna göre belirlenir. Bazý asemptomatik hastalarda cerrahi zorunlu deðildir. Diðer yandan, paratiroidektomi için cerrahi kriterleri olmayan bu hastalarda bile cerrahi daima bir seçenektir. Çünkü cerrahi, pHPT’nin tek kesin tedavisidir. Normokalsemik pHPT’li hastalarýn optimal tedavi stratejisi halen ortaya koyulamamýþtýr. Bu konunun deneyimli uzmanlarý Ca düzeyi normal devam etse bile osteoporoz, fraktür, böbrek taþý gibi pHPT kopmplikasyonlarýnýn varlýðýnda veya bunlarýn ortaya çýkmasýnda cerrahi önermektedirler. Taný anýnda komplikasyonsuz hastalar hastalýk ilerlemesi için takip edilebilir

Primary hyperparathyroidism (pHPT) is the third most common endocrine disease and the most common cause of outpatient hypercalcemia. Historically, most patients presented with overt symptoms and signs of pHPT. With the advent and widespread use of automated blood analyzers, currently the majority of patients are diagnosed through routine biochemical laboratory testing done for other aims. The majority of patients are minimally symptomatic or asymptomatic. The clinical presentation of pHPT varies from asymptomatic disease to classic symptomatic disease in which renal and/or skeletal complications are observed. The term “mild pHPT” has been interpreted in many different ways over the past 30 years. Mild pHPT was clearly defined as a disease in asymptomatic patients who do not meet surgical criteria set out by the updated International Guidelines. Normocalcemic pHPT was first defined formally at the time of the ‘’Third International Workshop on the Management of Asymptomatic pHPT’’ in 2008. Normocalcemic pHPT, a variant of the traditional hypercalcemic presentation of pHPT, is characterized by consistently elevated PTH concentrations with normal total and ionized serum calcium (Ca) concentration in the absence of secondary causes for elevated PTH concentrations. Primary hyperparathyroidism may present as classic pHPT (in which both Ca and PTH are high), nonclassic (normohormonal or nonsuprese) pHPT (in which Ca is high and PTH is normal), normocalcemic pHPT (in which Ca is normal and PTH is high) biochemically. The only curative therapy for pHPT is parathyroidectomy. Parathyroidectomy is clearly indicated in all symptomatic patients. ‘’Fourth International Workshop on the Management of Asymptomatic pHPT’’ had been performed in 2013. Surgical indications for pHPT are determined according to the age, Ca level, skeletal and renal findings. In some patients with asymptomatic disease, surgery is not mandatory. On the other hand, even in these patients who don’t meet any criteria for parathyroidectomy, surgery is always an option because it is the only exact treatment for pHPT. The optimal treatment strategy for patients with normocalcemic pHPT has not yet been proved. Experts advise that patients be referred for parathyroidectomy if they have or progress complications of pHPT such as osteoporosis, fragility fractures or kidney stones, even if normocalcemia continues. Patients without complications at the time of diagnosis could be monitored for disease progression.

Amaç: Tiroid hastalýðý nedeniyle hastanemize baþvuran hastalarýn profili ve hastalýklarý ile ilgili farkýndalýðýn deðerlendirilmesi
Gereç ve Yöntem: Çalýþmamýz 1-31 Aralýk 2014 tarihleri arasýnda tiroid hastalýðý nedeniyle takipli olan 18-75 yaþ arasý hastalar ile anket çalýþmasý yapýlarak gerçekleþtirildi. Gebe, tiroid maligniteli ve onam vermeyen hastalar çalýþmaya dahil edilmedi. Hastalarýn yaþ, cinsiyet, eðitim durumu, hastalýk süresi, kontrol sýklýðý gibi demografik özellikleri, ilaç kullaným þekli, dozu, süresi, ilacý sabit dozda alýp almadýðý, ilaçla birlikte alýnmamasý gereken gýda/ilaç bilgisi sorgulandý. Hastalara kullandýklarý tuz çeþidi soruldu.
Bulgular: Yaþ ortalamasý 46 olan, 4’ü (%3.7) erkek, 103’ü (%96.3) kadýn toplam 107 hasta ile görüþüldü. Hastalarýn 85’inin (%79.4) bir yýldan fazla süredir takip edildiði, çoðu hasta (56, %52.4) ile bir yýl içinde en az 3 kez karþýlaþýldýðý görüldü. Hastalarýn 69’u (%64.5) hipotiroidi, 11’i (%10.3) hipertiroidi ve geri kalan 27’si (%25.2) ötiroid nodüler guatr tanýlý idi. 78 (%72.9) hastanýn tanýsýný yanlýþ ya da eksik bildiði tespit edildi. Ýyotlu tuz kullanmasý gerektiðini bilen hasta sayýsý 54 (%50.4) olarak saptanmýþ olup, hastalarýn yaklaþýk 41’i (%38.4) nasýl tuz kullanmasý gerektiðini bilmediðini söyledi. Çalýþmamýzda hastalara levotiroksin ile etkileþen yiyecekler ve ilaçlardan haberdar olup olmadýklarý sorulduðunda 55 hasta (%86) haberdar olmadýðýný ifade etti. Demir preparatý ve proton pompa inhibitörlerinin %30’a yakýn oranlarda levotiroksinle birlikte kullanýldýðý tespit edildi.
Sonuç: Tiroid hastalarýnýn taný, takip ve tedavileri ile ilgili farkýndalýklarý ve bilgi düzeyleri düþük seviyelerdedir. Hastalarýn farkýndalýklarýnýn artýrýlmasý ile ilgili hekimlerin daha fazla çaba sarf etmeleri gerekmektedir.

Objective: To evaluate the level of awareness among patients with thyroid disorders presenting to our hospital and determine patient profiles.
Material and Method: The present study was conducted using a survey technique on patients aged between 18 and 75 years, who were admitted to our hospital for follow-up for thyroid disease between December 1, 2014 and December 31, 2014. The pregnant women and those with a thyroid malignancy and patients who did not consent for the study were excluded. Demographic data such as age, gender, educational level, disease duration, control frequency as well as drug usage pattern, dose, duration and whether or not the patient received fixed dose drug regimen and food/drugs that are not to be taken with the drug were recorded. Type of salt used by the patients was also recorded.
Results: An interview was conducted with a total of 107 patients (4 males [3.7%] and 103 females [96.3%]) with a mean age of 46 years. Of these patients, 85 (79.4%) attended follow-up visits for more than a one-year period and most patients (n=56) were seen at least three times in the last year (52.4%). Of these patients, 69 (64.5%) had hypothyroidism, 11 (10.3%) had hyperthyroidism, and the remaining 27 patients (25.2%) had euthyroid nodular goitre. It was found that 78 patients (72.9%) were inaccurately or incompletely informed about their disease. Of the patients, 54 (50.4%) were aware that they needed to use iodized salt and 41 patients (38.4%) were not aware of what kind of salt they had to use. When the patients in the study were asked whether they were aware of food and drugs interacting with levothyroxine, 55 patients (86%) were not aware of these food and drugs. Approximately 30% of patients used iron supplements and proton pump inhibitors together with levothyroxine.
Conclusion: The patients with thyroid disorders had a low level of awareness and low level of knowledge about their disease, follow-up data and their treatments. The physicians must make an endeavor to increase the level of awareness among the patients.

Amaç: Vitreoretinal patoloji nedeniyle pars plana vitrektomi ve fakoemülsifikasyon (fakovitrektomi) ile birlikte göz içi lens (GÝL) implantasyonu yapýlan ameliyatlarýn cerrahi sonuçlarýný sunmak
Gereç ve Yöntem: Bu retrospektif çalýþma 3 yýllýk süre zarfýnda fakovitrektomi ve GÝL implantasyonu ameliyatý yapýlan ardýþýk 80 hastanýn (44 kadýn/36 erkek) 91 gözünü içermektedir. Ameliyat öncesi ve sonrasý düzeltilmiþ en iyi görme keskinlikleri (DEÝGK), fakovitrektomi nedenleri, eþlik eden sistemik hastalýk, ameliyat öncesi lens durumu, daha önce geçirdiði ameliyatlar, kullanýlan tamponad cinsi, komplikasyonlar, ilave tedavi giriþimleri ve son göz muayene bulgularý incelendi.
Bulgular: Yaþ ortalamasý 64.8±9.5 yýl idi. Diyabetes mellitus (DM), hipertansiyon (HT), DM+HT, koroner arter hastalýðý sýrasýyla hastalarýn %74, %56, %45 ve %18.7’sinde mevcuttu. Fakovitrektomi ameliyatý yapýlma endikasyonlarýný %52 olguda maküla yüzey hastalýðý, %31 olguda vitreus hemorajisi (VH), %11 olguda diyabete baðlý traksiyonel retina dekolmaný (TRD), diyabetik retinopati ya da proliferatif vitreoretinopati (PVR) ve %5.5 olguda regmatojen retina dekolmaný (RRD) oluþturdu. Ortalama takip süresi 14.2±10.7 (2-39) ay idi. Ortalama DEÝGK deðerleri preoperatif ve postoperatif dönemlerde sýrasýyla 0.10±0.14 ve 0.122±0.22(0.001-0.9) idi (p<0.001). DEÝGK olgularýn %61’inde arttý, %24’ünde deðiþmedi. En sýk komplikasyonlar ön segmentte %16.5 oranýnda GÝL ile ilgili, arka segmentte ise %11 oranýnda VH idi. Son muayenede makülanýn fonksiyonel olduðu 63 gözde retina yatýþýk idi. Takip süresi sonunda görme azalmasý ya da kaybý foveada atrofi, makülada delik oluþmasý, optik atrofi, VH, nüks RD ya da fitizise baðlý olarak görüldü.
Sonuç: Fakovitrektomi+GÝL implantasyonu ameliyat esnasýnda ortamýn iyi görülebilmesini saðlayarak ve sonradan oluþacak katarakt için gerekecek baþka bir cerrahi iþlemin önüne geçerek özellikle sistemik hastalýklarý olan hastalar için etkili ve güvenli bir tedavi yaklaþýmýdýr.

Objective: To present the surgical results of pars plana vitrectomy and phacoemulsification (phacovitrectomy) plus intraocular lens (IOL) implantation in eyes with vitreoretinal pathology
Material and Method: This retrospective study included 91 eyes of 80 (44 female/36 male) consecutive patients undergoing phacovitrectomy plus IOL implantation during a 3-year period. Baseline and last best corrected visual acuity (BCVA), retinal pathologies, presence of systemic disease, preoperative lens status, history of any therapeutic intervention prior to surgery, type of intravitreal tamponade used, need for additional intervention, complications and the latest ocular examination results were considered.
Results: Mean age was 64.8±9.5 years. Diabetes mellitus (DM), hypertension (HT), DM+HT and coronary artery disease (CAD) were the accompanying systemic diseases, observed in 74%, 56%, 45% and 18.7% of the patients, respectively. Indications for phacovitrectomy were macular surface disease in 52%, vitreus hemorrhage (VH) in 31%, tractional retinal detachment (TRD), diabetic retinopathy or proliferative vitreoretinopathy (PVR) in 11% and rhegmatogenous retinal detachment (RRD) in 5.5% of the eyes. Mean preoperative and postoperative BCVA were 0.10±0.14, 0.22±0.22, (p<0.001), respectively. BCVA increased in 61%, remained stable in 24% of the eyes. The most common anterior and posterior segment complications were related to IOL in 16.5% and VH in 11% eyes, respectively. At the last visit, retina was attached with functional macula in 63 eyes. Foveal atrophy, macular hole formation, optic atrophy, VH, phthisis and recurrent RD were the causes of decrease or loss of vision.
Conclusion: Phacovitrectomy with IOL implantation is a safe and effective surgery providing good visualization during vitrectomy and preventing a cataract operation in another session in such a patient group with serious systemic diseases.

Amaç: Periampüller divertikül, duodenum ikinci kýsýmda bulunan, içerisinde veya kenarýnda Ampulla
Vateri’nin yerleþtiði kazanýlmýþ bir luminal anomalidir. Bu çalýþmada, endoskopik retrograd kolanjiyopankreatografi
(ERCP) yapýlan hastalarda periampuller divertikül sýklýðýný ve periampuller divertikül varlýðýnýn ERCP
baþarýsýný ve komplikasyon oranlarýný etkileyip etkilemediðinin deðerlendirilmesi amaçlandý.
Gereç ve Yöntem: Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi Gastroenteroloji Kliniði Endoskopi
Ünitesi’nde 2011-2014 arasýnda yapýlan ERCP iþlemleri retrospektif olarak deðerlendirildi.
Bulgular: Çeþitli endikasyonlarla ERCP yapýlan 948 hastanýn 112’sinde (%11.8) periampuller divertikül vardý.
Periampuller divertikül olmayan 836 hastaya 1026, periampuller divertikül olan 112 hastaya 136 iþlem yapýldý.
Hasta baþýna düþen ERCP iþlemi sayýsý açýsýndan karþýlaþtýrýldýðýnda periampuller divertikül olan ile olmayan
hastalar arasýnda anlamlý fark yoktu (1.21’e karþý 1.23 p=0.838). Periampuller divertikülü olan hastalarýn
8’inde (%7) koledok kanüle edilemezken, periampüller divertikülü olmayan 54 (%6.4) hastada kanülasyon
baþarýsýzdý (p=0.859). Periampuller divertikülü olan hastalarýn ortalama yaþý (72.7±12.2 yýl), periampuller
divertikülü olmayan hastalardan (56.8±16.4 yýl) anlamlý olarak yüksekti (p<0.001). Periampuller divertikülü
olan grupta kadýn oraný, periampuller divertikülü olmayan gruptaki kadýn oranýndan yüksekti (%72.2’e karþý
%54.6, p=0.042). Kanama, pankreatit ve perforasyon komplikasyon oranlarý yönünden gruplar arasýnda
anlamlý fark saptanmadý.
Sonuç: Bu çalýþmada periampuller divertikülün yaþlýlarda ve kadýnlarda daha sýk olduðu tespit edildi.
Literatürde periampuller divertikül hastalarýna yapýlan ERCP iþlemlerinde kanama ve perforasyon gibi komplikasyonlarda
artýþ bildirilse de bu çalýþmada periampuller divertikül olmayan hastalarla karþýlaþtýrdýðýmýz
zaman komplikasyon oranlarýnda artýþ saptanmadý. Bu sonuçlar dkkatli endoskopistler tarafýndan deneyimli
merkezlerde yapýlan ERCP’lerde periampuller divertikülü olan hastalarýn olmayanlarla ayný baþarý ve güvenlikle
iþleme alýnabileceðini göstermesi açýsýndan önemlidir.

Objective: Periampullary diverticulum (PAD) is an acquried luminal pathology that is located in the second
segment of duodenum and Ampulla of Vater is located in or aside of it. We aimed to determine the frequency
of periampullary diverticulum in endoscopic retrograde cholangiopancreatography (ERCP) and the effect of
presence of periampullary diverticulum on ERCP success and complications.
Material and Method: The ERCP procedures held in Gastroenterologic Endoscopy Unit of Sisli Hamidiye Etfal
Training and Research Hospital between years 2011-2014 were retrospectively evaluated.
Results: Periampullary diverticulum was found in 112 of (11.8%) 948 cases who underwent ERCP with
various indications. A 1026 procedures were done to 836 patients without periampullary diverticulum
and 136 procedures were done to 112 patients with periampullary diverticulum. No statistically significant
difference was found in terms of number of ERCP procedure per patient between patients with and without
periampullary diverticulum (1.21 vs. 1.23 p=0.838). Common bile duct cannulation failed in 8 (7%) of patients
with periampullary diverticulum whereas this cannulation was unsuccessful in 54 (6.4%) of patients without
periampullary diverticulum (p=0.859). The mean age of cases with periampullary diverticulum (72.7±12.2
years) was statistically significantly higher than the ones without periampullary diverticulum (56.8±16.4
years) (p<0.001). The rate of female gender was statistically significantly higher in patients with periampullary
diverticulum compared to ones without (72.2% vs. 54.6%, p=0.042). No statistically significant difference
was found in terms of ERCP complications such as bleeding, pancreatitis, and perforation between two
groups.
Conclusion: Periampullary diverticula are more frequently found in elderly and female patients. Although
some of the studies reported increased rates of ERCP complications in patients with periampullary
diverticula, no significant difference was found in terms of ERCP complications between patients with and
without periampullary diverticulum in this study. These results are important because they demonstrate that
patients with periampullary diverticulum can undergo ERCP as safely and efficiently as the patients without
periampullary diverticulum when the procedure is done by careful endoscopists in experienced clinics.

Amaç: Bu çalýþmanýn amacý açýk açýlý glokomlu hastalardan trabekülektomi cerrahisi uygulanmýþ olanlarý (TRAB) ve cerrahi geçirmeyenleri (POAG) koroid kalýnlýklarý açýsýndan artýrýlmýþ derinlik görüntüleme optik koherens tomografi (EDI-OKT) kullanarak karþýlaþtýrmaktýr.
Gereç ve Yöntem: Kesitsel, non-randomize klinik olgu serisi olarak planlanan çalýþmaya en az 6 ay önce trabekülektomi cerrahisi geçirmiþ 12 hastanýn 14 gözü ve primer açýk açýlý glokomlu 12 bireyin 20 gözü dahil edildi. Uveit, diyabetik retinopati, yaþa baðlý makula dejenerasyonu, optik nöropati veya baþka bir retina, koroid veya optik sinir hastalýðý bulunanlar ile belirlenmiþ sýnýrlarýn dýþýnda bir refraksiyon kusuru olan bireyler çalýþmaya dahil edilmedi. Tam bir göz muayenesini takiben koroid kalýnlýðý RTVue-100 5.1 (EDI-OKT) cihazý ile; retina pigment epitelinin hiperreflektif dýþ bandý ile skleranýn iç yüzeyi arasýndan, sýrasýyla subfoveal alandan ve subfoveal alanýn 1.5 mm temporal ile 1.5 mm nazalinden ölçüldü.
Bulgular: Çalýþmaya dahil edilen hastalarýn yaþ ortalamasý TRAB grubunda 59.9±13.4 (yaþ aralýðý 29-76), POAG grubunda 58.4±9.7 (yaþ aralýðý 29-73) idi. Yaþ, cinsiyet, lateralite, GÝB, kýrma kusuru, görme keskinliði, aksiyel uzunluk ve SKK açýsýndan gruplar arasýnda istatistiksel olarak anlamlý fark saptanmadý (p>0.05). Ortalama Koroid kalýnlýðý TRAB grubunda subfoveal, temporal ve nazalde (sýrasýyla 388.2±84.1, 372.4±77.1, 374.1±84.1 µm) POAG grubuna göre (sýrasýyla 383±64, 358.6±62, 357.5±61.5 µm) daha yüksek ölçüldü fakat istatistiksel olarak anlamlý deðildi (p>0.05). POAG grubunda GÝB ile subfoveal ve nazal koroid kalýnlýklarý arasýnda orta seviyede negatif korelasyon saptandý (sýrasýyla: p=0.048, r=-0.458; p=0.042, r=-0.458)
Sonuç: Subfoveal ve perifoveal koroid kalýnlýðý trabekülektomi sonrasý geç dönemdeki bireyler ile hiç operasyon geçirmemiþ, medikal tedavi ile GÝB regüle, primer açýk açýlý glokom tanýlý kiþiler karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý farklýlýk göstermemektedir. POAG hastalarýnda, GÝB yükselmesine koroid incelmesi eþlik edebilir.

Objective: The aim of this study is to compare choroidal thickness using enhanced depth imaging optical coherence tomography between primary open angle glaucoma patients with or without previous trabeculectomy.
Material and Method: Fourteen eyes of 12 patients with a history of previous trabeculectomy surgery (TRAB) at least 6 months ago and 20 eyes of 12 patients who has a diagnosis of primary open angle glaucoma (POAG) and did not experience trabeculectomy surgery were recruited to this cross-sectional non-randomised study. Patients with a history of uveitis, diabetic retinopathy, age related macular degeneration, refractive errors other than the determined limits, optic neuropathy or other retinal, choroidal or optic nerve diseases were excluded. Following the complete ophthalmologic examination, choroidal thickness was measured between the hyperreflective outer layer of retinal pigment epithelium and inner layer of sclera, at subfoveal region and 1.5 mm temporal and 1.5 nasal to the fovea, respectively, using RTVue-100 5.1 (EDI-OCT) device.
Results: The mean age of the patients in the TRAB group was 59.9±13.4 (range 29-76), while it was 58.4±9.7 (range 29-73) in POAG group. Groups showed homogeneous distribution in terms of age, gender, laterality, IOP, refractive errors, visual acuity, axial length and central corneal thickness (CCT) (p>0.05). The mean subfoveal, temporal and nasal choroidal thickness of TRAB group was higher (388.2±84.1, 372.4±77.1, 374.1±84.1 µm, respectively) compared to the POAG group (383±64, 358.6±62, 357.5±61.5 µm, respectively), but the difference was not statistically significant (p>0.05). There was a moderate negative correlation between IOP and subfoveal and nasal choroidal thickness in patients with POAG (p=0.048, r=-0.458; p=0.042, r=-0.458; respectively)
Conclusion: There was not any statistically significant difference regarding subfoveal and perifoveal choroidal thickness between patients with previous trabeculectomy at least 6 months ago and patients with diagnosis of POAG who had medically regulated IOP rates and did not experienced trabeculectomy. Patients with POAG may experience choroidal thinning in case of high IOP rates.

Amaç: Kemik metastazý geliþen meme kanserli hastalarda kemiðe baðlý olay (SRE) geliþimini azalttýðý bilinen zoledronik asitin (ZA) en önemli yan etkilerinden biri renal yetmezlik geliþimidir. Bizim bu çalýþmadaki amacýmýz, bu yan etkinin sýklýðýný ve geliþimini etkileyen risk faktörlerini deðerlendirmektir.
Gereç ve Yöntem: Ýstanbul Florence Nightingale Çalýþma Grubu arþivinde yer alan ve Mart 2006-Aralýk 2013 tarihleri arasýnda ZA tedavisi verilen kemik metastazlý 97 meme kanseri hastasý çalýþmamýza dahil edilmiþtir. Renal yetmezlik deðerlendirmesi için, serum kreatinin seviyesi her tedavi öncesi ölçülüp, baþlangýç ve en yüksek kreatinin deðerleri alýnarak, Crockcroft-Gault formülüne göre kreatinin klirensi hesaplanmýþtýr. Hastalarýn yaþý, ZA kullaným süresi, ZA infüzyon sayýsý, eþzamanlý antikanser tedaviler, nonsteroidal antiinflamatuar ilaç kullanýmý, diabetes mellitus ve hipertansiyon varlýðý kaydedilmiþtir.
Bulgular: Ortalama hasta yaþý 54±10 yýl ve ortalama ZA kullanýmý süresi 37±18 ay olarak bulundu. Baþlangýç kreatinin deðeri tüm hastalarda 1.4 mg/dL’nin altýnda idi. 22 hastamýzda (%23) kreatinin deðerinde 0.5 mg/dL’nin üzerinde artýþ olup, kreatinin klirensinde düþüþ saptanmýþ ve renal toksisite olarak deðerlendirilmiþtir. Ýki hastamýzda kreatinin klirensi <30 ml/min. düþmüþ ve 1 hastamýzda diyaliz ihtiyacý olmuþtur. Renal yetmezlik geliþimi için tek baðýmsýz risk faktörü ileri yaþ (60≤) olarak saptanmýþtýr (p=0.017).
Sonuç: Sonuç olarak, metastatik meme kanserli hastalarda ZA kullanýmý sýrasýnda karþýlaþýlabilecek en önemli sorunlardan biri renal yetmezliktir. Bu riski azaltmanýn en önemli yolu her tedavi öncesi serum kreatinin kontrolü ve özellikle ileri yaþ hasta grubunda hidrasyona dikkat etmektir.

Objective: Renal failure is one of the most prominant adverse effect of the zoledronic acid (ZA) which is well known to decrease the skeletal-related events (SREs) in breast cancer patients developing bone metastasis. In this particular study, our object was to evaluate the incidence of this side effect and the risk factors leading to the development of renal failure.
Material and Method: A total of 97 patients who underwent ZA treatment for breast cancer with bone metastasis in our institute between March 2006 and December 2013 were evaluated. For the assesment of renal failure, serum creatinine levels were obtained before the treatment. Preliminary and the highest levels of creatinine levels during the treatment were used in calculation of creatinine clearance according to the Crockcroft-Gault formula. The age of the patients, the number ZA treatment periods, number of the infusions, the simultaneous anti-cancer treatments, non-steroidal anti-inflammatory drug use, diabetes mellitus and presence of hypertension were recorded.
Results: The mean age of the patients was 54±10 years and the treatment period of ZA was 37±18 months. In all of the patients participated in this study the preliminary creatinine levels were under 1.4 mg/dl. In 22 of our patients (23%) creatinine levels increased more than 0.5 mg/dL, besides creatinine clearance were found out to be decreased both of which were pointing out the renal toxicity. In two patients creatinine clearance was under 30 ml/min. and one of the patients has undergone renal dialysis. The only independent risk factor underlined was the advanced age (60 years ≤) (p=0.017).
Conclusion: As a conclusion breast cancer patients with bone metastasis undergoing ZA treatment are prone to the development of renal failure. In order to avoid this particular risk of developing renal failure, serum creatinine levels should strictly be monitored before the treatment and meticulous attention to the hydration should be given during the treatment especially in patients with advanced age.

Amaç: Sað kolon tümörü daha çok kanama ve buna baðlý semptomlar ile kendini gösterir. Buna baðlý olarak anemi bulgusu, kolonun diðer bölge yerleþimli tümörlerinden daha sýk görülür. Biz bu çalýþmada kliniðimizde opere olan kolon tümörlü hastalarda tümör yerleþiminin kan transfüzyon ihtiyacýna etkisini incelemeyi amaçladýk.
Gereç ve Yöntem: Çalýþmaya Kasým 2007–Þubat 2013 tarihleri arasýnda kolon tümörü nedeniyle opere olan 192 hasta alýndý. Hastalar sað kolon (Grup A=94) ve sol kolon tümör (Grup B=98) hastalarý olarak iki grupta incelendi. Bu hastalarýn demografik verileri, operasyon prosedürleri, preoperatif ve postoperatif hemoglobin (Hgb) deðerleri, eritrosit süspansiyon (ES) transfüzyon ihtiyaçlarý, komplikasyonlar ve mortalite sonuçlarý incelendi.
Bulgular: Demografik veriler açýsýndan iki grup arasýnda farklýlýk bulunamadý. Preoperatif Hgb deðerleri Grup A da anlamlý düþük saptandý (ortalama 10.9±2 mg/dL’ye 11.6±2 mg/dL, p=0.031). Preoperatif ES transfüzyonu oraný Grup A’da anlamlý yüksek bulundu (%19’a %8, p=0.034). ES transfüzyon miktarý Grup A’da ortalama 0.56 ünite ile istatistiksel olarak yüksek saptandý (Grup B: 0.23’ü, p= 0.038). Fakat genel ES transfüzyon oraný 2 grup arasýnda anlamlý deðildi (%62’ye %47, p=0.06). Hastanede kalýþ süreleri, postoperatif komplikasyon (%18’e %17) ve mortalite (%2’ye %5) deðerleri karþýlaþtýrýldýðýnda iki grup arasýnda fark izlenmedi. Sað ve sol kolon yerleþimli tümörü olan hastalarda mortalite ES uygulanmasý ile iliþkili bulunmamýþtýr (p=0.515).
Sonuç: Sað kolon yerleþimli tümörü olan hastalarda preoperatif Hgb deðerleri sol kolon tümörlü hastalara nazaran daha düþük bulundu. Bu da bu hastalarda artmýþ preoperatif ES transfüzyonu ile iliþkilendirilmiþtir. Fakat postoperatif morbidite ve mortalite deðerlerinde artýþ saptanmamýþtýr. Biz sonuçlarýmýz doðrultusunda sað kolon tümörlerinde daha fazla transfüzyon yapýlmasýnýn sol kolon tümörlerine göre daha fazla morbidite ve mortaliteye neden olmadýðýný düþünüyoruz.

Objective: Right colon tumor often presents with bleeding and related-symptoms. Therefore, most of these patients are diagnosed with anemia in the preoperative assessment. We aimed to investigate whether tumor location affect the frequency and volume of blood transfusion in patients who underwent colon cancer surgery.
Material and Method: A total of 192 patients who underwent colon cancer surgery between November 2007-February 2013 were included in the study. The patients were evaluated in 2 groups as patients with right colon tumor (Group A=94) and patients with left colon tumor (Group B=98). Collected data included demographic features, preoperative and postoperative hemoglobin (Hgb) values, packed red blood cell (PRBC) transfusion requirements, surgical procedures, complications and mortality results.
Results: There was no difference between the groups regarding demographic data. Preoperative Hgb values were significantly lower in Group A (10.9±2.08 mg/dL vs 11.6±2.02 mg/dL, p=0.031). Preoperative PRBC transfusion rates were significantly higher in Group A (19% vs 8%, p=0.034). While volume of in-hospital PRBC transfusion was statistically significant higher in Group A compared to Group B (0.56 U vs 0.23 U, respectively, p=0.038), the frequency of overall PRBC transfusion was similar (62% vs, 47%, p=0.06). Hospital stay, postoperative complications (18% vs 17%) and mortality (2% vs 5%) were not statistically different between two groups. Mortality was not associated with PRBC transfusion in both groups (p=0.515).
Conclusions: Preoperative Hgb values were found lower in patients with right colon cancer. This resulted in increased frequency and volume of PRBC transfusion during hospital stay but no increased mortality rate. We believe that within our results, the higher rates of transfusion in right colon cancer do not cause higher mortality and morbidity compared to patients with left colon cancer.

Amaç: Bu çalýþmadaki amacýmýz kadýnlar için daha kabul edilebilir bir yöntem olan transabdominal servikal uzunluðun erken doðumu ön görmedeki önemini araþtýrmaktýr.
Gereç ve Yöntem: Bu çalýþmada tarihleri Mart 2014 - Ocak 2015 arasýnda kliniðimizde 18-24 hafta arasýnda rutin fetal anatomik tarama yapýlýr iken transabdominal ultrasonografi ile servikal uzunluk bakýlan hastalarýn dosyalarýnýn retrospektif olarak taranmasý ile elde edilen veriler incelenmiþtir. Hasta dosyalarýndan yaþ, obstetrik öykü ve doðum yaptýðý hafta kayýt edildi. Servikal uzunluk ölçümleri 30 mm ve 25 mm cut-off deðer olarak kabul edildiðinde servikal uzunluðun erken doðumu ön görmedeki sensitivite ve spesifisite deðerleri hesaplandý.
Bulgular: Çalýþmada toplamda 142 hastanýn verileri deðerlendirildi. 11 kadýn erken doðum yapmýþ iken 131 kadýn term doðum yapmýþtý. Preterm doðum yapanlarýn servikal uzunluk ortalama 32.90±8.45 mm, term yapanlarda ise 35.31±7.54 mm idi (p>0.05).
Sonuç: Bu çalýþma, transabdominal ultrasonografi ile servikal uzunluk ölçümünün erken doðumu öngörmede sýnýrlý bir tanýsal deðere sahip olduðunu düþündürmektedir.

The importance of the transabdominal cervical length measurement to predict preterm delivery in low-risk pregnant women for premature birth.
Objective: The aim of the present study is to evaluate the efficacy of transabdominal cervical length measurement using ultrasound on predicting preterm birth.
Material and Method: The data retrospectively obtained from the records of the patients who were admitted to our department between March 2014 and January 2015 during fetal anatomic survey in 18-24 weeks of pregnancy were retrospectively assessed. Age, obstetric history, delivery week and transabdomial cervical length measurement using ultrasound were obtained form the records. The specificity and sensitivity values were calculated while accepting a cut-off value of 30 mm and 25 mm for cervical length.
Results: A total of 142 patients were enrolled. Eleven women had preterm birth, since 131 had term. The mean cervical length was 32.90±8.45 mm in women with preterm birth, and 35.31±7.54 mm in term (p>0.05).
Conclusion: The present study suggests that transabdominal cervical length measurement using ultrasound has a limited diagnostic value on the prediction of preterm birth.

Amaç: Lenf nodu tutulumu deri kanserlerinin prognozu açýsýndan önemlidir. Klinik olarak lenf nodu tutulumu olmayan veya tutulum açýsýndan þüpheli olan vakalarda agresif bir yöntem olan bölgesel lenf nodu disseksiyonu yerine günümüzde sentinel lenf nodu örneklemesi (SLNB) tercih edilmektedir. Çalýþmamýzda, kliniðimizde malign deri tümörlerine yönelik yapýlan SLNB deneyimlerimizi paylaþmayý amaçladýk.
Gereç ve Yöntem: Aðustos 2009 ve Aðustos 2015 tarihleri arasýnda sentinel lenf nodu örneklemesi yapýlan; yaþlarý 21-81 arasýnda deðiþen, 13’ü kadýn, 17’si erkek, toplam 30 hasta retrospektif olarak incelendi.
Bulgular: 30 hastada toplam 33 SLNB yapýldý. Tüm prosedürlerde sentinel lenf nodu (SLN) ortaya kondu ve baþarýlý bir þekilde eksize edildi. Toplamda 8 adet pozitif sentinel lenf nodu saptandý. Dört hastada sentinel lenf nodu örnekleme sonucu negatif olmasýna raðmen, takiplerinde metastaz lehine bulgular saptanmasý üzerine terapötik lenf nodu disseksiyonu uygulandý.
Sonuç: Klinik olarak lenf nodu tutulumu olmayan ancak tutulum açýsýndan þüpheli olan hastalarda morbiditesi ve komplikasyon oraný daha düþük ve güvenilirliði yüksek olan, sentinel lenf nodu örneklemesi tercih edilmelidir.

Objective: Nodal involvement is important for the prognosis in skin cancers. In the absence of palpable lymph nodes or when the nodal involvement is suspicious, sentinel lymph node biopsy (SLNB) is the preferred method instead of agrressive regional lymph node dissection. In our study we aimed to share our experience regarding SLNB in malignant skin tumors.
Material and Method: From August 2009 to August 2015, 30 patients (17 male, 13 female) aged between 21-81, who underwent SLNB, were analysed retrospectively.
Results: Thirty-three SLNBs were performed in 30 patients. In all procedures sentinel lymph node was identified and excised successfully. Eight positive sentinel lymph nodes were obtained. Four patients, who had negative SLNB previously, developed symptoms on behalf of metastasis on followup, and underwent therapeutic lymph node dissection.
Conclusion: Patients, who have no clinical evidence of nodal involvement but suspicion of nodal status, should undergo SLNB procedure, which has a low morbidity and complication rate.

Amaç: Tiroid kanseri nedeni ile santral diseksiyon prolaktik veya terapötik amaçlý uygulanmaktadýr. Yeterli evreleme için tek taraflý santral boyun diseksiyonunda en az 4, 2 taraflý santral boyun diseksiyonunda 8 lenf bezi çýkarýlmasý gerektiði bildirilmesine ragmen, uygulanan santral diseksiyonlarýn geniþliði halen net deðildir. Bu çalýþmada santral lenf nodu diseksiyonunda çýkarýlan lenf bezi sayýlarý ve lokalizasyonlarýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Diferansiye tiroid kanseri için ayný cerrah tarafýndan total tiroidektomiye ek olarak standart tek taraflý veya iki taraflý santral diseksiyon yapýlan hastalarda lenf nodu sayýlarý ve anatomik lokalizasyonlarý deðerlendirildi. Ýstatistik olarak ‘’Ki-kare’’ ve ‘’Fisher’in kesin olasýlýk’’ testleri kullanýldý.
Bulgular: Diferansiye tiroid kanseri nedeni ile proflaktik veya terapötik santral boyun diseksiyonu uygulanan 43 hastanýn (30K, 13E) yaþ ortalamasý 45.7±15.1’di. Hastalarýn 32’sine bilateral, 11’ine tek taraflý santral boyun diseksiyonu uygulandý. Çýkarýlan lenf bezi sayýsý tek taraflý 9±6 (2-23), bilateral 14±6 (5-30) olup, bilateral disesiyon yapýlan grupta yüksekti (p<0.05). Prelaringeal, pretrakeal, sað paratrakeal, sol paratrakeal, lenf bezi sayýlarý sýrasý ile 3±3, 2±3, 5±2, 5±4 idi. Pretrakeal lenf bezi sayýsýna göre sað paratrakeal lenf bezi sayýsý (p=0.001) ve sol paratrakeal lenf bezi sayýsý (p>0.01) anlamlý olarak yüksek bulundu. Ayrýca sað paratrakeal lenf bezi sayýsý prelaringeal lenf bezi sayýsýna göre anlamlý olarak yüksek (p=0.001) bulundu.
Sonuçlar: Çýkarýlan lenf bezi sayýsý ortalamalarý evreleme için önerilen sayýnýn üzerinde ve yeterli olmasýna raðmen, çýkarýlan lenf bezi sayýsýnýn 2-30 arasýnda geniþ bir aralýkta olduðu dikkat çekmektedir. Anatomi çalýþmalarýnda santral bölgedeki lenf bezlerinin 2/3 kadarýnýn pretrakeal yerleþimli olduðu bildirilmesine ragmen, santral diseksiyon materyalinde lenf bezlerinin önemli bir bölümü paratrakeal bölgede yerleþmektedir. Santral diseksiyon anatomik sýnýrlara uygun olarak uygulanmalý ve paratrakeal bölge lenf bezleri göz ardý edilmemelidir. Özellikle sað paratrakeal bölgede diseksiyonun tam olabilmesi için reküren laringeal sinir arkasýndaki dokunu diseksiyonu önemlidir.

Objectives: The central neck dissection (CND) for thyroid cancer is applied prophylactically or therapeutically. Although it’s reported that minimum 8 lymph nodes should be resected in bilateral central dissection and minimum 4 in unilateral for proper staging, the extent of the applied central neck dissections are not clear yet. We aimed to evaluate the localizations and the number of the lymph nodes resected in central neck dissection in this study.
Material and Method: The number of the lymph nodes and their anatomical localisations of the patients whom underwent standard unilaterally or bilaterally central neck dissection in addition to total thyroidectomy for differentiated thyroid carcinoma by the same surgeon were evaluated. Chi-square and Fisher’s exact test were used for statistics.
Results: The mean age of 43 patients who underwent central neck dissection prophylactically or therapeutically for differentiated thyroid cancer was 45.7±15.1. Bilateral and unilateral central neck dissections were applied to 32 patients and 11 patients, respectively. The unilaterally resected number of lymph nodes was 9±6 (2-23), and bilaterally 14±6 (5-30), which was higher in the bilaterally dissected group (p<0.05). The number of prelaryngeal, pretracheal, right paratracheal and left paratracheal lymph nodes were 3±3, 2±3, 5±2, 5±4, respectively. The number of right paratracheal (p=0.001) and left paratracheal (p>0.01) lymph nodes were significantly higher than pretracheal. Additionally the number of right paratracheal lymph nodes was significantly higher (p=0.001) than prelaryngeal.
Conclusions: Although the average number of the resected lymph nodes was adequate and higher than the advised, it was seen that the number of resected lymph nodes was in a wide range, between 2-30. Although the 2/3 of the lymph nodes of the central neck area were located in the pretracheal region in cadaveric studies, the important part of the lymph nodes were in paratracheal region in the central neck dissection specimen. Central neck dissection should be applied according to anatomical borders of the regions and the lymph nodes of paratracheal region should not be excluded. Notably, the tissue behind the recurrent laryngeal nerve is important for the complete dissection of the right paratracheal area.

Trakeanýn iç lümen obstrüksiyonu oldukça nadir olup genellikle hemanjiyom, hamartom ve larengeal web gibi sorunlarda görülmektedir. Yazýmýzda zamanýnda doðan bir yenidoðan bebekte aralýklý desatürasyon ve ekspiratuvar hýrýltý ataklarýna neden olan konjenitaal trakeal polip olgusu sunulmuþtur. Bilgilerimize göre yenidoðan döneminde konjenital trakeal polip ilk kez bildirildiði için yazýmýz sunulmuþtur.

Intrinsic obstruction of the tracheal lumen is extremely rare and usually caused by hemangiomas, hamartomas, or webs. We report a congenital tracheal polyp in a term neonate causing intermittent desaturations and expiratory wheezing. To our knowledge, this represents the first report with congenital tracheal polyp in the neonatal period.

Giriþ: Jüvenil rekürren parotit (JRP), çocuklarda görülen parotis bezinin tek veya iki taraflý þiþmesiyle karakterize, ataklar þeklinde seyreden, spesifik, týkayýcý ve süpüratif olmayan inflamatuar hastalýðýdýr. Etyolojisi bilinmemekle beraber otoimmünite, duktal obstrüksiyon, immün yetmezlik ve enfeksiyöz nedenler suçlanmaktadýr. Tanýsý anamnez, fizik muayene ve radyolojik bulgularla konulur. Birçok tedavi modalitesi önerilmiþtir. Ýlk basamak tedavisi antibiyotikler, analjezikler gibi konservatif tedavidir.
Olgu Sunumu: Bu makalede kliniðimizde tekrarlayan akut parotit nedeniyle takip edilen ve etyolojisi araþtýrýlan 11 yaþýnda çocuk hasta güncel literatür bilgileri ýþýðýnda sunuldu.
Sonuç: JRP tekrarlayan akut parotis bezi þiþliklerinin ayýrýcý tanýsýnda düþünülmelidir. Nadir etyolojilerin saptanmasýnda klinik þüphe oldukça önemlidir

Introduction: Juvenile recurrent parotitis (JRP) is a nonspecific, nonobstructive, nonsuppurative disease that is characterized by intermittent swelling of one or both parotid glands in children. The aetiology is unknown but autoimmunity, ductal obstruction, immune deficiency, and infectious causes have all been proposed. The diagnosis is suggested from the history of the disease, the clinical examination and radiological findings. Several treatment modality is proposed. The first line of treatment consists of conservative observation such as antibiotics, analgesics.
Case Report: Herein, we report a 11-years old child patient with recurrent acute parotitis with the evaluaion of the etiology of disease and review the relevant literature.
Conclusion: JRP should be considered in the differential diagnosis of patients with acute recurrent parotis swelling. A high degree of clinical suspicion is needed to determine this rare potential etiology.

Jarcho-Levin sendromu sayýsal ve yapýsal kosta-vertebral anomalileri içeren nadir bir konjenital sendromdur. Spondilotorasik dizositoz ve spondilokostal dizositoz olmak üzere iki alt tipi bulunmaktadýr. Kosta ve vertebralarda yaygýn deformite olduðu için solunum sýkýntýsýna, sýk tekrarlayan solunum yolu enfeksiyonlarýna neden olmaktadýr. Bu olgu sunumunda, nadir olmasý nedeniyle, yenidoðanda meningomyeloselin eþlik ettiði, aðýr hidrosefali nedeniyle ventrikülo-peritoneal þant takýlan ve göðüs deformitesine baðlý olarak solunum cihazýndan ayýramadýðýmýz spondilotorasik dizositoz tip JarchoLevin Sendromu olgusu sunulmuþtur.

Jarcho-Levin syndrome is rare a congenital disorder characterized by numerical and structural costo-vertebral abnormalities. The subtypes of this syndrome are, spondylothoracic and spondylocostal dysostosis. Rib and vertebrae aberrations cause respiratory insufficiency and result in recurrent respiratory infections. Since it is a rare entity, a newborn diagnosed as spondylothoracic dysostosis with meningomyelocele, who had ventriculoperitoneal shunting due to severe hydrocephalus and could not be weaned from respiratory support due to chest deformity, is presented in this case report.

5 aylýkken oksipital bölgede þiþlik ve ara ara akýntý þikayeti üzerine kurumumuz beyin cerrahi polikliniðine baþvurduktan sonra, yapýlan tetkiklerin ardýndan ‘’Dermal Sinüs Traktý’’ tesbit edilmesi üzerine opere edilmek üzere Beyin Cerrahi Kliniðine yatýrýlan hastaya 18.12.2008 tarihinde oksipital dermal sinüs onarýlmasý ameliyatý yapýlmýþtýr. Operasyon iþleminin ardýndan herhangi bir komplikasyon geliþmeyen hasta 22/12/2008 tarihinde taburcu edilmiþtir. Poliklinik takipleri yapýlan hasta huzursuzluk ve genel durum bozukluðu ile ailesi tarafýndan Beyin Cerrahi Polikliniðine getirilmiþtir. Hastanýn deðerlendirilmesi sonucunda BT’sinde 4. ventrikül posteriorunda kistik lezyon tespit edilmesi üzerine
2. Yatýþý saðlanmýþtýr. 06.04.2009 tarihinde apse boþaltýmý giriþimi yapýlmýþ ve yoðun bakým ünitesine kabul edilmiþtir. Yoðunbakým ünitesine geldiðinde genel durumu kötü, þuuru kapalý, spontan solunumu olmayan hastaya bireye özgü hemþirelik bakýmý planlanarak uygulanmýþ ve baþarý saðlanmýþtýr. Solunum aktivitesine, enfeksiyon riskine, beslenme ve sývý volüm eksikliðine, güvenli çevrenin saðlanmasý ve sürdürülmesine, idrar tutamama/kaçýrmaya, deri bütünlüðü bozulma riskine ve aktivite intoleransýna yönelik bireysel hemþirelik bakýmý uygulanmýþtýr. Vücut ýsýsý 36-37°C civarýnda, boy ve kilo geliþimi normal çocuklarýn geliþmesine uygun oranda seyretmiþtir. Yoðunbakýmda deneyimli hemþireler tarafýndan yapýlan bireysel bakým planlarý sonucunda hasta normal yaþýtlarý ölçüsünde geliþmeye devam etmiþ, basý yarasý oluþmamýþ, enfeksiyon geliþmemiþtir. Makalenin yazýldýðý tarihte yoðun bakým ünitesinde bakýlmaya devam edilmektedir. Literatürlerde bu kadar uzun süre hastanede yatan çocuk hastaya rastlanmamýþtýr.

Five-months old patient admitted to our institute’s neurosurgery outpatient clinic for swelling and intermittent discharge at the occipital region; and diagnosed as “dermal sinus tract” following the tests. The patient was interned in the Neurosurgery Clinic and occipital dermal sinus repair was performed in 18/12/2008. The patient was discharged without any complications in 22/12/2008. The patient was under outpatient follow-up, while due to unrest and bad medical condition, he was brought back to the neurosurgery outpatient clinic. The CT evaluation of the patient revealed a cystic lesion at the posterior of the 4th ventricule, so the patient was admitted to the hospital again. Abscess drainage was performed at 06/04/2009 and the patient was admitted to the intensive care unit (ICU). The patient’s medical condition was bad, he was unconscious, and had no spontaneous respiration when he was taken to the ICU; thus, individualized nursing care was planned, and implemented, and success was achieved. Individualized nursing care was applied in terms of respiratory activity, infection risk, nutrition and fluid volume deficiency, providing of a safe environment and maintaining it, urinary retansion/incontinence, risk of disturbance of skin integrity and intolerance to activity. The body temperature was around 36-37°C, and the height and weight development remained within favorable range with the normal children. As a result of the individualized care plans performed by the experienced nurses in the ICU, the patient grew in the normal range as the children with the same ages, no pressure sore or infection developed. The patient was still being cared at the ICU when this article was written. This is the longest period of hospitalization of a child in the literature as we found out.