GÝRÝÞ ve AMAÇ: Bu araþtýrma; hastanelerde ortopedik týbbi malzemelerin satýn alýnmasý, depolanmasý ve klinikte kullanýlmasý aþamalarýnda yaþanan sorunlarý belirlemek, çözüm önerilerini ortaya koymak ve ortopedik malzemelere odaklanmanýn nedenlerini belirlemek amacýyla yapýlmýþtýr.
YÖNTEM ve GEREÇLER: Araþtýrmada yüzyüze görüþme ile çalýþmacýlar tarafýndan hazýrlanan anket yöntemi kullanýlmýþ ve 2011 yýlýnda uygulanmýþtýr. Araþtýrmada tesadüfi örnekleme yöntemi seçilmiþ ve anketi eksiksiz yanýtlayan 181 kiþi örneklem olarak belirlenmiþtir. Eksik doldurulan 9 anket deðerlendirmeye alýnmamýþtýr. Ankette beþli Likert ölçeði uygulanmýþ ve anketin deðerlendirilmesinde SPSS 15,0 istatistik yazýlýmý kullanýlmýtýr.
BULGULAR: Araþtýrma kapsamýna; ortopedi ve travmatoloji hekimleri ve satýnalma ile depo sorumlularý dahil edilmiþtir. Asistanlar kapsam dýþýnda býrakýlmýþtýr. Anketi, araþtýrma konusunda deneyimli yetkililerin doldurmasý saðlanmýþtýr.
TARTIÞMA ve SONUÇ: Genel olarak ortopedik malzemelerin klinikte kullanýlmasý aþamasýnda %72.4, satýn alýnmasý aþamasýnda %66.9 ve depolanmasý aþamasý nda %52.5 oranýnda sorun yaþandýðý belirlenmiþtir. Bu sorunlara yönelik farklý çözüm önerileri tespit edilmiþtir. Ortopedik týbbi malzemelere odaklanmanýn en önemli nedeni, hizmet kalitesini arttýrmak olarak belirlenmiþtir. Araþtýrmanýn üst yönetimin ortopedik týbbi malzemelerle ilgili yönetsel kararlarýnda destekleyici olacaðý varsayýlmaktadýr.

INTRODUCTION: This research was carried out to determine the problems regarding purchase, storage and use of the orthopedic medical supplies in clinic, to put forward the proposed solutions and to specify the reasons for focusing on orthopaedic materials.
METHODS: In this study, face to face interviews and the survey prepared by the researchers were used and implemented in 2011. The random sampling method was applied and 181 individuals responded to the survey completely were identified as a sample.
RESULTS: 9 incomplete surveys were not assessed. In the survey, five point likert scale was applied and the survey was evaluated by the help of the SPSS 15,0 statistical software. Orthopedic and traumatology physicians along with purchasing and warehouse managers were included in the scope of the research. However, physician assistances were excluded from the scope.
DISCUSSION AND CONCLUSION: The survey has been filled out by officials with experienced in research. In general, it is identified that people encountered with the problems during the usage of orthopaedic materials in the clinic by the rate of 72.4%, and during purchasing and storage stages by the rates of 66.9% and 52.5%, respectively. Different solutions for these problems have been identified. The most important reason for focusing on orthopaedic medical devices is to improve the quality of service. This research is assumed to be supportive of managerial decisions regarding top management of orthopaedic medical supplies.

GÝRÝÞ ve AMAÇ: Yoðun bakým ünitesinde (YBÜ) yatak baþý yükseltme ventilatör iliþkili pnömoniden (VÝP) korunmak için kolay ve etkili yöntemdir.
YÖNTEM ve GEREÇLER: Çalýþmamýzda YBÜ’nde bu uygulamanýn her gün hatýrlatýlmasýnýn uygulamaya katkýsý olup olmadýðýný araþtýrmayý amaçladýk.
BULGULAR: Ýleriye dönük kohort çalýþma 22 yataklý göðüs hastalýklarý YBÜ’de Aralýk 2010 ve Ocak 2011 de yapýldý. Çalýþma yürütücüleri dýþýnda ünitedeki diðer çalýþanlarýn gözleme dayalý çalýþmadan haberi yoktu. Aralýk ayýnda her gün sabah 08: 00 de ve akþam 17: 00 de 22 YBÜ yataðý için hasta baþlarýnýn 30–45 derecede veya düz olup olmadýklarý kayýt edildi.
TARTIÞMA ve SONUÇ: Ocak ayýnda her gün yatak sorumlu hemþirelerine yatak baþý yükseltmesi söylendi ve 08: 00 ve 17: 00? de yatak baþý durumu tekrar kayýt edildi. Enfeksiyon hemþiresi her iki ayda VÝP olgularýný kayýt etti. Aralýk ayýnda 1 hastada VÝP geliþti ve 12. gün yaþamýný yitirdi. Ocak 2011 de 3 VÝP, 1 aspirasyon pnömonisi ve 4 hasta toplam 64 gün YBÜ de yatýrýldý, 1 hasta yaþamýný yitirdi. YBÜ’lerinde yatak baþý yükseltilmesi gereði her gün, belli saatlerde, nöbet þifti deðiþiminde hatýrlatýlmasý uygun olmayan yatak baþ pozisyon sayýlarýný azaltýr. Bu yöntem YBÜ kalýþ gününü kýsaltýr, ülke gelirine katký, enfeksiyona baðlý mortalitede azalma saðlar.

INTRODUCTION: Lifting head of bed is the easiest and most important way to prevent ventilator-associated pneumonia (VAP) in intensive care unit (ICU).
METHODS: In our study we investigated contribution of reminding this application.
RESULTS: Prospective study was done in 22 bed intensive care unit (ICU) during December 2010 and January 2011. None of the staff other than researchers were aware of this observational study. Every day during December 2010 at 8.00 a.m and 5.00 p.m 22 ICU bed head position were recorded whether their heads were 30-45 degrees elevated or horizantal.
DISCUSSION AND CONCLUSION: During January 2011, nurses responsible for beds were told to lift bed head positions and bed head positions were recorded again. Infection nurse noted aspiration or VAP cases every two months. Values were summarized with descriptive method. One patient had VAP and died 12th day of stay in December 2010 In January 2011; 3 VAP, 1 aspiration pneumonia were observed and they stayed total 64 days in ICU and one of these was died. Reminding of lifting bed head positions at certain hours, during shift changes reduce inappropriate bed head position. This method which is used in reducing the risk of VAP and aspiration pneumonia, shortens ICU stay, contribute country income, decrease aspiration related mortality.

GÝRÝÞ ve AMAÇ: Ýntestinal metaplazinin Helicobacter pylori enfeksiyonu ile sýký bir birliktelik gösterdiði, Helicobacter pylorinin intestinal metaplazi patogenezinde kolaylaþtýrýcý rol oynadýðý birçok kaynakta bildirilmiþtir.
YÖNTEM ve GEREÇLER: Bu çalýþmanýn amacý Siverek bölgesindeki Helicobacter pylori sýklýðýný belirlemek ve intestinal metaplazi ile birlikteliðini saptamaktýr.
BULGULAR: Toplam 157 olguya ait endoskopik biyopsi materyalini retrospektif olarak deðerlendirdik.
TARTIÞMA ve SONUÇ: Helicobacter pylori 69 (%43,9) hastada pozitif olarak saptandý. Helicobacter pylori earlýðý ile intestinal metaplazi arasýnda anlamlý bir iliþki bulunamadý.

INTRODUCTION: Concordence of intestinal metaplasia with Helicobacter pylori infection and the role of Helicobacter pylori in pathogenesis of intestinal metaplasia have been reported in many reviews.
METHODS: The aim of this study to evaluate the frequency of Helicobacter pylori and concordance of intestinal metaplasia in Siverek.
RESULTS: We evaluated totally 157 endoscopic biopsies retrospectively. H.pylori was found in 69 (%43.9) patients.
DISCUSSION AND CONCLUSION: There is no a significantly relation between positivity of Helicobacter pylori and intestinal metaplasia.

GÝRÝÞ ve AMAÇ: Bu çalýþmada, hastanemizde mamografi ve ultrasonografi ile tespit edilen ve sonrasýnda patolojik deðerlendirilmesi yapýlan lezyonlarýn BI-RADS skorlarý ile patolojik sonuçlarýnýn karþýlaþtýrýlmasý, her kategori için sensitivite, spesifisite, pozitif ve negatif prediktif de¤erlerin hesaplanmasý, bulgularýn literatür ile karþýlaþtýrýlmasý ve kliniðimizin performansýnýn deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmamýza Mayýs 2008 ve Aralýk 2010 tarihleri arasýndaki 32 aylýk dönemde, Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi Radyoloji Kliniði mamografi ünitesine baþvuran 9703 olgunun mamografi tetkikleri ve ek olarak yapýlan ultrasonografileri dahil edildi. Bu incelemeler ile tespit edilen ve sonras›nda kliniðimizde biyopsi uygulanan ya da hastanemizde opere edilen lezyonlarýn patolojik sonuçlarý ile BI-RADS skorlarý karþýlaþtýrýldý.
BULGULAR: Patolojik taný verilen toplam 419 hastadan kategori 1, 2, 3 grubunda yer alanlar benign yani hastalýk açýsýndan radyolojik olarak negatif kabul edildi. Benzer þekilde kategori 4 ve 5 grubunda yer alanlar ise radyolojik olarak malign yani pozitif kabul edildi. Kategori 1, 2 veya 3 grubunda yer alan toplam 175 hastadan 169’u benign, 6’sý malign idi. Kategori 4, 5 grubunda ise toplam 244 hastadan 136’sý benign, 108’i malign idi. Bu þekilde yapýlan gruplamalar patoloji sonuçlarý ile karþýlaþtýrýlarak sensitivite, spesifisite, doðruluk, pozitif prediktif de¤er(PPD) ve negatif prediktif deðer(NPD) hesaplandý. Kategori gruplamasý için sensitivite % 94,5, spesifisite % 55,4, pozitif prediktif deðer % 43,0, negatif prediktif deðer % 95,6 olarak bulundu.
TARTIÞMA ve SONUÇ: Çalýþmamýzda elde edilen sensitivite, spesifisite, pozitif prediktif deðer ve negatif prediktif deðerler literatürdeki benzer çalýþmalar ile uyumlu bulunmuþtur. Ayrýca çalýþmamýz sýrasýnda, benign olarak kategorize edilmelerine karþýn klinisyenlerin talebiyle çok sayýda hastaya yapýlan biyopsilerin, beklendiði gibi benign sonuçlar verdiðini ve bu durumun zaman, emek ve maliyet artýþýna neden olduðunu gördük. Yani BI-RADS uygulamasýnýn sadece radyoloji kliniði tarafýndan deðil, meme hastalýklarýnýn taný ve tedavisinde rolü bulunan diðer dallara mensup hekimler tarafý ndan da benimsenmesinin yöntemin etkinliðini artýracaðýný düþündük.

INTRODUCTION: In this study, we aimed to correlate the BI-RADS scores and histopathologic results of lesions detected by mammography and/or sonography in our clinic. Positive and negative predictive values, sensitivity and specificity for each category were also calculated and compared with the literature in order to evaluate quality of care in our department.
METHODS: 9703 patients referrring to the mammography department of Haydarpafla Numune Training and Research Hospital between May 2008 and December 2010 were included in the study. BI-RADS scores obtained with mammography and complementary sonography were compared with pathology findings, as determined by means of fine needle, core needle or excisional biopsies.
RESULTS: 419 lesions in 9703 patients received pathological evalution. BI-RADS category 1,2 and 3 were radiologically considered to be benign and those in category 4 or 5 malignant. Out of 175 lesions in category 1, 2 or 3, 169 were benign and 6 malignant; while out of 244 lesions in categoy 4 or 5, 136 lesions were benign and 108 were malignant. The respective sensitivity was calculated as 94.5 %, specificity as 55.4%, positive predictive value 43 % and negative predictive value 95.6 %.
DISCUSSION AND CONCLUSION: The sensitivity, specificity, positive and negative predictive values calculated in our study were found to be consistent with those from other studies in the literature. However, a high number of biopsy procedures were carried out for lesions in the radiologically benign lesions on the request from other clinicians, revealing benign findings as expected. Thus integrating BIRADS lexicon into the daily practice, not only for radiologists but also for clinicians diagnosing and treating breast diseases, will contribute to the cost-effectiveness and improvement of patient care.

GÝRÝÞ ve AMAÇ: Son yýllarda pnömoni tedavisinde erken ve etkili antibiyotiklerin kullanýmý ile akciðer apselerin insidansý azalsa da, hala nadir olarak görülmektedir. Bu çalýþmada, kliniðimizde nekrotizan akciðer enfeksiyonlarýna baðlý, piyojenik bakterilerle oluþan, akciðer apsesi tanýsý alan olgularýn etyolojik ve klinik özelliklerini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: 2002–2008 yýllarý arasýnda Süreyyapaþa Hastanesi 3. kliniðinde, 11 akciðer apseli ( K/E = 2/9, yaþ ortalamasý: 44( 23-65 yýl )) olgu geriye dönük olarak incelendi.
BULGULAR: En yaygýn risk faktörü pnömoni tedavisinin gecikmesi, diyabet ve yaþtý (sýrasýyla: n= 4, 3, 3). En sýk semptom öksürük-balgam ve halsizlikti (sýrasýyla: n=9, 6). Apselerin radyolojik yerleþiminde fark yoktu. Bakteriyolojik çalýþmalar etkeni belirlemede yardýmcý olmadý. Ayýrýcý taný ve bakteriyolojik örnekleme amacýyla bronkoskopi kullanýldý (n=9 ). Tedavide, genellikle 4 haftadan 4 aya kadar uzayan sürelerde, amoksisilin-sulbaktam ve/veya clindamisin kullanýldý. Tüm olgular klinik ve laboratuar olarak düzelirken; radyolojik olarak 5 olguda tam düzelme, 5 olguda sekelli düzelme görüldü. 1 olguda radyoloji ayný kaldý, cerrahi gerektiren vaka olmadý.
TARTIÞMA ve SONUÇ: Sonuç olarak; kliniðimizde takip edilen akciðer apseli olgularda etkeni saptamada yetersiz kalýnsa da ampirik tedavi ile baþarýlý sonuçlar alýnmýþtýr.

INTRODUCTION: Although the incidence of abscess has decreased recently because of using effective antibiotic therapy, it has still observed rarely. Our aim in this study was to assessment clinical and etiologic features of lung abscess that was arouse from necrotizing lung infection due to pyogenic bacteria, in our clinic
METHODS: 11 in patients with lung abscess [F/M=2/9, mean age: 44 (23–65) years] were reviewed at Süreyyapasa Hospital in the 3rd Clinic from 2004 to 2008, retrospectively.
RESULTS: The most common predisposing factors included; delayed of pneumonia treatment, diabetes mellitus and age (respectively n=4,3,3). The most frequent symptoms were cough-sputum and weakness (respectively n =9,6). There were no differences in radiologic zones of lung abscess. Bacteriological examination was not confirm to ethology. Fiberoptic bronchoscopy was extremely used to differentiate diagnosis and bacteriological sampling (n=9). Antibiotics such as amoxicillin-sulbactame and/ or clindamisine have been used to treatment for a long period, usually four weeks to four months. While all cases were complete clinical and laboratory improvement; in five patients complete radiological improvements and other five of them recovered with radiologic sequel, one case was stable radiological feature and no patient had to be operated.
DISCUSSION AND CONCLUSION: As a conclusion; in patients with lung abscess which were follow up in our clinic were improved by empiric antibiotic treapy, although insufficient of detected of bacteriologic agents.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, Yozgat’ta yaþayan gebelerin normal vaginal doðum ve sezaryen seksiyonun pelvik taban saðlýðý üzerine olan etkilerini anlama düzeylerini belirlemektir.
YÖNTEM ve GEREÇLER: Kliniðimize Temmuz 2011-Ocak 2012 arasýnda baþvuran toplam 322 hasta göre bu kesitsel çalýþmaya dahil edildi. Hastalar maternal eðitim düzeylerine göre dört gruba bölündü. Grup 1 hiç okula gitmeyen kadýnlardan oluþuyordu. Grup 2’deki hastalarýn ilköðretim diplomasý vardý. Grup 3’teki kadýnlarýn lise diplomasý vardý. Grup 4 üniversite mezunu deneklerden oluþuyordu. Katýlan kadýnlara yüz yüze görüþme metodu ile ayrýntýlý bir anket uygulandý. Hem demografik bilgiler hem de deneðin vaginal doðum ya da sezaryen seksiyo sonrasý pelvik tabanýn durumu hakkýndaki bilgileri deðerlendirildi.
BULGULAR: Anne eðitim düzeyi ile gebelerin doðum þeklinin pelvik taban üzerine olan etkileri hakkýndaki farkýndalýklarý arasýndaki iliþki araþtýrýldý. Deneklerin eðitim düzeyi arttýkça vaginal doðum ya da sezaryen seksiyonun üriner inkontinansý artýrýp artýrmadýðý sorularýna ‘hayýr’ yanýtlarýnýn yüzdesi de anlamlý þekilde artmaktaydý (p<0.05). ilginç bir þekilde, hastalarýn %65.9’u pelvik taban kas egzersizlerinin mesane ve/veya barsak problemlerini azaltmaya yardým edip etmediði sorusuna ‘evet’ dedi (p<0.05).
TARTIÞMA ve SONUÇ: Çalýþmamýza katýlan hastalar doðum þekli ne olursa olsun, gebelik sonrasý üriner inkontinansý n arttýðýný ifade ettiler. Pelvik taban kaslarýný kuvvetlendirici egzersizlerin doðum sonrasý üriner ve/veya fekal inkontinansý azaltýcý etkisi olduðuna inananlar anlamlý þekilde daha fazlaydý.

INTRODUCTION: The aim of this study is to determine the understanding level of pregnants living in Yozgat about the consquences of normal vaginal childbirth and caesarean section on pelvic flor health.
METHODS: A total 322 patients referred to our clinic between July 2011- January 2012 included to this cross-sectional study. The patients were divided into the four groups according to the maternal educational level. Group 1 was consist of women who never went to school. In Group 2, the patients had a certificate of elementary school. In Group 3, women had a certificate of high school. Group 4 was containing subjects graduated from university. A detailed questionnaire was addressed to the participating women by face-to-face interviewing method. Both demographic information and the subject’s knowledge about pelvic flor status after vaginal birth or caesarean section were assessed.
RESULTS: The association between maternal educational level and the awareness of the pregnant about the outcome of the delivery type on pelvic floor was investigated. The percentage of ‘no’ answers were getting significantly higher to the questions of whether vaginal delivery or caesarean section increase the urinary incontinence while the education of subjects increased (p<0.05). Interestingly, 65.9% of the patients said ‘yes’ to the question of whether exercises of the muscles of pelvic area help lessen the bladder and/or bowel problems (p<0.05).
DISCUSSION AND CONCLUSION: The patients paticipated our study reported that urinary incontinence after pregnancy was increased independant with the birth type. The subjects believed the protective effect of pelvic muscle strengthening exercises on urinary and/or fecal incontinence were statistically more.

GÝRÝÞ ve AMAÇ: Son 20 yýlda, perinatal ve neonatal týp alanýndaki geliþmelere paralel olarak prematüre doðan bebeklerin yaþam oranlarý artmýþtýr. YDYBÜ’de yatarak takip edilen gestasyon yaþý 36 hafta ve altýnda olan 59 prematüre bebek alýndý ve bu bebeklerin demografik özellikleri, klinik bulgularý ve prognozlarý deðerlendirildi.
YÖNTEM ve GEREÇLER: En yüksek mortalite oranlarý doðum aðýrlýklarý 999 gr altýnda (%31,5) ve gestasyon yaþý 28 hafta ve altý olan olgularda (%26,3) saptandý. Olgularýn ventilatörde (SIPPV/SIMV+VG) kalma süreleri 4,52±10,2 gün, CPAP süreleri ise 1,5±2.12 gün idi.
BULGULAR: Tüm olgularda BPD oran› %6,7, 28 haftanýn altýndaki bebeklerde %15,8 idi. Doðum aðýrlýklarýna ve gestasyon yaþýna göre BPD gözlenme oranlarý arasýnda istatistiksel olarak ileri düzeyde anlamlý farklýlýk saptanmadý (p>0,05). Doðum aðýrlýklarýna ve gestasyon yaþý 28 hafta ve altý olan olgularda IVK (evre 2-3) oraný anlamlý düzeyde yüksekti (p<0,01). PR oraný %6,7, 1000 gr altýndaki olgularda %18,8 idi. PR oraný 500-999 gr arasýnda olan olgularda anlamlý þekilde yüksek saptandý (p: 0,027).
TARTIÞMA ve SONUÇ: Sonuç olarak, YDYBÜ’mizde takip edilen 28 hafta ve 1000gr altýndaki bebeklerde saðkalým oranlarý yüksektir, ayrýca BPD, PR, ÝVK ve NEK gibi erken neonatal komplikasyon oranlarý düþüktür.

INTRODUCTION: In recent 20 years survival of preterm infants increased with development in perinatal and neonatal intensive care units. In our study, demographic features, clinical findings and prognoses of 59 preterm infants with gestational ages ≤36 week were evaluated.
METHODS: The most highest mortality rate was determined in the group of infants who were <999g ( 31,5%) and ≤28 week (26,3%). Duration of ventilation was 4,52±10,2 days, duration of CPAP was 1,5±2,12 days.
RESULTS: The BPD rate was 6,7%, in infants <28 week was 15,8 %. There was no difference between the BDP rates in the groups in terms of birth weight and the gestational age (p>0.05). The IVH (stage 2-3) rates were statistically higher in infants ≤28 weeks (p<0.01). ROP rate was 6,7%; in inflates <1000g was 18,8%. The ROP was significantly higher in the 500-999g group (p: 0,027).
DISCUSSION AND CONCLUSION: In conclusion; the survival rates of inflates <28 we eks and <1000g fallowed at our Neonatal Intensive Care Unit are notably high; and rates of the early neonatal complication such as BPD, ROP, IVH and NEC are lower.

GÝRÝÞ ve AMAÇ: Faktör V Leiden (FVL) gen mutasyonu, tromboza eðilim yaratan genetik risk faktörleri arasý nda en sýk görülenlerden biridir. Bu çalýþmada son iki yýlda Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesine tromboz saptanan olgularda, FVL gen mutasyonunun sýklýðýný, arteriyel ve venöz tromboz ile iliþkisini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Gözlemsel, olgu- kontrollü, retrospektif olarak tasarlanan çalýþmaya, 2008-2010 tarihleri aras›nda nöroloji, genel cerrahi, iç hastalýklarý kliniklerinde yatarak veya ayaktan izlenen, arteriyel ve/veya venöz trombozu klinik olarak saptanan ve radyolojik yöntemler ile de trombozu kanýtlanmýþ ve FVL gen mutasyonu tetkiki yapýlmýþ olgular alýndý. Periferik kandan DNA izolasyonu sonrasý nda FVL 1691 nükleotid mutasyonu Real-time PCR yöntemi ile çal›fl›ld›. PCR’› takiben 100-300 ngr genomik DNA kullan›larak erime e¤risi analizi ile mutasyon varlýðý deðerlendirilmiþtir. Çalýþmada elde edilen bulgular deðerlendirilirken, istatistiksel analizler için NCSS (Number Cruncher Statistical System) 2007&PASS 2008 Statistical Software (Utah, USA) programý kullanýldý.
BULGULAR: Çalýþmaya 67 trombozlu olgu ve kontrol grubu olarak 22 olgu alýndý. Trombozlu grubun yaþ ortalamasý 42,94±14,52 (Ortalama ± 1 Standart Sapma), cinsiyet daðýlýmý 37 (%55,2) kadýn, 30 (%44,8) erkek iken; kontrol grubunun yaþ ortalamasý 42,09±11,19 (Ort. ± 1SD), cinsiyet daðýlýmý 13 (%59,1) kadýn, 9 (%40,9) erkek þeklindeydi. Çalýþmamýzda 67 trombozlu olgunun 18(%26.9)inde, 22 kontrol grubunun 5(%22.7)’inde FVL mutasyonu pozitif bulundu. Trombozlu grupta FVL mutasyonu pozitif saptan 18 olgunun 16(%23.9)’s›nda FVL heterozigot mutant, 2(%3)’sinde ise homozigot mutant bulundu.
TARTIÞMA ve SONUÇ: FVL mutasyon sýklýðý ülkemizde, gen polimorfizminden söz ettirecek kadar yaygýn olmakla birlikte tek baþýna heterozigot mutant varlýðý, santral/periferik, gerek arteryel, gerekse venöz tromboz için bir risk faktörü gibi görünmemektedir. Olgu sayýsýnýn az olmasý nedeni ile homozigot mutant olgularýn tromboz risk deðerlendirilmesini yapamamakla birlikte, FVL gen mutasyonunun varlýðýnda, tromboz riski ilave diðer genetik ve edinsel risk faktörlerine baðlý gibi görünmektedir.

INTRODUCTION: Factor V Leiden(FVL) Mutation is one of the most common causes of genetic risk factors for thrombosis. In this study, we aimed to determine the frequency of, and association to arterial and venous thrombosis with FVL Mutation in patients diagnosed with thrombosis in the last two years in Haydarpafla Numune Research and Training Hospital.
METHODS: In this observational, case-controlled, retrospective study; patients diagnosed with thrombosis between the years 2008-2010 in the Internal Medicine, Neurology, and General Surgery Clinics who had this diagnosis comfirmed by radiological methods: and had Factor V Leiden Mutation screening done were chosen. Following DNA isolation from peripheral blood, FVL 1691 nucleotide mutation was searched using Melting Curve Analysis following Real-Time PCR. NCSS (Number Cruncher Statistical System) 2007&PASS 2008 Statistical Software (Utah, USA) programs were use for statistical analysis.
RESULTS: Two groups were formed for the study. Group 1 consisted of 67 patients diagnosed with thrombosis and group 2(control group) consisted of 22 healthy inviduals. Group 1 had a mean age of 42,94±14,52 (Mean ± 1SD), 37 (%55,2) of whom were female and 30 (%44,8) were male; whereas Group 2’s mean age was 42,09±11,19 (Mean ± 1SD), consisting of 13 (%59,1) female and 9 (%40,9) male healthy people. 18(%26.9) of 67 patients and 5(%22.7) of 22 healthy people tested positive for FVL mutation. Of the 18 patients of group 1 who tested positive for FVL mutation, 16(%23.9) were heterozygote mutant and, 2(%3) were homozygote mutant.
DISCUSSION AND CONCLUSION: Although FVL mutation is frequent enough in our country to contemplate gene polymorphism, heterozygote FVL mutation doesn’t seem to be a risk factor for either arterial or venous or central or periphery thrombosis by itself. Due to the small number of patients in the study we were not able to assess the risk for homozygote mutation. However, it seems likely that in the presence of FVL mutation, the risk for thrombosis is related to the other present risk factors.

Nöbet sonrasý iki taraflý humerus anatomik boyun kýrýðý geçirilmesi ve sonrasýnda osteonekroz geliþmesi çok az görülen bir durumdur. Bu yazýda her iki omuz bölgesinde çýkýk olmaksýzýn hareket kýsýtlýlýðý ve aðrý ile baþvuran, radyolojik deðerlendirmesinde her iki humerus anatomik boyun kýrýðý tespit edilen ve çok kýsa süre içinde her iki humerus baðýnda osteonekroz geliþmiþ olan 33 yaþýnda erkek hasta sunuldu. Tonik-klonik nöbetlerin eþlik ettiði “Stiffman sendromu” (SMS) tanýsý konulan hastaya öncelikle sað omuz için parsiyel protez uygulandý. Sol taraf için cerrahi planlanan hastada tekrarlayan nöbetler yeni bir giriflime izin vermedi. Genel vücut katýlýðý ve sistemik sorunlar nedeniyle hasta kaybedildi. Belirgin travma ve dislokasyon olmayan anatomik boyun kýrýklarýnýn ayýrýcý taný sýnda nöbetle iliþkili sendromlar göz önüne bulundurulmalýdýr.

Bilateral humerus diapyhsis fracture after a tonic clonic seisure is a rare condition. In this report we presented a 33 years old male patient admitted to emergency department with bilateral shoulder pain and after diagnostic workup patient was diagnosed as bilateral humeral head osteonecrosis caused by bilateral humeral anatomical neck fracture without dislocation. Patient was diagnosed as Stiffman Syndrome (SMS) with accompanying tonic clonic seisures and right shoulder was treated with partial shoulder prothesis. Recurrent seisures did not allow the surgical team to perform any surgical intervention for left shoulder. Patient died because of generalised stifness and systemic diseases. Seizure related syndromes should always be kept in mind in patients with anatomical humeral neck fractures without a history of trauma or dislocation.

Aksesuar meme seyrek nadir olarak görülmektedir. Asemptomatik kitleler veya kol hareketlerinin kýsýtlanmasý veya aðrý gibi belirtiler ile karþýmýza çýkabilir. Meme hattý boyunca yada meme hattý dýþýndaki yerlerde bulunmasý durumunda tanýsal zorluk nedenleri arasýndadýr. Aberran meme dokusu bulunan hastalara malignite ihtimali, fonksiyonel þikayetler ve kozmetik sebeplerde göz önünde bulundurarak, erken dönemde eksizyonel biyopsi uygulanmalýdýr. Bu olgu sunumumuzda bilateral aksiler yerleþim gösteren bir olgu nedeniyle aksesuar meme konusu gözden geçirilmitir.

Accessory breasts are an uncommon entity. They may present as asymptomatic masses or cause symptoms such as pain or restriction of arm movements. They may prove to be a diagnostic challenge if found in locations along or outside the mammary line. Aberrant breast tissue in patients with the possibility of malignancy, functional and cosmetic reasons, complaints, considering excision biopsy should be applied in the early period.We reported a case of accessory axillary breast and reviewed this anomaly.

Sistosarkoma phyllodes nadir bir meme tümörüdür. Tümör fibroepitelyal veya epitelyal ve stromal hücre bileþenidir. Bu tümörler genellikle iyi huyludur. Fibroadenomdan gelen phyllodes tümörü ayýrt etmek için spesifik bir belirti veya radyolojik görüntü yoktur. Bu nedenle taný için histolojik inceleme þarttýr. Tedavinin en önemli bileþeni geniþ cerrahi eksizyondur: Mastektomi sadece yeniden eksizyonlara raðmen normal doku elde edilemez ise gereklidir. Aksilla tutulumu nadir olup, rutin aksiller diseksiyon endike deðildir. Neyse ki, bu tümörlerin çoðu iyi huylu ve hastalýðýn yerel tekrarýný önlemek en önemli faktör olduýu gerçeði göz önüne alýndýðýnda, serbest doku yayýlýmý cerrahisinde meme koruyucuda maksimum alan iþleme alýnýr.Bu olgu sunumunda, meme koruyucu cerrahi uygulanan kadýn hastada benign sistosarkoma phyllodes tanýsý sunulmaktadýr.

Cystosarcoma phyllodes is an uncommon breast neoplasm.It is a fibroepithelial tutor composed or an epithelial and a cellular stromal component. These tumors are usually benign. There are no specific symptoms or radiological images to distinguish phyllodes tumor from fibroadenoma; therefore, histological examination is mandatory for diagnosis. The most important component of therapy is wide surgical excision, and mastectomy is necessary only when free margins cannot be achieved despite of re-excusion(s). Involvement of axillary nodes is rare, and routine axillary dissection is not indicated. Fortunately, the majority of these tumors are benign, and treatment maximizes breast conservation with free infiltration margins surgery, given that this fact is the most important factor to prevent local recurrence. In this article, we describe a rare case of diagnosed the benign Cystosarcoma phyllodes in a 53-year-old woman applied to breast conservation surgery.

Lipoma arboresens, etyolojisi bilinmeyen nadir bir intra-artiküler lezyondur. Genellikle dizde yerleþir. Sinoviyal membranýn yaygýn villöz proliferasyonu, subsinoviyal membranýn ve subsinoviyal yað dokusunun hiperplazisiyle karakterizedir. Yavaþ geliþen aðrýsýz þifllik en sýk bulgudur. Bu makalede lipoma arboresens için nadir bir lokalizasyon olan el bileði yerleþimli olgu sunulmuþtur.

Lipoma arborescens is a rare intra-articular lesion with unknown etiology characterised by extensive villous proliferation of the synovial membrane and hyperplasia of subsynovial membrane and hyperplasia of subsynovial fat tissue and typically located in the knee. Clinically,the most common finding is a slow-growing painless swelling,accompanied by intermittent effusion of the joint.‹n this article, localised unilateral wrist that is unusual for lipoma arborescens is reported.