Vestibüler yaklaþýmla transoral endoskopik tiroidektomi (TOETVA) minimal invaziv, görünür yara izi olmayan naturel orifis transluminal endoskopik cerrahi (Naturel orifice transluminal endoscopic surgery (NOTES) tekniktir. Aðýz içinden vestibüler bölgeden uygulanan 1 adet 10 mm ve 2 adet 5 mm port yardýmý ile düþük CO2 basýncý altýnda tamamen endoskopik olarak lobektomi veya total tiroidektomi uygulanabilir. Dünyada giderek uygulamasý artmaktadýr. Deneyimli merkezlerde seçilmiþ hastalarda güvenli bir þekilde uygulabilmektedir. Bu çalýþmada minimal invaziv tiroit cerrahisinin geliþimi, TOETVA için hasta seçimi ve dýþlama kriterleri, bölgesel anatomi, ameliyat tekniði, preoperatif ve postoperatif bakým, yöntemin avantajlarý, dezavantajlarý ve olasý komplikasyonlarý tartýþýlacaktýr

Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is a minimally invasive, natural orifice transluminal endoscopic surgery (NOTES) technique with no visible scarring. Endoscopic lobectomy or total thyroidectomy can be performed completely under low CO2 pressure level with the aid of one 10 mm and two 5 mm ports applied from vestibular region through the mouth. Its application is increasing worldwide. It can be safely performed in selected patients in experienced centers. In this study, the development of minimally invasive thyroid surgery, patient selection and exclusion criteria for TOETVA, regional anatomy, surgical technique, preoperative and postoperative care, advantages and disadvantages and possible complications of the procedure will be discussed.

Gebelik haftasý 340/7 – 366/7 arasýnda olan bebekler geç preterm bebek olarak tanýmlanmaktadýr. Son yýllarda özellikle geliþmiþ ülkelerde geç preterm bebeklerin sayýsý artan preterm doðumlarla birlikte yükselme göstermiþtir. Geç preterm bebekler her ne kadar prematüre olsalar da zamanýnda doðmuþ gibi ele alýnmýþtýr. Solunumsal problemler geç preterm bebeklerin en sýk ortaya çýkan sorunudur. Bu nedenle geç preterm bebeklerde solunum problemlerinin iyi anlaþýlýr olmasý çok önemlidir. Bu makalede geç preterm bebeklerin erken solunumsal problemleri yeni literatür bilgileri eþliðinde ele alýnmaktadýr.

Late preterm infants (LPI) are defined as delivery between 340/7 – 366/7 weeks of gestational age. In recent years, the number of LPI has risen according to preterm births especially in developed countries. Even though the LPI are premature, they have been considered as mature infants. Respiratory problems are the most common consequences of LPI. Therefore it is important to understand respiratory problems of LPI clearly. This review presents the updated data of early respiratory problems of LPI.

Amaç: Hastanemizde doðan bebeklerin doðum sonrasý izlem sonuçlarýnýn epidemiyolojik açýdan incelenmesi.
Gereç ve Yöntem: Çalýþmaya belirlenen iki yýl içerisinde (2014-2015 yýllarý) hastanemizde doðan tüm bebekler dahil edildi. Bebeklerin bilgileri, muayene bulgularý, doðumhanede uygulanan giriþimler, izlem sonuçlarý ve mevcut hastalýklarý günlük olarak kaydedildi. Elde edilen veriler ülkemiz verileri ile karþýlaþtýrýldý.
Bulgular: Belirlenen süre içerisinde 7172 gebelikten, 7175’i (%99.02) canlý doðum ve 71’i (%0.98) ölü doðum olmak üzere toplam 7246 bebek doðmuþtu. Sezaryen ile doðum sýklýðý %41.66, çoðul gebelik sýklýðý %1.03 (n: 74), majör anomali sýklýðý %0.77 (n: 55) olarak belirlendi. Gebelik süresine göre prematüre doðum (<37 hafta) %13.7 (n: 995), term doðum (38-42 hafta) %84.8 (n: 6143) ve postmatüredoðum (>42 hafta) %1,5 (n: 108) þeklindeydi. Bebeklerin doðum aðýrlýðýna göre daðýlýmý: < 1000 gram %0.8 (n: 61), 1000-1500 gram %1.1 (n: 79), 1500 – 2500 gram %8.4 (n: 611), 2500-4000 gramý %84.5 (n: 6119) ve 4000 gram üstü %5.2 (n: 376) olduðu saptandý. Bebeklerde SGA oraný %6.7, AGA oraný %79.8 ve LGA oraný %13.5 idi. Bebeklerin %3.1’inin yenidoðan ünitesinde takip edildiði, %8.2’sini
yenidoðan yoðun bakým ünitesine yatýrýldýðý ve %1.4’ünün baþka hastanelere sevk edildiði belirlendi. Bebeklere doðumhanede %7.5 oranýnda oksijen verildiði, %2.4 oranýnda T parça canlandýrýcý desteði verildiði ve %1.04 bebeðe entübasyon ve/veya göðüs kompresyonu uygulandýðý belirlendi.
Sonuç: Ülkemizde yenidoðan bebeklerin doðumhanedeki kýsa süreli izlemi ile ilgili yeterli çalýþma bulunmamaktadýr. Hastanemizde prematüre doðum oranlarý ve sezaryen doðum oranlarýnýn ülkemiz deðerlerinin altýnda ancak geliþmiþ ülke deðerlerinden yüksek olduðu belirlendi.

Objective: Epidemiologic examination of the results of postnatal follow-up of infants born at our hospital.
Material and Method: All the babies born within two years (2014-2015) in our hospital were included in the study. Babies’ information, physical examination findings, interventions used in the delivery room, follow-up results and existing diseases were recorded daily. The obtained data were compared with the national data of our country.
Results: A total of 7246 newborns were born from 7172 pregnancies, 7175 (99.02%) live births and 71 (0.98%) stillbirths within the specified period. Rate of cesarean section, multiple pregnancy and major anomaly were 41.66%, 1.03% (n: 74) and 0.77% (n: 55) respectively. According to the gestational age, preterm delivery (<37 weeks) was 13.7% (n: 995), term delivery (38-42 weeks) was 84.8% (n: 6143) and postterm delivery (>42 weeks) was 1.5% (n: 108). Distribution of infants according to birth weight was determined as; <1000 grams 0.8% (n: 61), 1000-1500 grams 1.1% (n: 79), 1500-2500 grams 8.4% (n: 611), 2500-4000 84.5% (n: 6119) and > 4000 grams 5.2% (n: 376). The SGA rate in infants was 6.7%, the AGA rate was 79.8% and the LGA rate was 13.5%. It was found that 3.1% of babies were followed in newborn unit, 8.2% were admitted to neonatal intensive care unit and 1.4% were referred to other hospitals. In delivery room, babies were given oxygen at a rate of 7.5%, in 2.4% infants were used T-piece resuscitation support and 1.04% of babies were subjected to intubation and/or chest compression.
Conclusion: In our country, there are not enough studies about newborn babies’ short-term follow-up at delivery room. The preterm delivery rates and cesarean birth rates in our hospital were found to be below the country values but higher than the developed countries.

Amaç: Plazmaferez, immunolojik renal hastalýklarýn tedavisinde son 40 yýldýr kullanýlmaktadýr. Bu yaklaþýmýn altýnda yatan mekanizma antikorlar ve immun kompleksler gibi patojenik immun mediatörlerin dolaþýmdan temizlenmesidir. Bu çalýþmada kliniðimizde plazmaferez tedavisi gören hastalarýn retrospektif olarak deðerlendirilmesi amaçlanmýþtýr.
Gereç ve Yöntemler: Son 10 yýlda kliniðimizde yatan ve terapötik plazmaferez tedavisi alan toplam 27 hastanýn kayýtlarý deðerlendirildi. Demografik özellikleri, biyokimyasal parametreleri, biyopsi sonuçlarý, plazmaferez komplikasyonlarý ve tedavisi sonrasý saðkalýmlarý kayýt edildi.
Bulgular: Hastalarda ortalama yaþ 39±18 (17-71) yýl, ortalama plazmaferez seans sayýsý 13.9±8.8 (2-41) olarak saptandý. Altý hastada Goodpasture hastalýðý, 5 hastada ANCA (+) küçük damar vasküliti, 5 hastada trombotik mikroanjiyopati, 4 hastada sistemik lupus eritematozus, 3 hastada akut humoral rejeksiyon, 3 hastada primer kresentik glomerulonefrit ve 1 hastada ise multipl myelom saptandý. Tedavi esnasýnda bir hasta exitus oldu, 9 hastada renal iyileþme görüldü, 12 hastada son dönem böbrek yetmezliði nedeniyle diyaliz tedavisine baþlandý. Renal düzelme saptanan hastalardan birinde nüks saptandý ve bu hasta ile birlikte toplam 6 hastada da Evre 2-3 böbrek yetmezliði devam etti.
Sonuç: Plazmaferez nefroloji kliniklerinde bazý özel grup hastalarda adjuvan tedavi olarak düþünülmelidir. Son dönem böbrek yetmezliðine ilerlemeyi önleyebilir ve renal iyileþmede hýzlanmaya neden olabilir.

Objective: Plasmapheresis has been used in the management of immune-mediated renal diseases for the last 40 years. The rationale behind this approach is to remove pathogenic immune mediators, such as autoantibodies and immune complexes, from the circulation. In this study, we aimed to evaluate retrospectively the patients treated with plasmapheresis in our clinic.
Material and Method: A total of 27 patients who had been hospitalized and treated in our clinic in the last 10 years were evaluated. Demographic characteristics, biochemical parameters, biopsy results, plasmapheresis complications and survival analyses following treatments were recorded.
Results: The mean age of the patients was 39±18 (17-71) years and the mean number of plasmapheresis sessions was 13.9±8.8 (2-41). Six patients had Goodpasture Syndrome, 5 patients had ANCA (+) small vessel vasculitis, 5 patients had thrombotic microangiopathy, 4 patients had Systemic Lupus Erythematosus, 3 patients had Acute Humoral Rejection, 3 patients had primary crescentic glomerulonephritis and 1 patient had multiple myeloma. One patient died, 9 patients had renal improvement and 12 patients underwent dialysis due to end stage renal disease during the treatment. One patient with renal improvement experienced recurrence, and including this patient, Grade 2-3 renal failure continued in a total of 6 patients.
Conclusion: In conclusion, plasmapheresis should be considered as an adjuvant treatment in some specific groups in Nephrology Clinics. It can prevent progression to end stage renal failure and accelerate renal improvement.

Amaç: Beklenen yaþam sürelerininin artýþý ile ileri yaþlarda görülen hastalýklarýn da sýklýðý artmaktadýr. Sýklýkla basit düþmeler sonucu görülen kalça kýrýklarý ilerleyen yaþ gruplarýnda belirgin ölçüde daha yaygýndýr. Bu çalýþmada 65 yaþ üstü proksimal femur kýrýklý hastalarýn postoperatif yoðun bakým üniteleri ve ortopedi klinklerinde yatýþlarýnýn sonuçlarýný deðerlendirmeyi amaçladýk.
Gereç Yöntem: Çalýþmamýza 2010-2015 tarihleri arasýnda ortopedi ve travmatoloji kliniklerimizde opere edilen ileri yaþ (65 üzeri), ASA skoru 3 olan proksimal femur kýrýklý ve hastane kayýtlarýndan ulaþýlabilen 118 hasta dahil edilmiþtir. Hastalarýn postoperatif erken dönem (0-30 gün) mortalitelerinin deðerlendirlmesi amaçlanmýþtýr. Hastalar postoperatif dönemde nereye baþvurduklarýna göre iki gruba ayrýldý.
Bulgular: ASA skoru 3 olan 118 proksimal femur kýrýklý 65 yaþ üstü hasta, postoperatif yoðun bakým ünitesinde ve ortopedi kliniklerinde yatan hastalar iki grup olarak deðerlendirildi. Bu iki grup hastanýn erken postoperatif dönem mortaliteleri arasýnda anlamlý fark saptanmadý.
Sonuç: Preop iyi deðerlendirilen ASA 3, 65 yaþ üstü, proksimal femur kýrýklý hastanýn, postop yoðun bakým gereklilikleri ihtimaline karþý uzun süre bekletilmeden opere edilmeleri, preop bekleme sürelerinin uzamasý sonucu oluþan komplikasyonlarý minimale indirebilir.

Objective: As life expectancy increases, so does the prevalence of diseases observed in the elderly. Hip fractures that usually occur with simple falls are profoundly more common in the elderly population. In the present study, we aimed to examine the outcomes of patients with proximal femoral fractures aged >65 years who admitted to post-operative intensive care units and orthopaedic clinics.
Materials and Method: The study included 118 elderly patients (aged >65 years) who were available from medical records of hospital archives, with proximal femoral fractures who were surgically treated between 2010 and 2015 in our orthopaedic and traumatology clinics, with American Society of Anesthesiologists (ASA) 3 scores. Our aim was to evaluate the mortality rate during the early postoperative period (30 days). Patients were categorised into two groups based on where they were admitted to during the postoperative period.
Results: A total of patients over 65 years of age with 118 proximal femur fractures with an ASA score of 3 were evaluated in two groups; in the postoperative intensive care unit and in orthopaedic clinics. There was no significant difference between the two groups in terms of mortality rate during the early postoperative period.
Conclusion: For patients with proximal femoral fractures aged >65 years with an ASA score of 3 and who are thoroughly evaluated preoperatively, complications that may develop as a result of delays in the time-to-surgery, caused by postoperative intensive care requirements may be reduced by performing the surgery without delay

Amaç: Travmatik beyin hasarlý hastalarda nörolojik rehabilitasyon etkinliðini araþtýrmak.
Gereç ve Yöntem: Çalýþmaya travmatik beyin hasarý sonrasý rehabilite edilen 45 hasta alýndý.Hastalarýn sosyodemografik özellikleri, yaralanma nedeni, koma süresi, posttravmatik amnezi süresi, yar alanma sonrasý diðer kliniklerde kalýþ süresi, yaralanma ile rehabilitasyon kliniðine yatýþ arasýndaki süre, rehabilitasyon kliniðinde kalma süreleri ve uzun dönem komplikasyonlarý belirlendi. Hastalarýn kliniðimize ilk yatýþlarý ile son kontrolleri arasýndaki fark fonksiyonel açýdan; Özürlülük Derecelendirme Ölçütü (Disability Rating Scale, DRS), Fonksiyonel Baðýmsýzlýk Ölçütü (Functional Independence Measure, FIM) ve Fonksiyonel Ambulasyon Skalasý (FAS), biliþsel açýdan ise Rancho Los Amigos biliþsel fonksiyon düzeyleri skalasý (RLAS) son durum ölçütleri kullanýlarak karþýlaþtýrýldý.
Bulgular: Nörolojik rehabilitasyon sonrasýnda hastalarýn fonksiyonel durumlarýnda belirgin iyileþme oldu. Baþlangýç ve tedavi sonrasý DRS, FÝM, FAS ve RLAS skorlarýnda istatistiksel olarak anlamlý deðiþimler oldu. Baþlangýç DRS skoru düþük, FÝM ve RLAS skoru yüksek olanlarda fonksiyonel son durumun daha iyi olduðu tespit edildi.
Sonuç: Travmatik beyin hasarý sonrasý nörolojik rehabilitasyon fonksiyonel son durumun daha iyi olmasýný saðlamaktadýr.

Objective: The aim of this study is to investigate the effectiveness of neurological rehabilitation in patients with traumatic brain injury. Materials and Method: Forty-five patients who were rehabilitated after traumatic brain injury were included in the study. The sociodemographic characteristics of the patients, the cause of the injury, the duration of coma and posttraumatic amnesia, the duration of stay in the other clinics after injury, the time between injury and admission to the rehabilitation clinic, the duration of stay in the rehabilitation clinic and long-term complications were determined. The functional differences between the admission of the patients and their final control examinations were compared using Disability Rating Scale (DRS), Functional Independence Measure (FIM), and Functional Ambulation Scale (FAS), and cognitive differences were compared using their recent status criteria, with Rancho Los Amigos Scale (RLAS).
Results: There was a significant improvement in the functional status of patients after neurological rehabilitation. There were statistically significant changes in DRS, FIM, FAS and RLAS scores after treatment compared to initial status. Better improvement in the functional status was detected in patients with lower initial DRS scores and higher FIM and RLAS scores.
Conclusion: The neurologic rehabilitation significantly affects the recovery of functional status after traumatic brain injury.

Amaç: Çocuklarda kraniosinostoz cerrahisi, arteriel kan gazý deðiþikliklerine baðlý olarak artan miktarda, kan tranfüzyonu gerektirir. Bu çalýþmada çocuklarda kraniosinostoz cerrahisinde arteriel kan gazý deðiþiklikleriyle kan transfüzyonu arasýndaki iliþkiyi incelemeyi amaçladýk.
Gereç ve Yöntem: Beyin cerrahisi kliniðimizde beþ yýl içinde ameliyat edilmiþ çocuklarýn verileri retrospektif olarak deðerlendirildi. Kraniosinostoz cerrahisi geçirmiþ çocuklarýn demografik deðerleri, arteriel kan gazý örneklerinin sonuçlarý, transfüzyon durumlarý kaydedildi.
Bulgular: 23 olgunun yaþ ortalamasý 19.00±16.26 ay, olgularýn %73.9’u tek ya da multipl sütürlü düzeltme operasyonu geçirmiþ, operasyon süresi 154.13±17.49 dakika idi. 152.63±61.18 mL eritrosit süpansiyonu ve 125.00±57.74 mL taze donmuþ plazma transfüzyonu yapýlmýþtý. Baþlangýç ve perioperatif deðelerle karþýlaþtýrýldýðýnda, cerrahi sonu HCO3 deðeri yükselmiþ, baz defisit azalmýþ, ionize kalsiyum yükselmiþti. Preoperatif ve postoperatif hemoglobin deðerleri (10.20±1.06/9.91±2.42) deðiþiklik göstermedi (p=0.583).
Sonuç: Bu retrospektif çalýþmadaki veriler, kraniosinostoz cerrahisi geçiren çocuklarda perioperatif ve postoperatif stabil þartlarýn arteriel kan gazý deðiþiklikleri ile uyumlu kan replasmanýna baðlý olduðunu
göstermiþtir.

Objective: Craniosynostosis surgery in infants may require increased blood transfusions, leading to arterial blood gas variations. In this study, we aimed to evaluate the relation between blood transfusion and arterial blood gas changes in infants during craniosynostosis surgery.
Material and Methods: Data of all children, who were operated in our neurosurgery clinic during a five-year period were screened retrospectively. Demographics, arterial blood gas sample results, transfusion requirements in children who underwent craniosynostosis surgery were recorded.
Results: The mean age of 23 cases was 19.00±16.26 months, 73.9% of the patients underwent single/ multiple suture correction, and the mean duration of operation was 154.13±17.49 minutes. The mean transfused materials were 152.63±61.18 mL erythrocyte suspension and 125.00±57.74 mL fresh frozen plasma. At the end of the surgery, HCO3 was higher, base deficit was decreased and ionized calcium was higher compared to beginning and perioperative values. Preoperative and postoperative hemoglobin values (10.20±1.06 / 9.91±2.42) showed no difference (p=0.583).
Conclusions: Our data from this retrospective study has confirmed, that in children undergoing craniosynostosis surgery, perioperative and postoperative stable condition is related to adequateblood replacement compatible with arterial blood gas changes.

Amaç: Üriner sistemde taþ varlýðý; yaþ, cinsiyet, diyet, iklim ve genetik nedenlerle iliþkilidir. Enfeksiyonlar, anatomik ve metabolik bozukluklar taþ oluþuma eðilim yaratan nedenlerdir. Bu çalýþmada üriner sistem taþý olan çocuklarda epidemiyolojik ve metabolik faktörlerin deðerlendirilmesi amaçlanmýþtýr.
Gereç ve Yöntemler: Retrospektif olan bu çalýþmada, ürolitiazis, mikrolitiazis ve ürolitiazis hikayesi olan 0-18 yaþ aralýðýndaki 89 (46 kýz) hastanýn dosyasý geriye dönük þekilde incelendi. Güncel yaþ, cinsiyet, taný yaþý, baþvuru semptomlarý, ailede taþ hikayesi, fizik muayene bulgularý, kullandýklarý ilaçlar, laboratuvar tetkikleri (kan üre nitrojeni, serum kreatinin, elektrolit, kan gazlarý; idrarda kalsiyum, ürik asit, okzalat, sistin, sitrat, magnezyum ve kreatinin düzeyleri deðerlendirildi) ve radyolojik bulgular kaydedildi.
Bulgular: Yaþ ortalamasý 6.20±5.27 (minimum-maksimum, 0.2-18.2) yýl idi. Taþlar en sýk böbrekte yerleþmekteydi (n=52, %58.4). Yirmi iki hasta (%24.7) mikrolitiazis, 64 hasta (%71.9) ürolitiazis ve üç hasta (%3.4) ürolitiazis hikayesi olan grupta idi. Anatomik sorunlar %17.9 hastada saptandý. Tüm hastalarýn 31’inde (%34.8) idrar analizlerinde metabolik bozukluk saptandý. Yirmi altý (%29.2) hastada
tek metabolik bozukluk saptanýrken, birden fazla metabolik bozukluk beþ (%5.6) hastada tespit edildi. Kýzlarda metabolik bozukluk erkeklerden iki kat fazla idi (p=0.027). En sýk metabolik bozukluk hipositratüri (n=16, %17.9) ve sonrasýnda hiperokzalüri (n=8, %8.9), hiperkalsiüri (n=6, %6.7) ve hiperürikozüri (n=6, %6.7) olarak tespit edildi.
Sonuçlar: Üriner sistem taþý olan çocuklarda metabolik bozukluklar sýk saptandý. Hipositratüri en sýk saptanan bozukluklardan olup hasta yönetimi için kapsamlý deðerlendirme gereklidir. Kýz cinsiyet metabolik bozukluk için yatkýnlýk oluþturan bir faktör olarak kabul edilebilir.

Objective: Urinary stone disease is associated with age, gender, diet, climate, and genetic causes. Infections, anatomic and metabolic abnormalities can lead to stone formation. We aimed to evaluate epidemiologic and metabolic factors in children with urolithiasis.
Material and Methods: A total of 89 patients (46 girls), aged between 0 and 18 years with diagnosis of urolithiasis, microlithiasis and a history of urolithiasis were recruited in this retrospective study. Medical records were assessed for current age, gender, age at diagnosis, presenting symptoms, family history, physical findings, medications, results of laboratory tests (including blood urea nitrogen, serum creatinine, electrolytes, blood gases, urinalysis: urinary calcium, uric acid, oxalate, cystine, citrate, magnesium and creatinine levels) and radiological findings.
Results: The mean age was 6.20±5.27 (range, 0.2-18.2 years). Stones were mostly located in the kidneys (n=52, 58.4%). Microlithiasis, urolithiasis and urolithiasis history were defined in 22 (24.7%), 64 (71.9%), and 3 (3.4%) patients, respectively. Anatomic abnormalities were determined in 17.9% of the patients. Of all patients, 31 (34.8%) had metabolic abnormalities in their urinary analyses. While 26 patients (29.2%) had one metabolic abnormality, five (5.6%) patients had more than one. Metabolic abnormalities were two times more in girls than in boys (p=0.027). The most common metabolic disorder detected was hypocitraturia (n=16, 17.9%), followed by hyperoxaluria (n=8, 8.9%), hypercalciuria (n=6, 6.7%), and hyperuricosuria (n=6, 6.7%).
Conclusions: Metabolic abnormalities were detected frequently in children with urinary stone disease. Hypocitraturia was the most common metabolic abnormality. Detailed evaluation is needed to manage patients with urolithiasis. Female gender may be accepted as a predisposing factor for metabolic abnormality.

Amaç: Bu çalýþmada amacýmýz, primer veya metastatik karaciðer kanseri olan hastalarýn radyofrekans ablasyon (RFA) tedavisinin lokal terapötik etkinliðini retrospektif olarak deðerlendirmekti.
Gereç ve Yöntem: Kliniðimizde radyofrekans ablasyon tedavisi uygulanmýþ 35 hasta çalýþmaya dahil edildi ve retrospektif olarak deðerlendirildi. Hastalar yaþlarýna, lezyonun primer ya da metastatik oluþuna, lezyon sayýlarýna ve lezyon büyüklüklerine göre gruplandýrýldý. Lokal tümör büyümesi, yeni lezyon oluþumu ve genel saðkalýma etki edebilecek unsurlar istatistiksel olarak deðerlendirildi.
Bulgular: Radyofrekans ablasyon tedavisi sonrasý takip sýrasýnda sadece bir lezyonda (%1.9) tedavi edilen alanda rezidü saptandý. Takiplerde 50 lezyonda (%98.0) total ablasyon saðlandý. Lokal tümör büyümesi ise sekiz hastanýn 9 lezyonunda (%17.6) geliþti. Yirmi iki hastada (%62.8) ise takiplerinde farklý bir karaciðer bölgesinde yeni bir lezyon geliþtiði görüldü. RFA iþlemi sonrasý bir hastada kolesistit, iki hastada ise intraperitoneal minimal hemoraji geliþti.
Sonuç: RFA tedavisi saðlam karaciðer dokusunun korunmasý, tedavinin direk tümöre yönelik olmasý, mortalite ve morbiditenin diðer tedavilere kýyasla az olmasý sebebiyle karaciðer tümörlerinin tedavisinde günümüzde güvenle uygulanabilen bir yöntemdir.

Objective: The aim of this present study was to retrospectively evaluate the local therapeutic efficiency of radiofrequency ablation (RFA) treatment in patients with primary and metastatic liver cancer.
Material and Methods: A total of 35 patients who had undergone RFA in our clinic were included in the study and evaluated retrospectively. Patients were grouped according to their ages, lesion’s primary or metastatic formation, number of lesions and lesion sizes. Local tumor growth, new lesion formation and general survival factors were evaluated statistically.
Results: During the follow-up after RFA treatment, the residual tumor was determined in the treatment area in only one (1.9%) lesion. Total ablation was achieved in 50 lesions (98.0%). Local tumor growth occured in 9 lesions of eight patients (17.6%). During follow-up, development of a new lesion at a different liver region was seen in 22 (62.8%) patients. Following RFA, one patient had cholecystitis while intraperitoneal minimal hemorrhage was encountered in two patients.
Conclusion: As RFA treatment protects intact liver tissues, directly targets the tumor, and the mortality and morbidity rates are lower when compared to other treatments, it is currently considered safe for the treatment of liver tumors.

Amaç: Kardiyak troponinler miyokard infarktüsünün taný ve risk deðerlendirilmesinde standart belirteçler olarak kabul edilmiþtir. Ancak kardiyak troponinler akut koroner sendrom dýþý nedenle baþvuran bazý hastalarda da yüksek bulunmaktadýr. Burada nadir görülen bir kardiyak dýþý troponin yüksekliði akut kolesistit vakasý sunulmuþtur.
Olgu: Acil servise epigastrik bölgede aðrý ile baþvuran 56 yaþýnda bayan hastanýn yapýlan batýn ultrasonografide akut kolesistit lehine bulgular izlendi. Koroner arter hastalýðý açýsýndan risk faktörleri olan hastanýn elektrokardiyografi bulgularý normal olmakla birlikte bakýlan troponin pozitif saptandý. Akut koroner sendrom ekarte edilemeyen hastanýn yapýlan koroner anjiyografisinde koroner arterleri normal saptandý ve hastadaki troponin yüksekliði akut kolesistite baðlandý.
Sonuç: Troponin yüksekliði akut koroner sendromlarda bir belirteç olarak kullanýlsa da, akut koroner sendrom dýþý nedenle baþvuran bazý hastalarda da yüksek bulunmaktadýr. Bu durum yanlýþ tanýlara ve gereksiz giriþimlere yol açabilmektedir. Sonuç olarak benzer semptomlarý olan (epigastrik bölgede aðrý), elektrokardiyografide deðiþiklikleri olan ve troponin yüksekliði olan hastalarda akut kolesistit
tanýsý akýlda tutulmalýdýr.

Objective: Cardiac troponins are accepted as the standard markers for diagnosis and risk management of patients with acute coronary syndromes. However, cardiac troponins are elevated in some patients presenting with non-cardiac situations. In this paper, a rare case of non-cardiac troponin elevation with acute cholecystitis is presented.
Case: A 56 year old female patient admitted to the emergency room with pain in the epigastric region. The abdominal ultrasound revealed acute cholecystitis. She had some coronary risk factors and electrocardiogram showed no segment deviation but troponin was positive. Acute coronary syndrome couldn’t be ruled out and coronary angiography revealed normal coronary arteries. Therefore, elevated troponin was linked to acute cholecystitis.
Conclusion: Although troponin elevation is a cornerstone marker for diagnosis the patients with acute coronary syndromes, there are various conditions with non-coronary-related troponin elevations. This can lead to misdiagnosis and unnecessary interventions. As a result, in patients with similar sypmtoms (pain in the epigastric region), electrocardiogram wave changes and elevated troponin levels, acute cholesystitis diagnosis should be considered.

Amaç: Tiroid bezinin nadir görülen bir hastalýðý olan Riedel tiroiditi tanýsý konulan bir olgunun taný ve tedavi seyri sýrasýnda karþýlaþýlan güçlüklerin tartýþýlmasý amaçlandý.
Olgu: Boyunda orta hatta aðrýsýz, sert kitle ve nefes darlýðý þikayeti ile baþvuran 43 yaþýnda kadýn hastaya yapýlan radyolojik görüntülemeler, ince iðne aspirasyon biyopsisi, tru-cut biyopsi ve açýk biyopsiler ile taný konuldu. Hastalýðýn yaygýn ekstratiroidal yayýlýmý nedeniyle cerrahi tedavi planlanmadý. Trakeal kompresyon nedeniyle trakeotomi açýlan hastaya, literatürde bildirilmiþ medikal tedavi protokolleri incelenerek, sistemik steroid tedavisi baþlanmasýna karar verildi. Takiplerinde tiroid kitlesi boyutlarýnda belirgin regresyon izlendi.
Sonuçlar: Riedel tiroiditi tanýsý histopatolojik bulgularýn yanýsýra, radyolojik ve fizik muayene bulgularý eþliðinde konulmaktadýr. Tanýda öncelikle, hastalýktan þüphelenilmesi ve tiroidin habis hastalýklarýnýn dýþlanmasý önemlidir. Cerrahi tedavi, basý semptomlarý dýþýnda, yüksek morbidite olasýlýðý nedeniyle önerilmezken standart bir medikal tedavi protokolü de bulunmamaktadýr. Bu nedenle olgu bazlý tedavi seçimlerinin bildirilmesi ve tartýþýlmasý yararlýdýr.

Objective: We aimed to discuss the diagnostic and therapeutic difficulties of Riedel’s thyroiditis case which is a rarely seen disease of thyroid gland.
Case: A 43-year-old female patient who admitted to the hospital with a firm, painless midline mass, and shortness of breath. Diagnosis was made by radiographic imaging, fine needle aspiration biopsy, tru-cut biopsy and open biopsies. Surgical treatment was not planned due to extensive extrathyroidal spread of the disease. Systemic steroid treatment was decided to be initiated to the patient, who had tracheotomy due to tracheal compression, after examining the medical treatment protocols reported in the literature. A distinct decrease in the size of the thyroid mass was noticed at follow up.
Conclusion: Riedel thyroiditis is diagnosed in the presence of histopathological findings as well as radiological and physical examination findings. For diagnosis, primarily, it is important that the disease is suspected and that thyroid malignancies are excluded. Surgical treatment is not recommended because of the high morbidity except for the symptoms of compression, but there is also no standard medical treatment protocol. Therefore, reporting and discussion of the treatment choices of Riedel’s thyroiditis on an individual basis will be beneficial.

Amaç: Mukopolisakkaridozlar, genetik geçiþli ve lizozomlarda glikozamino glikan depolanmasý sonucu vücuttaki çeþitli organlarda hasara yol açan hastalýklardýr. Burada nadir görülen bir tür olan Morquio sendromlu bu olguyu konuya dikkat çekmek amacý ile sunmaktayýz.
Olgu: Onbir yaþýndaki erkek hasta, hastanemize boy kýsalýðý ve kemik bozukluklarý nedeni ile baþvurdu. Anne baba akraba deðildi ve olgumuzun üç saðlýklý küçük kardeþi vardý. Fizik muayenede kaba yüz, hipertelorizm, orantýsýz boy kýsalýðý, çarpýk bacak, pektus karinatum, kifoskolyoz saptandý. Ördekvari yürüyüþü vardý. Nöromotor geliþimi yaþýna uygundu. Kemik grafilerinde kifoskolyoz, iliak kanatlarda parlama, koksa valga, femoral epifizlerde düzleþme, geniþlemiþ kaburga kemikleri ve dar iliak kanatlar tespit edildi. Ýdrarda glikozaminoglikan (keratan sülfat) pozitif bulundu. Enzimatik analizde glukoz-6- fosfataz düþük bulunarak [15 pmol/mg/saat (n: 400-2000)] kesin taný kondu.
Sonuçlar: Morquio sendromunun benzer klinik tablolarý olan ve otozomal resesif kalýtýlan A ve B tipleri vardýr. Tip 4A galactosamine-6-sulfatase (GALNS) enzim eksikliðine baðlý 16q24.3 geni ile kodlanan hastalýk iken, Tip 4B beta galaktozidaz eksikliði ile ortaya çýkar. Her iki tip hastalýkta da, keratan sülfat ve kondrotin 6 sülfat birikmektedir. Bizim olgumuzda da bulgular 1 yaþ civarýnda belirginleþmiþ ve giderek ilerlemiþtir. Zeka problemi olmayan hastamýzýn, dizostozis multipleks olarak adlandýrýlan kemik radyolojik bulgularý tipiktir. Enzim replasman tedavisinin yürüme fonksiyonunu kaybetmeden baþlanmasý önemlidir.

Objective: Mucopolysaccharidoses, develop with genetic transmission which cause destructive changes in various organs as a result of glycasoaminoglycans deposition in lysosomes. Herein, we are presenting a case with Morquio syndrome so as to attract attention to this rarely seen disease.
Case: A 11-year-old male patient presented to our hospital with complaints of short stature, andbone deformities. The parents were not relatives, and he had 3 healthy younger siblings. On physicalexamination, coarse facial features, hypertelorism, disproportionate short stature, genu valgum, pectus carinatum, kyphoscoliosis, were detected. He demonstrated a waddling gait. His neuromotor development was normal for his age. On bone radiograms, kyphoscoliosis, flared iliac wings, coxa valga, flattening of femoral epiphysis, widened ribs, and narrowed iliac wings were detected. Urine tests were positive for glycosaminoglycans (keratan sulphate). Enzymatic analysis revealed low levels of glucose-6-phosphatase [15 pmol/mg/hr, (n: 400-2000)], which made the final diagnosis.
Conclusions: Morquio syndrome has Aand B types with similar clinical manifestations which are transmitted as an autosomal recessive trait. Tip 4A is a disease due to a deficiency of galactosamine6-sulfatase (GALNS) enzyme, which is encoded by the 16q24.3 gene, while Type 4B is characterized by deficiency of beta galactosidase. In both types of the disease, keratan sulphate, and chondrotin
6 sulphate accumulate. Also in our case manifestations became more prominent around age 1, and gradually progressed. Our patient without mental problems had typical skeletal signs on radiograms which is named dysostosis multiplex. It is necessary to initiate enzyme replacement therapybefore the onset of gait disorders.

Akciðerlerin konjenital kistik adenomatoid malformasyonu (KKAM) terminal bronþiollerin anormal proliferasyonu sonucu geliþen nadir bir geliþimsel anomali olup insidansý 1/4000 ila 1/35000’dir. Olgularýn büyük çoðunluðu (%90) hayatýn ilk iki yýlý içinde tespit edilmekte ve ileri yaþlarda, özellikle adolesanlarda çok nadir görülmektedir. Yenidoðan döneminde pulmoner kompresyon ve hipoplaziye baðlý solunum sýkýntýsý geliþirken daha büyük yaþtaki olgularda rekürren ve persistan pnömoniler görülebilir. Lezyon Stocker ve arkadaþlarý tarafýndan 5 tipe ayrýlmýþtýr. Burada daha önce hiçbir yakýnmasý olmayan, tedaviye yanýtsýz persistan pnömonisi nedeniyle video yardýmlý torasik cerrahi (VATS) yapýlarak tip II kistik adenomatoid malformasyon tanýsý alan 14 yaþýnda bir olgu sunulmuþtur.

Congenital cystic adenomatoid malformation (CCAM) of lungs is a rare congenital lesion that is associated with abnormal proliferation of terminal bronchi and has an incidence of 1/4000 to 1/35000. Most of the cases (90%) are seen in the first two years of life and it is rarely seen in adolescents and the older age groups. Respiratory distress related to pulmonary compression and lung hypoplasia occur during the neonatal period, whereas recurrent and persistant pneumonia may occur at the older ages. The lesion is classified into five types by Stocker et al. Herein, we present a fourteen-year-old case who had no symptoms previously and diagnosed as type 2 cystic adenomatoid malformation with video-assisted thoracic surgery (VATS) due to persistent and treatment-resistant pneumonia

Amaç: Ailesel Akdeniz Ateþi (AAA) tanýsý ile 6 yýldýr takip edilen ve sonrasýnda Çölyak hastalýðý tanýsýda alan 15 yaþýnda erkek bir olguyu sunmak istedik.
Olgu: AAA tanýsý olan hasta son 1 aydýr tekrarlayan yaygýn ve epigastrik karýn aðrýsý yakýnmalarýyla defalarca kez çocuk acile baþvurmuþtu. Baþvurularýn yaklaþýk olarak yarýsýnda akut faz belirteçleri normal saptanmýþtý. Ailesinde Çölyak hastalýðý öyküsü olduðu için, 10 yaþýnda iken hastaya çölyak hastalýðý serolojisi bakýlmýþ, ancak sonucu normal tespit edilmiþti. Son baþvurusunda þiddetli epigastrik aðrý ve hassasiyetin olmasý üzerine hastaya gastroduodenoskopi yapýlarak çok sayýda biyopsi alýndý. Gastroduodenoskopi sonrasý tekrar bakýlan doku transglutaminaz antikoru IgA düzeyi > 300 U/ml saptandý. Patolojisi ise Çölyak hastalýðý ile uyumlu idi.
Sonuç: Benzer klinik bulgulara sahip olduðu için AAA tanýlý hastalarda Çölyak hastalýðý tanýsý konulmasý güçleþmektedir. Bu olgu nedeniyle bu tip semptomlarý olan AAA hastalarýnda daha önceden Çölyak hastalýðý yönünden tetkik edilse bile özellikle aile öyküsü de varsa hastamýzda da olduðu gibi taný gecikmesine neden olabileceði için Çölyak hastalýðý düþünülmelidir.

Objective: We present a 15-year-old male patient with a diagnosis of Familial Mediterranean Fever followed up for 6 years, then diagnosed with also Celiac disease.
Case: The patient with Familial Mediterranean Fever (FMF) was admitted to the pediatric emergency unit many times in the last month with the complaint of recurrent widespread and epigastric pain. Acute phase reactants were in normal range in nearly half of his admissions. Since he had a family history of Celiac disease, at the age of 10, he was referred for Celiac disease serology exmination, but the result was normal. Due to the presence of severe epigastric tenderness and pain at the last visit, gastroduodenoscopy was performed and multiple biopsies were obtained. After gastroduodenoscopy procedure, tissue transglutaminase (tTG) antibody IgA level was reanalysed and the result was >300 U/ml. The pathology result was also consistent with Celiac disease.
Conclusion: The diagnosis of Celiac disease is difficult in patients with FMF because both of them have similar clinical symptoms. Even if previous screening is negative for Celiac disease as in this case, Celiac disease should be considered as it may cause delay in diagnosis, particularly in patients with Familial Mediterranean Fever who have similar symptoms and a positive family history for celiac disease.