GÝRÝÞ ve AMAÇ: Böbrek biyopsileri renal parankimal hastalý klarýn tanýsýnýn konmasýnda altýn standart olarak kullanýlan bir yöntemdir. Hastalýðýn prognozunun belirlenmesinde ve doðru tedavinin seçimi için gereklidir. Bu çalýþmada böbrek biyopsisi sonuçlarý mýzýn klinikopatolojik açýdan deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmamýzda 2004-2009 yýllarý arasýnda 2. ve 5. dahiliye kliniklerinde yapý lmýþ olan 140 adet nativ böbrek biyopsileri retrospektrif olarak deðerlendirilmiþtir. Biyopsiler USG eþliðinde otomatik biyopsi iðneleri kullanýlarak yapýlmýþtýr. Iþýk mikroskop inceleme için hematoksilen eozin (HE), periodic-acid-schiff (PAS), periodic-acid-silver-metanamin (PAS-M), Mason trikrom, kristal viole ve Kongo kýrmýzýsý boyalarý kullanýlmýþ, immün þoresan inceleme için IgA, IgG, IgM, C3 ve fibrinojen antikorlarý ile direk immün þoresan yöntemle boyanmýþtýr.
BULGULAR: Hastalarýn yaþ ortalamasý 43.2±17.1 olup, 81’i (%58.7) erkek,57’si (%41.3) kadýndý. Taný konulan biyopsilerde glomerül sayýlarý 2 ile 37 arasýnda deðiþmekte olup ortalama glomerül sayýsý 15.3±7.5 olarak bulundu. Yeterli materyal oraný %70 (98/140) olarak saptandý. 104(%75.4) biyopside immünþoresan çalýþma yapýldý. Biyopsi endikasyonlarý arasýnda en sýk olaný 85(%60.7) hastada nefrotik sendromdu. Biyopsiler arasýnda en sýk karþýlaþýlan taný Fokal segmental glomeroloskleroz (FSGS)(n=29, %21) olarak saptandý.
TARTIÞMA ve SONUÇ: Çalýþmamýzda biyopsi tanýlarý arasýnda en sýk FSGS ikinci sýklýkta amiloidoz gelmekteydi. Yapýlan çeþitli çalýþmalarda en sýk biyopsi taný sý olarak IgA nefropatisi olarak raporlanmasýna raðmen bizim çalýþmamýzda %5.8 ile düþük bir oranda saptandý. Ayrýca FSGS tanýsý alan biyopsiler incelendiðinde bir kýsmýnýn benign nefroskleroz olarak deðerlendirilebileceði kanýsýna varýlmýþ olup FSGS tanýsý konulurken, sekonder FSGS ‘lerin mutlaka titiz bir klinikopatolojik deðerlendirme ile ayýrt edilmesi tedavi ve prognoz açýsýndan önemli olduðunu düþünmekteyiz.

INTRODUCTION: Renal biopsy is the gold standard diagnostic choice for renal diseases. It is used for determining the prognosis, and choosing the right treatment modality for renal diseases. The purpose of this study was the clinicopathological evaluation of our renal biopsies in the last 5 years.
METHODS: In our study, we evaluated 140 native percutaneus renal biopsies retrospectively, that were taken in the years 2004 –2009,from patients interned in the 5th and 2nd Internal Medicine Clinics of our hospital. The biopsies were performed with full-automatic biopsy needles under ultrasonographic guidance. Hematoxylin-Eosin (HE), Periodic Acid-Schiff(PAS), Periodic Acid-Schiff Metanamine (PAS-M), Masson Trichrome, Crystal Violet and Kongo Red were applied for light microscopy; and IgG, IgM, IgA, C3, and Fibrinogen antibodies were applied with the direct immunfluorescent method for Immunofluorescent study.
RESULTS: The mean age was 43.2±17.1. 81 of 140 patients were male(58.7%), whereas 57 patients were female(41.3%). There were a minimum of 2 and maximum 37 glomerules (Mean glomerule Count: 15.3±7.5) in the biopsy samples. Sufficent glomerule number was met in 70% cases (98/140). Most common endication for biopsy was nephrotic syndrome in 85 of 140 (60.7%) patients; whereas most common diagnosis was Focal Segmental Glomerulosclerosis (FSGS) (N=29, 21%).
DISCUSSION AND CONCLUSION: In our study most common diagnosis was FSGS; and second most common was amiloidosis. Even though in many studies the most frequent renal-biopsy diagnosis is Berger’s nephropathy; in our study it was as low as 5.8%. Furthermore; upon futher examination of the biopsies diagnoased as FSGS; we have come to the conclusion that a considerable portion of them might in fact be benign nephrosclerosis, and when diagnosing biopsy samples as FSGS, considering secondary FSGS with a thorough clinicopathological evaluation would be beneficial for both treatment and prognosis.

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GÝRÝÞ ve AMAÇ: Bu araþtýrma; istanbul’da bir eðitim ve araþtýrma hastanesinde, personelin dýþardan satýn alýnan hizmetleri tercih ve tercih etmeme nedenleri ile bu hizmetlerden genel memnuniyet düzeyini belirlemek amacýyla yapýlmýþtýr. Hastanede týbbi olmayan hizmetler olarak; özel güvenlik hizmetleri, malzemeli yemek (beslenme) hizmetleri, bilgi iþlem hizmetleri, malzemeli genel temizlik hizmetleri, teknik bakým onarým hizmetleri ve týbbi hizmet olarak; bilgisayarlý tomografi hizmetleri dýþardan satýn alýnmaktadýr.
YÖNTEM ve GEREÇLER: Araþtýrmada yüzyüze görüþme ve çalýþmacýlar tarafýndan hazýrlanan anket yöntemi uygulanmýþtýr. Ankette beþli Likert ölçeði kullanýlmýþtýr.
BULGULAR: Anketin deðerlendirilmesinde sorularýn yanýtlandýrýlma aðýrlýklarýný belirlemek için SPSS 11,5 paket istatistik programý kullaný lmýþtýr. Araþtýrma kapsamýna; kadrolu personelden tesadüfü örnekleme yöntemiyle belirlenen 300 kiþi örneklem olarak alýnmýþtýr.
TARTIÞMA ve SONUÇ: Hastanede çalýþan taþeron þirket personeli ile yardýmcý hizmetliler kapsam dýþýnda býrakýlmýþtýr. Araþtýrma tanýmlayýcý niteliktedir. Araþtýrma sonuçlarýna göre; genel olarak hastane personelinin dýþ kaynaklardan yararlanma (DKY) konusunda olumlu bir bakýþ açýsýna sahip olduklarý belirlenmiþtir. DKY yöntemini tercih etme nedenlerinin baþýnda hizmetin sürekliliðini saðlamak (%67.9), tercih etmeme nedenlerinin baþýnda ise personelin iþsiz kalma kaygýsý taþýyabileceði (%53.6) yer almaktadý r. Personelin DKY yöntemiyle saðlanan hizmetlerden (genel temizlik %51.5, yemek %62.2 ) önemli oranda memnun olmadýklarý bulunmuþtur. DKY yöntemiyle saðlanan hizmetlerin bulgularý literatür ile uyumlu olmakla birlikte, kurumlarý n DKY ve yararlanmama nedenlerinde önceliklerin farklý olabileceði, personelin hizmetlerden memnuniyet düzeylerinin deðiþebileceði belirlenmiþtir. DKY uygulamasýnýn olumlu katkýlarda bulunabileceði görülmektedir.

INTRODUCTION: This study aimed to determine the reasons for preferring and not preferring outsourced services and the general level of satisfaction with these services among the personnel of a training and research hospital in Istanbul. The non medical outsourced services involved special security, catering (nutrition), information technologies, general cleaning services with supplies, and technical maintenance whereas the outsources medical services involved computerised tomography services.
METHODS: We conducted face-to-face interviews and used questionnaires developed by the researchers. A 5 Likert type scale was used in the questionnaire.
RESULTS: The SPSS 11.5 was used to evaluate the weight of the answers in the questionnaire. The sample of the research consisted of 300 regular personnel who have been chosen with random sampling.
DISCUSSION AND CONCLUSION: The subcontractor personnel and assisting attendants were excluded from the study. This was a descriptive study. According to the results, it has been determined that the personnel had a positive perspective regarding the utilization of outsources services (UOS). Main reasons for preferring UOS were maintaining the continuity of services (67.9%), whereas reasons for not preferring these services were that the personnel would worry about losing their jobs (53.6%). It has been found that the personnel was not satisfied with UOS (general cleaning 51.5%, catering 62.2%). Although findings regarding UOS seem to be consistent with the literature, institutions may have different priorities regarding reasons for not benefiting from UOS and the level of satisfaction with outsourced services may vary. On the other hand, it has been shown that UOS may have positive contributions.

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GÝRÝÞ ve AMAÇ: Ýntermittan ekzotropya (X(T))’nýn cerrahi tedavisinde çeþitli yöntemler ileri sürülmüþ ve bu yöntemlerin baþarý ve nüks oranlarý ile ilgili farklý sonuçlar bildirilmiþtir. Biz bu çalýþmamýzda X(T)’li olgularýmýzýn horizantal þaþýlýk cerrahi sonuçlarýný ve nüks oranlarýný deðerlendirdik.
YÖNTEM ve GEREÇLER: 17 yýllýk kayýtlarýmýzdan çalýþma kriterlerine uyan 70 X(T)’li olgu çalýþmaya alýndý. Olgular 1 saatlik diagnostik kapama testi (DKT) sonucunda uzak ve yakýn deviasyonlar arasýnda 10 prizm dioptri (PD) fark esas alýnarak temel tip, diverjans fazlalýðý, konverjans yetmezliði ve pdödodiverjans fazlalýðý olmak üzere 4 grupta deðerlendirildi. Tüm hastalar klinik özelliklerine göre iki cerrah tarafýndan opere edildi. Olgular ortalama 31,4±25,6 ay süre ile takip edildi.
BULGULAR: 1 saatlik DKT sonucunda psödodiverjans fazlalýðý olarak görülen 1 olgu temel X(T)’ye dönüþtü ve olgularýn subgruplara göre daðýlýmý sonucunda 38’i temel X(T), 13’ü konverjans yetmezlið i, 19’u diverjans fazlalýðý olarak tespit edildi. 38 temel X(T)’li olgudan 29’una bilateral MR kýsaltma, 4’üne geriletme-kýsaltma, 1’ine tek LR geriletme, 4’üne tek MR kýsaltma operasyonu uygulandý. 13 konverjans yetmezliði X(T) subgrubundaki olgunun 11’ine bilateral MR kýsaltma, 1’ine geriletme- kýsaltma, 1’ine tek MR kýsaltma, 19 diverjans fazlalýðý X(T) subgrubundaki olgunun 12’sine bilateral LR geriletme, 7’sine tek LR geriletme cerrahisi uygulandý. Olgularýn tümünde, postoperatif uzakta ve yakýnda kayma miktarlarý nýn preoperatif kayma miktarlarý ile kýyaslandýðý nda azalmanýn istatiksel olarak anlamlý olduð u gözlendi. Tüm X(T) subgruplarýnda da azalma istatiksel olarak anlamlý idi. Olgularýmýzýn postoperatif takibi sonucunda 20 (% 28,6) olguda nüks saptandý. 6 (%8,6) olgudan 1’i konsekütif ezotropya, 5’i rezidü ekzotropya nedeniyle reopere edildi. Olgularda hiçbirine 3. kez operasyon uygulanmadý. Reopere olan olgularda baþarý oranlarý uzak ve yakýnda %83,3 idi.
TARTIÞMA ve SONUÇ: Biz bu çalýþmanýn sonucunda diagnostik kapama testi ile doðru X(T) subgrubunun ve maksimal kayma açýsýnýn tesbiti ile, uygun cerrahi teknik uygulanmasý sonucunda X(T) tedavisinde baþarýlý sonuçlar alýnacaðýný düþünmekteyiz.

INTRODUCTION: We aimed to evaluate the surgical outcomes and recurrent rates of our patients with intermittent exotropia (X(T)) underwent horizontal strabismus surgery in this study.
METHODS: Retrospectively we recruited 70 patients with X(T) during 17 years in this study. All cases were seperated into four groups according to one hour diagnostic occlusion test (DOT): 1. Basic type 2. Divergence excess 3. Convergence insufficiency 4. Pseudodivergence excess. Bilateral resection of medial rectus muscle (MR), unilateral resection of MR, combined recession-resection, bilateral recession lateral rectus muscle (LR) and unilateral recession of LR were applied by two surgeons according to types of X(T). The postoperative following mean period was 31.4±25.6 months (6 months-9 years). Postoperative ±10 prism dioptric (PD) deviation was accepted for surgery success.
RESULTS: After DOT, we found 38 patients were basic type, 19 patients were divergence excess, 13 patients were convergence insufficiency. Forty patients underwent bilateral resection of MR, 5 patients underwent unilateral resection of MR, 5 patients underwent combined recession-resection, 12 patients underwent bilateral recession of LR and 8 patients underwent unilateral recession of LR. In all cases, the mean distance deviation was -27.5±12.9 PD preoperatively. It was found between -3.5±4.4 PD and -8.5±6.6 PD postoperatively. The mean near deviation was -24.3±13.6 PD preoperatively. It was found between -3.1±4.7 PD and -8.2±7.7 postoperatively. In all cases postoperatively success rate was 84.2% at distance, 81.4% at nearby. We observed 20 (28.6%) recurrent cases during follow up.
DISCUSSION AND CONCLUSION: We suggested to apply DOT to X(T) patients for detecting the maximal deviation angle and subgroups of X(T) for surgery success.

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GÝRÝÞ ve AMAÇ: Prostat biyopsisi sýrasýnda farklý anestezi ve analjezi kombinasyonlarýnýn aðrý kontrolü üzerine etkisini karþýlaþtýrmak, hasta konforunu arttýrýp biyopsi örnekleme kalitesini yükseltecek minimal invazif bir anestezi protokolü geliþtirmek.
YÖNTEM ve GEREÇLER: Þubat 2008-Haziran 2009 arasýnda PSA düzeyi >2,5 ng/ml ve/veya parmakla rektal inceleme bulgusu nedeniyle TRUS eþliðinde standart 10 kadran prostat biyopsisi yapýlan hastalar çalýþmaya alýndý. Hastalar, intrarektal topikal %2’lik lidokainli jel + Petidin 100mg i.m (Grup 1, n: 25), topikal %2’lik lidokainli jel + Lornoksikam 8mg i.m (Grup 2, n: 21), topikal %2’lik lidokainli jel + Midazolam 3mg i.m (Grup 3, n: 20) ve %2 prilokain ile apikal infiltratif anestezi + Petidin 100mg (Grup 4, n: 28), %2 prilokain + Lornoksikam 8mg i.m (Grup 5, n: 54), %2 prilokain + Midazolam 3mg i.m. (Grup 6, n: 45) olacak þekilde 6 gruba ayrýldý. Aðrý þiddeti, 0 (hiç aðrý hissetmemesi) ila 10 (hayatýnda duyduklarý en þiddetli aðrý) arasýnda deðiþen 10 ölçekli VAS (vizüel analog skala) ile deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 193 hasta için yaþ ortalamasý 64,7± 8,7 idi. Gruplar arasýnda yaþ, serum PSA deðerleri, prostat hacimleri için anlamlý farklýlýk saptanmadý (p>0,05). Lokal anestezi + larnoksikam uygulamasýnýn (Grup 5) en yüksek, topikal anestezi ve midazolam kombinasyonun (Grup 3) en düþük aðrý kontrolü saðladýðý saptandý. Lokal anestezi ile kombinasyon kullaný mýnýn (grup 4,5,6), topikal anestezi ile kombinasyon tedavilerine (grup 1,2,3) göre daha düþük VAS skorlarý saðladýðý bulundu. Topikal lidokain grubuna Petidin eklenmesi, lokal prilokain gruplarýyla benzer etkinlik gösterdi.
TARTIÞMA ve SONUÇ: Prostat biyopsisinde aðrý kontrolünde topikal lidokain + Petidin kombinasyonu, en az lokal infiltratif anestezi kadar etkili yöntemdir.

INTRODUCTION: To compare the efficacy of various anesthetic and analgesic combinations in pain control during prostate biopsy, and to develop a minimally invasive protocol aimed to improve patient comfort and raise the quality of sampling during biopsy.
METHODS: Between February 2008 and June 2009, patients with a high PSA (>2.5 ng/ml) and/or abnormal digital rectal examination findings who underwent standard 10-core TRUSguided prostate biopsy were included. Patients were randomly divided into: Intrarectal topical lidocaine 2% gel + Pethidine HCl 100mg im (Group 1, n: 25), topical lidocaine 2% + Lornoxicam 8mg im (Group 2, n: 21), topical lidocaine 2% + midazolam 3mg i.m (Group 3, n: 20), apical infiltration with 2% prilocaine + Pethidine Hal 100mg im (Group 4, n: 28), 2% prilocaine + Lornoxicam 8mg im (Group 5, n: 54), 2% prilocaine + Midazolam 3mg i.m. (Group 6, n: 45) into six groups. Severity of pain was assessed with visual analogue scale (VAS) ranging from 0 (no pain) to 10 (worst pain during lifetime).
RESULTS: Mean age was 64.7±8.7 years. There was no difference between groups for age, serum PSA levels and prostate volume (p> 0.05). Local anesthesia + larnoxicam (group 5) provided the best, topical anesthesia + midazolam (group 3) provided the worst pain control. Combination of analgesics with local anesthesia (groups 4,5,6) resulted in lower VAS scores as compared to combination with topical aesthetic (groups 1,2,3). The addition of Pethidine to topical lidocaine showed an equivalent efficacy with local anesthetic groups.
DISCUSSION AND CONCLUSION: Topical lidocaine + Pethidine combination is an alternative to local infiltrative anesthesia for pain control during prostate biopsy.

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GÝRÝÞ ve AMAÇ: Hepatit B enfeksiyonu akut, fulminan ve kronik hepatit; karaciðer sirozu ve sonunda hepatoselüler kansere neden olduðu için dünya genelinde yaygýn ve önemli bir saðlýk sorunudur. Hepatit B Virus (HBV) enfeksiyonu vertikal geçiþ nedeniyle gebelerde de önemli bir saðlýk sorunudur. Bu çalýþmamýzda kliniðimize baþvuran gebelerde antenatal dönemdeki Hepatit B Yüzey Antijeni (HBsAg) pozitiþiðini ve bunun sosyodemografik faktörlerle olan iliþkisini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýza 2009 yýlý Ocak-Temmuz aylarý arasýnda kliniðimize baþvuran 15-44 yaþlarý arasýndaki toplam 140 gebe hasta katýldý. Gebeler sosyodemografik özelliklerine (doðum yeri, saðlýk güvencesi, meslek, önceki cerrahi vs.) göre sýnýþandý.
BULGULAR: HBsAg (Hepatit B Yüzey Antijeni) pozitifliði yalnýzca 9 hastada (% 6.4) ve antiHBs antikoru pozitiþiði 20 hastada (% 14.2) saptandý. Bu 9 hastanýn tümünde Anti-HBs antikoru negatifti ve HBV aþýsý uygulanmamýþtý. Daha önce sezaryen öyküsü olanlarda öncesinde sezaryen öyküsü olmayanlardan istatistiksel olarak anlamlý þekilde daha yüksek HBsAg pozitiþiði bulundu (sýrasýyla, % 15.3’e karþý % 5.5, p< 0.05). Sezaryen dýþýnda herhangi bir operasyon geçiren gebeler opere olmamýþ hastalara göre anlamlý derecede daha yüksek HBsAg’e sahipti (sýrasýyla, % 12.9’a karþýn % 4.5, p< 0.05). AntiHBs antikor pozitiþiði saðlýk çalýþaný gebelerde % 62.5, diðer iþlerde çalýþan gebelerde ise % 11.3 idi.
TARTIÞMA ve SONUÇ: HBs Ag pozitifliði daha önce yapýlan çalýþmalarýn sonuçlarýyla uyumlu bulunmuþtur. HBsAg pozitiþiði önceden sezaryen ve/veya baþka bir cerrahi iþlem geçiren hastalarda daha yüksek bulunmuþtur. Ancak, virusun diðer bulaþma yollarý da göz önünde bulundurulmalýdýr.

INTRODUCTION: Hepatitis B infection is a worldwide health problem because of causing acute, fulminant and chronic hepatitis, which may result in cirrhosis and finally hepatocellular cancer. Hepatitis B Virus infection in the pregnants is also an important health problem because of the vertical transmission. We aimed to search the HBsAg positivity and its relationship with the socio-demographic factors in the pregnants referred to our clinic in the antenatal period.
METHODS: One hundred forty pregnant women aged 15-44 were included our study in 2009 January-July. Pregnants were classified with their socio-demographic parameters (birth place, health insurance, profession, previous surgery etc).
RESULTS: HBsAg positivity was detected only in 9 patients (%6,4), and antiHBs antibody positivity was detected in 20 patients (%14,2). Statistically significant HBsAg positivity was found higher in patients with previous sectio history than in patients without previous sectio history (respectively, 15.3 % vs. 5.5 %, p< 0.05). Pregnants with surgical procedure history (C/S cases not included), also had a significantly high HBsAg positivity against non-operated pregnants (respectively, 12.9 % vs. 4.5 %, p< 0.05). AntiHBs antibody positivity was found 62.5 % in pregnants work at health career and 11.3% in pregnants work in other fields.
DISCUSSION AND CONCLUSION: HBsAg positivity was found to be consistent with other previous study results. High levels of HBsAg positivity should be kept in mind in the patients who previously underwent surgery or sectio. But, the other routes of contamination should be evaluated.

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GÝRÝÞ ve AMAÇ: Romatoid Artirit (RA) de mortalitenin en önemli sebebi kardiyovasküler sistem (KVS) tutulumudur. Aortun mekanik özelliklerinin invaziv olmayan yöntemlerle deðerlendirilmesi aterosklerozun erken tanýsýnda oldukça yararlýdýr. Bu çalýþmada; ateroskleroz geliþimine yol açabilecek baþka hastalýðý ve risk faktörleri olmayan RA’lý hastalarda aortun elastisite parametreleri ile hastalýðýn aktivite ölçümleri arasýnda etkileþim olup olmadýðý araþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya 46 RA’li hasta ve 20 saðlýklý birey alýndý. Hastalarýn hastalýk süresi, DAS-28 skorlarý, eritrosit sedimentasyon hýzý (ESH), Creaktif proteinleri (CRP) ve lipid düzeyleri kaydedildi. Ekokardiyografik deðerlendirme ile aortun elastik parametreleri hesaplandý ve gruplar arasý nda karþýlaþtýrma yapýldý. RA’lý hastalarýn aktivite ölçümleri ile aortun elastik parametreleri arasýndaki iliþki araþtýrýldý.
BULGULAR: RA’lý hastalarýn aortik strain ve distensibilite düzeyi; kontrol grubuna göre daha düþük bulundu (p<0.002). Aortik strain ile ESH arasýnda istatistiksel olarak ileri düzeyde anlamlý bir iliþki saptanmýþtýr (p<0.01). Distensibilite ile DAS28 ve ESH arasýnda istatistiksel olarak anlamlý bir iliþki bulundu (p<0.05).
TARTIÞMA ve SONUÇ: Ekokardiyografi ile noninvaziv metod olarak ölçülen aortik elastisite parametreleri hastalýðý n erken döneminde kardiyovasküler riski tahmin etmede faydalý olabilir.

INTRODUCTION: In patients with RA, the cardiovascular system involvement is the most important reason for the increase of mortality. Evaluation by non-invasive methods of mechanical properties of the aorta is quite useful in early diagnosis of atherosclerosis. In this study we have investigated that the relation between aortic elasticity parameters and the disease activity criteria in the RA patients who has not have any risk factors and any diseases leading to the development of atherosclerosis.
METHODS: 46 RA patients and 20 healthy subjects were included in the study. The patients, disease duration and DAS-28 scores and ESR and CRP and lipid parametres results were recorded. Echocardiographic evaluation was performed and the aortic elastic parameters were calculated and compared between groups. Activity parameters of patients with RA and the relation between aortic elastic parameters were investigated.
RESULTS: Aortic strain and distensibility levels of RA patients, were lower than the control group (p <0.002). According to there is no statistically significant difference between patient and control groups. There is a statistically significant relationship between DAS28 and distensibility (p <0.05). And there is a statistically significant correlation between ESH and distensibility (p <0.01). And there is advanced level of statistically significant correlation between strain and the ESH (p <0.01).
DISCUSSION AND CONCLUSION: Aortic elasticity parameters measured by echocardiography as a noninvasive method may be useful to predict the risk of cardiovascular disease at early stages.

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Pelvik radyoterapi, birçok malignite tedavisinde sýklýkla uygulanmaktadýr. Radyoterapinin erken ve geç dönemde gastrointestinal sistem üzerinde etkileri iyi bilinmektedir. Erken dönemde meydana gelen enterit çoðu zaman konservatif yöntemler ile tedavi edilir. Geç dönemde görülen barsak yapýþýklýklarý, obstrüksiyon, perforasyon ve fistül oluþumu gibi kompikasyonlar cerrahi müdahale gerektirir. Radyoterapiye baðlý barsak perforasyonu nadirdir. Akut peritonit bulgularý geç dönemde ortaya çýkar ve taný zorluklarýna sebep olur. Hastane yatýþý sonrasý akut batýn bulgularý geliþen ve radyoterapiye baðlý ince barsak perforasyonu nedeni ile opere ettiðimiz hastayý sunuyoruz.

Pelvic radiotherapy is commonly used in treatment of many malignities. The early and late term effects of radiotherapy on gastrointestinal system are well known. Enteritis in early period is usually treated with conservative measures. Complications such as intestinal adhesion, obstruction, perforation and fistula formation are needed surgical intervention. Intestinal perforation due to radiotherapy is rare. The signs of acute peritonitis are delayed and cause diagnostic difficulties. We are presenting a patient with late signs of acute abdomen after his admission. He was operated due to intestinal perforation after radiotherapy.

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Osteoporoz; kemik kitlesinde azalmaya baðlý olarak, kemiðin zayýþamasý, özellikle vertebra, kalça ve el bileðinde kýrýk riskinde artýþa yol açan bir iskelet sistemi hastalýðýdýr. Osteoporoz tanýsý sýklýkla postmenopozal veya senil osteoporoza indirgenmiþ olup, kemik mineral yoðunluðu (KMY) düþük olan hastalar primer osteoporoz tanýsý ile tedavi edilmektedir. Bu durum sekonder osteoporoz nedenlerinin atlanmasýna veya tanýsýnýn konulmasýnda gecikmelere neden olmaktadý r. Altý ay önce bel aðrýsý þikayetiyle özel bir hastaneye baþvuran, yapýlan Dual Enerji X-ray Absorpsiyometre (DEXA) ölçümü sonrasý osteoporoz tanýsý konularak bifosfonat baþlanan ancak iç hastalýklarý kliniðimizde multipl miyelom taný sý konulan bir olguyu sunmak istedik.

Osteoporosis; the weakening of the bone due to a decrease in bone mass, is a skeletal disease that increase the risk of fractures especially in the spine, hip and wrist. Diagnosis of osteoporosis often is reduced in postmenopausal or senile osteoporosis, in patients with low bone mineral density (BMD) therapy is started with the diagnosis of primary osteoporosis. This situation leads to delay the diagnosis of secondary osteoporosis or causes to be bypassed. We wanted to present a patient who applied to a private hospital with low back pain 6 mount ago and according to the dual energy Xray Absorptiometry (DEXA) measurement diagnosed as osteoporoses and bisphosphonate treatment was started and then diagnosed as multiple myeloma in our internal medicine department.

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Sturge Weber sendromu, yüzde porto þarabý rengi leke, glokom ve koroidal hemangioma gibi göz anomalileri ve leptomeningial anjioma ile karakterize sporadik, nörokutanöz bir hastalýktýr. Klinik belirtiler, hafif inkomplet formdan leke, nöbetler, mental retardasyon ve glokom gibi tüm belirtilerin olduðu komplet forma kadar deðiþkenlik gösterebilir. Yüzün üst yarýsýnda, porto þarabý rengi leke ile doðmuþ çocuklar beyin tutulumu açýsýndan yüksek risk altýndadýr. Bu çocuklarda, nöbet ve diðer nörolojik tutulumlarýn geliþme sýklýðý yüksektir. Bu olguda, 8 aylýk kýz bebek kliniðimize travma sonrasý kusma, konvülziyon semptomlarý ile getirildi. Çocuðun yüzünün üst yarýsýnda, þarap rengi nevus mevcuttu. Beyin MR ý leptomeningial anjiomatozis ve cerebral atrofi ile uyumlu olup hastalýðý destekliyordu. Yaþamý n ilk bir yýlýnda nöroljik geliþim normal bile olsa, Sturge Weber Sendromlu infant ve küçük çocuklarý n erken tanýnmasý gereklidir çünkü fokal nöbetler ve lokal hipoksinin yol açtýðý serebral atrofi, ilerde geliþecek mental retardasyon, öðrenme ve davranýþ bozukluklarýnýn sorumlusudur.

Sturge weber syndrome is a sporadic neurocutaneous disease, characterized by facial port-wine stain, ocular abnormalities (glaucoma and choroidal hemangiomal) and leptomeningeal angioma. Clinical features vary from mild incomplete forms to complete disease with facial stain, seizures, mental retardation and glaucoma. Children born with a port wine stain on the upper part of the face are at risk for brain involvement. These infants and young children often develop seizures and other neurologic impairments. Eight months aged girl was taken to our clinic, presenting with the symptoms of vomiting, convulsions after having been dropped (trauma). She had a port-wine stain in her upper part of the face. Contrast enhanced MRI of brain revealed leptomeningeal angiomatosis and cerebral atrophy. Although neurologic development is normal in the first year of life, infants and young children with Sturge Weber syndrome, should be diagnosed as early as possible because focal convulsions and local hypoxia can cause cerebral atrophy, that is responsible for mental retardation, attention disorders and learning disabilities.

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