Haydarpa�a Numune Medical Journal

HAYDARPA�A NUMUNE MEDICAL JOURNAL - Haydarpasa Numune Med J: 53 (1)

Cilt: 53 Say�: 1 - 2013

�ZG�N ARA�TIRMA
1.	Hastanelerde Ortopedik T�bbi Malzemelerin Sat�n Al�nmas�, Depolanmas� ve Kullan�lmasi ile �lgili Sorunlar ve ��z�m �nerileri The Problems And Solution Proposals Regarding Purchase, Storage And Use Of The Orthopaedic Medical Supplies In The Hospitals Ayg�l Yan�k, M�cahit G�rge� Sayfalar 1 - 11 G�R�� ve AMA�: Bu ara�t�rma; hastanelerde ortopedik t�bbi malzemelerin sat�n al�nmas�, depolanmas� ve klinikte kullan�lmas� a�amalar�nda ya�anan sorunlar� belirlemek, ��z�m �nerilerini ortaya koymak ve ortopedik malzemelere odaklanman�n nedenlerini belirlemek amac�yla yap�lm��t�r. Y�NTEM ve GERE�LER: Ara�t�rmada y�zy�ze g�r��me ile �al��mac�lar taraf�ndan haz�rlanan anket y�ntemi kullan�lm�� ve 2011 y�l�nda uygulanm��t�r. Ara�t�rmada tesad�fi �rnekleme y�ntemi se�ilmi� ve anketi eksiksiz yan�tlayan 181 ki�i �rneklem olarak belirlenmi�tir. Eksik doldurulan 9 anket de�erlendirmeye al�nmam��t�r. Ankette be�li Likert �l�e�i uygulanm�� ve anketin de�erlendirilmesinde SPSS 15,0 istatistik yaz�l�m� kullan�lm�t�r. BULGULAR: Ara�t�rma kapsam�na; ortopedi ve travmatoloji hekimleri ve sat�nalma ile depo sorumlular� dahil edilmi�tir. Asistanlar kapsam d��nda b�rak�lm��t�r. Anketi, ara�t�rma konusunda deneyimli yetkililerin doldurmas� sa�lanm��t�r. TARTI�MA ve SONU�: Genel olarak ortopedik malzemelerin klinikte kullan�lmas� a�amas�nda %72.4, sat�n al�nmas� a�amas�nda %66.9 ve depolanmas� a�amas� nda %52.5 oran�nda sorun ya�and�� belirlenmi�tir. Bu sorunlara y�nelik farkl� ��z�m �nerileri tespit edilmi�tir. Ortopedik t�bbi malzemelere odaklanman�n en �nemli nedeni, hizmet kalitesini artt�rmak olarak belirlenmi�tir. Ara�t�rman�n �st y�netimin ortopedik t�bbi malzemelerle ilgili y�netsel kararlar�nda destekleyici olaca�� varsay�lmaktad�r. 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. Makale �zeti \| Tam Metin PDF

2.	Yo�un Bak�m �nitesinde Yatak Ba�� Y�kseltme Takibi Ve E�itimi Sonu�lar� Head Elevation In Intensive Care Unit C�neyt Salt�rk, Nalan Ad�g�zel, G�kay G�ng�r, Suat Solmaz, Raziye Sancar, Necla �rnek, R�ya Evin, �zlem Mo�in, Merih Balc�, Semra Bat� Kutlu, Zuhal Karakurt Sayfalar 12 - 15 G�R�� ve AMA�: Yo�un bak�m �nitesinde (YB�) yatak ba�� y�kseltme ventilat�r ili�kili pn�moniden (V�P) korunmak i�in kolay ve etkili y�ntemdir. Y�NTEM ve GERE�LER: �al��mam�zda YBܒnde bu uygulaman�n her g�n hat�rlat�lmas�n�n uygulamaya katk�s� olup olmad��n� ara�t�rmay� ama�lad�k. BULGULAR: �leriye d�n�k kohort �al��ma 22 yatakl� g��s hastal�klar� YBܒde Aral�k 2010 ve Ocak 2011 de yap�ld�. �al��ma y�r�t�c�leri d��nda �nitedeki di�er �al��anlar�n g�zleme dayal� �al��madan haberi yoktu. Aral�k ay�nda her g�n sabah 08: 00 de ve ak�am 17: 00 de 22 YB� yata�� i�in hasta ba�lar�n�n 30�45 derecede veya d�z olup olmad�klar� kay�t edildi. TARTI�MA ve SONU�: Ocak ay�nda her g�n yatak sorumlu hem�irelerine yatak ba�� y�kseltmesi s�ylendi ve 08: 00 ve 17: 00? de yatak ba�� durumu tekrar kay�t edildi. Enfeksiyon hem�iresi her iki ayda V�P olgular�n� kay�t etti. Aral�k ay�nda 1 hastada V�P geli�ti ve 12. g�n ya�am�n� yitirdi. Ocak 2011 de 3 V�P, 1 aspirasyon pn�monisi ve 4 hasta toplam 64 g�n YB� de yat�r�ld�, 1 hasta ya�am�n� yitirdi. YBܒlerinde yatak ba�� y�kseltilmesi gere�i her g�n, belli saatlerde, n�bet �ifti de�i�iminde hat�rlat�lmas� uygun olmayan yatak ba� pozisyon say�lar�n� azalt�r. Bu y�ntem YB� kal�� g�n�n� k�salt�r, �lke gelirine katk�, enfeksiyona ba�l� mortalitede azalma sa�lar. 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. Makale �zeti \| Tam Metin PDF

3.	�anl�urfa Siverek B�lgesindeki Helicobacter Pylori Pozitifli�i Oran� Ve Intestinal Metaplazi Ile Aras�ndaki �li�ki Relationship Between Helicobacter Pylori Positivity Rate and Intestinal Metaplasia Ile in �anl�urfa Region of Siverek �lkay Tosun, Tu�rul �ak�r Sayfalar 16 - 19 G�R�� ve AMA�: �ntestinal metaplazinin Helicobacter pylori enfeksiyonu ile s�k� bir birliktelik g�sterdi�i, Helicobacter pylorinin intestinal metaplazi patogenezinde kolayla�t�r�c� rol oynad�� bir�ok kaynakta bildirilmi�tir. Y�NTEM ve GERE�LER: Bu �al��man�n amac� Siverek b�lgesindeki Helicobacter pylori s�kl��n� belirlemek ve intestinal metaplazi ile birlikteli�ini saptamakt�r. BULGULAR: Toplam 157 olguya ait endoskopik biyopsi materyalini retrospektif olarak de�erlendirdik. TARTI�MA ve SONU�: Helicobacter pylori 69 (%43,9) hastada pozitif olarak saptand�. Helicobacter pylori earl�� ile intestinal metaplazi aras�nda anlaml� bir ili�ki bulunamad�. 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. Makale �zeti \| Tam Metin PDF

4.	Mamografi-Sonografik Bi-Rads Skorlar�n�n Patoloji �le Korelasyonu Pathologic Correlation Of Mammographic-Sonographic Bi-Rads Scores Mehmet O�uzhan A�a�l�, Zeynep Gamze K�l��o�lu, Mehmet Masum �im�ek, Kaan Meri�, Naciye K��, F�gen Vardar Aker, Hikmet Karag�ll� Sayfalar 20 - 28 G�R�� ve AMA�: Bu �al��mada, hastanemizde mamografi ve ultrasonografi ile tespit edilen ve sonras�nda patolojik de�erlendirilmesi yap�lan lezyonlar�n BI-RADS skorlar� ile patolojik sonu�lar�n�n kar��la�t�r�lmas�, her kategori i�in sensitivite, spesifisite, pozitif ve negatif prediktif de�erlerin hesaplanmas�, bulgular�n literat�r ile kar��la�t�r�lmas� ve klini�imizin performans�n�n de�erlendirilmesi ama�lanm��t�r. Y�NTEM ve GERE�LER: �al��mam�za May�s 2008 ve Aral�k 2010 tarihleri aras�ndaki 32 ayl�k d�nemde, Haydarpa�a Numune E�itim ve Ara�t�rma Hastanesi Radyoloji Klini�i mamografi �nitesine ba�vuran 9703 olgunun mamografi tetkikleri ve ek olarak yap�lan ultrasonografileri dahil edildi. Bu incelemeler ile tespit edilen ve sonras�nda klini�imizde biyopsi uygulanan ya da hastanemizde opere edilen lezyonlar�n patolojik sonu�lar� ile BI-RADS skorlar� kar��la�t�r�ld�. BULGULAR: Patolojik tan� verilen toplam 419 hastadan kategori 1, 2, 3 grubunda yer alanlar benign yani hastal�k a��s�ndan radyolojik olarak negatif kabul edildi. Benzer �ekilde 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�s� malign idi. Kategori 4, 5 grubunda ise toplam 244 hastadan 136�s� benign, 108�i malign idi. Bu �ekilde yap�lan gruplamalar patoloji sonu�lar� ile kar��la�t�r�larak sensitivite, spesifisite, do�ruluk, pozitif prediktif de�er(PPD) ve negatif prediktif de�er(NPD) hesapland�. Kategori gruplamas� i�in sensitivite % 94,5, spesifisite % 55,4, pozitif prediktif de�er % 43,0, negatif prediktif de�er % 95,6 olarak bulundu. TARTI�MA ve SONU�: �al��mam�zda elde edilen sensitivite, spesifisite, pozitif prediktif de�er ve negatif prediktif de�erler literat�rdeki benzer �al��malar ile uyumlu bulunmu�tur. Ayr�ca �al��mam�z s�ras�nda, benign olarak kategorize edilmelerine kar��n klinisyenlerin talebiyle �ok say�da hastaya yap�lan biyopsilerin, beklendi�i gibi benign sonu�lar verdi�ini ve bu durumun zaman, emek ve maliyet art��na neden oldu�unu g�rd�k. Yani BI-RADS uygulamas�n�n sadece radyoloji klini�i taraf�ndan de�il, meme hastal�klar�n�n tan� ve tedavisinde rol� bulunan di�er dallara mensup hekimler taraf� ndan da benimsenmesinin y�ntemin etkinli�ini art�raca��n� d��nd�k. 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. Makale �zeti \| Tam Metin PDF

5.	Akci�er Apseli Olgular�m�z�n �zellikleri Features Of The Patients With Lung Abscess In Our Clinic Murat Yal��nsoy, Sevin� Bilgin, Sinem G�ng�r, Bilgen Beg�m Af�ar, Belma Akbaba Ba�c�, Esen Akka Sayfalar 29 - 34 G�R�� ve AMA�: Son y�llarda pn�moni tedavisinde erken ve etkili antibiyotiklerin kullan�m� ile akci�er apselerin insidans� azalsa da, hala nadir olarak g�r�lmektedir. Bu �al��mada, klini�imizde nekrotizan akci�er enfeksiyonlar�na ba�l�, piyojenik bakterilerle olu�an, akci�er apsesi tan�s� alan olgular�n etyolojik ve klinik �zelliklerini de�erlendirmeyi ama�lad�k. Y�NTEM ve GERE�LER: 2002�2008 y�llar� aras�nda S�reyyapa�a Hastanesi 3. klini�inde, 11 akci�er apseli ( K/E = 2/9, ya� ortalamas�: 44( 23-65 y�l )) olgu geriye d�n�k olarak incelendi. BULGULAR: En yayg�n risk fakt�r� pn�moni tedavisinin gecikmesi, diyabet ve ya�t� (s�ras�yla: n= 4, 3, 3). En s�k semptom �ks�r�k-balgam ve halsizlikti (s�ras�yla: n=9, 6). Apselerin radyolojik yerle�iminde fark yoktu. Bakteriyolojik �al��malar etkeni belirlemede yard�mc� olmad�. Ay�r�c� tan� ve bakteriyolojik �rnekleme amac�yla bronkoskopi kullan�ld� (n=9 ). Tedavide, genellikle 4 haftadan 4 aya kadar uzayan s�relerde, amoksisilin-sulbaktam ve/veya clindamisin kullan�ld�. T�m olgular klinik ve laboratuar olarak d�zelirken; radyolojik olarak 5 olguda tam d�zelme, 5 olguda sekelli d�zelme g�r�ld�. 1 olguda radyoloji ayn� kald�, cerrahi gerektiren vaka olmad�. TARTI�MA ve SONU�: Sonu� olarak; klini�imizde takip edilen akci�er apseli olgularda etkeni saptamada yetersiz kal�nsa da ampirik tedavi ile ba�ar�l� sonu�lar al�nm��t�r. 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 S�reyyapasa 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. Makale �zeti \| Tam Metin PDF

6.	Yozgat �linde Gebelerin Do�um �eklinin Pelvik Taban �zerine Olan Etkileri Hakk�ndaki Bilgi D�zeyleri Knowledge Levelof Pregnants Living In Yozgat Province About The Effects Of Birth Type On Pelvic Floor Mustafa Kara Sayfalar 35 - 38 G�R�� ve AMA�: Bu �al��man�n amac�, Yozgat�ta ya�ayan gebelerin normal vaginal do�um ve sezaryen seksiyonun pelvik taban sa�l�� zerine olan etkilerini anlama d�zeylerini belirlemektir. Y�NTEM ve GERE�LER: Klini�imize Temmuz 2011-Ocak 2012 aras�nda ba�vuran toplam 322 hasta g�re bu kesitsel �al��maya dahil edildi. Hastalar maternal e�itim d�zeylerine g�re d�rt gruba b�l�nd�. Grup 1 hi� okula gitmeyen kad�nlardan olu�uyordu. Grup 2�deki hastalar�n ilk��retim diplomas� vard�. Grup 3�teki kad�nlar�n lise diplomas� vard�. Grup 4 �niversite mezunu deneklerden olu�uyordu. Kat�lan kad�nlara y�z y�ze g�r��me metodu ile ayr�nt�l� bir anket uyguland�. Hem demografik bilgiler hem de dene�in vaginal do�um ya da sezaryen seksiyo sonras� pelvik taban�n durumu hakk�ndaki bilgileri de�erlendirildi. BULGULAR: Anne e�itim d�zeyi ile gebelerin do�um �eklinin pelvik taban �zerine olan etkileri hakk�ndaki fark�ndal�klar� aras�ndaki ili�ki ara�t�r�ld�. Deneklerin e�itim d�zeyi artt�k�a vaginal do�um ya da sezaryen seksiyonun �riner inkontinans� art�r�p art�rmad�� sorular�na �hay�r� yan�tlar�n�n y�zdesi de anlaml� �ekilde artmaktayd� (p<0.05). ilgin� bir �ekilde, hastalar�n %65.9�u pelvik taban kas egzersizlerinin mesane ve/veya barsak problemlerini azaltmaya yard�m edip etmedi�i sorusuna �evet� dedi (p<0.05). TARTI�MA ve SONU�: �al��mam�za kat�lan hastalar do�um �ekli ne olursa olsun, gebelik sonras� �riner inkontinans� n artt��n� ifade ettiler. Pelvik taban kaslar�n� kuvvetlendirici egzersizlerin do�um sonras� �riner ve/veya fekal inkontinans� azalt�c� etkisi oldu�una inananlar anlaml� �ekilde daha fazlayd�. 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. Makale �zeti \| Tam Metin PDF

7.	Yenido�an Yo�un Bak�m �nitesinde Takip Edilen Premat�re Bebeklerimizin De�erlendirilmesi The Evaluation Of The Premature Infants Followed At Neonatal Intensive Care Unit �irin G�ven, H�lya Saner, Ahmet Sami Yazar Sayfalar 39 - 44 G�R�� ve AMA�: Son 20 y�lda, perinatal ve neonatal t�p alan�ndaki geli�melere paralel olarak premat�re do�an bebeklerin ya�am oranlar� artm��t�r. YDYBܒde yatarak takip edilen gestasyon ya�� 36 hafta ve alt�nda olan 59 premat�re bebek al�nd� ve bu bebeklerin demografik �zellikleri, klinik bulgular� ve prognozlar� de�erlendirildi. Y�NTEM ve GERE�LER: En y�ksek mortalite oranlar� do�um a��rl�klar� 999 gr alt�nda (%31,5) ve gestasyon ya�� 28 hafta ve alt� olan olgularda (%26,3) saptand�. Olgular�n ventilat�rde (SIPPV/SIMV+VG) kalma s�releri 4,52�10,2 g�n, CPAP s�releri ise 1,5�2.12 g�n idi. BULGULAR: T�m olgularda BPD oran� %6,7, 28 haftan�n alt�ndaki bebeklerde %15,8 idi. Do�um a��rl�klar�na ve gestasyon ya��na g�re BPD g�zlenme oranlar� aras�nda istatistiksel olarak ileri d�zeyde anlaml� farkl�l�k saptanmad� (p>0,05). Do�um a��rl�klar�na ve gestasyon ya�� 28 hafta ve alt� olan olgularda IVK (evre 2-3) oran� anlaml� d�zeyde y�ksekti (p<0,01). PR oran� %6,7, 1000 gr alt�ndaki olgularda %18,8 idi. PR oran� 500-999 gr aras�nda olan olgularda anlaml� �ekilde y�ksek saptand� (p: 0,027). TARTI�MA ve SONU�: Sonu� olarak, YDYBܒmizde takip edilen 28 hafta ve 1000gr alt�ndaki bebeklerde sa�kal�m oranlar� y�ksektir, ayr�ca BPD, PR, �VK ve NEK gibi erken neonatal komplikasyon oranlar� d��kt�r. 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. Makale �zeti \| Tam Metin PDF

8.	Haydarpa�a Numune E�itim Ve Ara�t�rma Hastanesinde Son Iki Yilda Arteriyel Ve Ven�z Tromboz Saptanan Hastalarda Fakt�r V Leiden S�kl�� Factor V Leiden Mutation Prevalence In Patients With Arterial And Venous Thrombosis In The Last Two Years Toluy �zg�m��, M�jdat Kahraman, Tolga G�m��kemer, Mustafa M. G�ld�, Ozan Durmaz, Alper Bayrak, Eray Y�ld�z, P�nar Ata Eren, Funda T�rkmen Sayfalar 45 - 50 G�R�� ve AMA�: Fakt�r V Leiden (FVL) gen mutasyonu, tromboza e�ilim yaratan genetik risk fakt�rleri aras� nda en s�k g�r�lenlerden biridir. Bu �al��mada son iki y�lda Haydarpa�a Numune E�itim ve Ara�t�rma Hastanesine tromboz saptanan olgularda, FVL gen mutasyonunun s�kl��n�, arteriyel ve ven�z tromboz ile ili�kisini ara�t�rmay� ama�lad�k. Y�NTEM ve GERE�LER: G�zlemsel, olgu- kontroll�, retrospektif olarak tasarlanan �al��maya, 2008-2010 tarihleri aras�nda n�roloji, genel cerrahi, i� hastal�klar� kliniklerinde yatarak veya ayaktan izlenen, arteriyel ve/veya ven�z trombozu klinik olarak saptanan ve radyolojik y�ntemler ile de trombozu kan�tlanm�� ve FVL gen mutasyonu tetkiki yap�lm�� olgular al�nd�. Periferik kandan DNA izolasyonu sonras� nda FVL 1691 n�kleotid mutasyonu Real-time PCR y�ntemi ile �al�fl�ld�. PCR�� takiben 100-300 ngr genomik DNA kullan�larak erime e�risi analizi ile mutasyon varl�� de�erlendirilmi�tir. �al��mada elde edilen bulgular de�erlendirilirken, istatistiksel analizler i�in NCSS (Number Cruncher Statistical System) 2007&PASS 2008 Statistical Software (Utah, USA) program� kullan�ld�. BULGULAR: �al��maya 67 trombozlu olgu ve kontrol grubu olarak 22 olgu al�nd�. Trombozlu grubun ya� ortalamas� 42,94�14,52 (Ortalama � 1 Standart Sapma), cinsiyet da��l�m� 37 (%55,2) kad�n, 30 (%44,8) erkek iken; kontrol grubunun ya� ortalamas� 42,09�11,19 (Ort. � 1SD), cinsiyet da��l�m� 13 (%59,1) kad�n, 9 (%40,9) erkek �eklindeydi. �al��mam�zda 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. TARTI�MA ve SONU�: FVL mutasyon s�kl�� lkemizde, gen polimorfizminden s�z ettirecek kadar yayg�n olmakla birlikte tek ba��na heterozigot mutant varl��, santral/periferik, gerek arteryel, gerekse ven�z tromboz i�in bir risk fakt�r� gibi g�r�nmemektedir. Olgu say�s�n�n az olmas� nedeni ile homozigot mutant olgular�n tromboz risk de�erlendirilmesini yapamamakla birlikte, FVL gen mutasyonunun varl��nda, tromboz riski ilave di�er genetik ve edinsel risk fakt�rlerine ba�l� gibi g�r�nmektedir. 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. Makale �zeti \| Tam Metin PDF

OLGU SUNUMU
9.	Stiffen Sendromlu Olguda �ki Tarafl� Humerus Anatomik Boyun K�r�� ve Osteonekrozis Bilateral Humeral Anatomical Neck Fracture And Osteonecrosis In Patient With Stiffman Syndrome: A Case Report Mehmet Kerem Canbora, Atilla Polat, Kemal G�kku�, M�cahit G�rge� Sayfalar 51 - 54 N�bet sonras� iki tarafl� humerus anatomik boyun k�r�� ge�irilmesi ve sonras�nda osteonekroz geli�mesi �ok az g�r�len bir durumdur. Bu yaz�da her iki omuz b�lgesinde ��k�k olmaks�z�n hareket k�s�tl�l�� ve a�r� ile ba�vuran, radyolojik de�erlendirmesinde her iki humerus anatomik boyun k�r�� tespit edilen ve �ok k�sa s�re i�inde her iki humerus ba��nda osteonekroz geli�mi� olan 33 ya��nda erkek hasta sunuldu. Tonik-klonik n�betlerin e�lik etti�i �Stiffman sendromu� (SMS) tan�s� konulan hastaya �ncelikle sa� omuz i�in parsiyel protez uyguland�. Sol taraf i�in cerrahi planlanan hastada tekrarlayan n�betler yeni bir giriflime izin vermedi. Genel v�cut kat�l�� ve sistemik sorunlar nedeniyle hasta kaybedildi. Belirgin travma ve dislokasyon olmayan anatomik boyun k�r�klar�n�n ay�r�c� tan� s�nda n�betle ili�kili sendromlar g�z �n�ne bulundurulmal�d�r. 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. Makale �zeti \| Tam Metin PDF

10.	Bilateral Aksiller Aksesuar Meme Dokusu Bilateral Axillary Accessory Breast Tissue: A Case Report Murat Tan, �efik K�pr�l� Sayfalar 55 - 57 Aksesuar meme seyrek nadir olarak g�r�lmektedir. Asemptomatik kitleler veya kol hareketlerinin k�s�tlanmas� veya a�r� gibi belirtiler ile kar��m�za ��kabilir. Meme hatt� boyunca yada meme hatt� d��ndaki yerlerde bulunmas� durumunda tan�sal zorluk nedenleri aras�ndad�r. Aberran meme dokusu bulunan hastalara malignite ihtimali, fonksiyonel �ikayetler ve kozmetik sebeplerde g�z �n�nde bulundurarak, erken d�nemde eksizyonel biyopsi uygulanmal�d�r. Bu olgu sunumumuzda bilateral aksiler yerle�im g�steren bir olgu nedeniyle aksesuar meme konusu g�zden ge�irilmitir. 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. Makale �zeti \| Tam Metin PDF

11.	Filled T�m�r (Sistosarkoma Filloides) Phyllodes Tumor: A Case Report Murat Tan, �efik K�pr�l� Sayfalar 58 - 63 Sistosarkoma phyllodes nadir bir meme t�m�r�d�r. T�m�r fibroepitelyal veya epitelyal ve stromal h�cre bile�enidir. Bu t�m�rler genellikle iyi huyludur. Fibroadenomdan gelen phyllodes t�m�r� ay�rt etmek i�in spesifik bir belirti veya radyolojik g�r�nt� yoktur. Bu nedenle tan� i�in histolojik inceleme �artt�r. Tedavinin en �nemli bile�eni geni� cerrahi eksizyondur: Mastektomi sadece yeniden eksizyonlara ra�men normal doku elde edilemez ise gereklidir. Aksilla tutulumu nadir olup, rutin aksiller diseksiyon endike de�ildir. Neyse ki, bu t�m�rlerin �o�u iyi huylu ve hastal��n yerel tekrar�n� �nlemek en �nemli fakt�r oldu�u ger�e�i g�z �n�ne al�nd��nda, serbest doku yay�l�m� cerrahisinde meme koruyucuda maksimum alan i�leme al�n�r.Bu olgu sunumunda, meme koruyucu cerrahi uygulanan kad�n hastada benign sistosarkoma phyllodes tan�s� sunulmaktad�r. 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. Makale �zeti \| Tam Metin PDF

12.	El Bile�inde Lipoma Arboserens Lipoma Arborescens Of The Wrist: Case Report Tuba �zdelice, Korcan Aysun G�nen, Murat Tonbul, Aliye Y�ld�r�m G�zelant, �ner Serdaro�lu Sayfalar 64 - 66 Lipoma arboresens, etyolojisi bilinmeyen nadir bir intra-artik�ler lezyondur. Genellikle dizde yerle�ir. Sinoviyal membran�n yayg�n vill�z proliferasyonu, subsinoviyal membran�n ve subsinoviyal ya� dokusunun hiperplazisiyle karakterizedir. Yava� geli�en a�r�s�z �ifllik en s�k bulgudur. Bu makalede lipoma arboresens i�in nadir bir lokalizasyon olan el bile�i yerle�imli olgu sunulmu�tur. 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. Makale �zeti \| Tam Metin PDF