GÝRÝÞ ve AMAÇ: Tip 2 diyabetes mellituslu hastalarda sigara kullanýmýnýn mikroalbuminüri düzeyleri üzerine etkisini araþtýrmak.
YÖNTEM ve GEREÇLER: 51 sigara kullanan ve 57 sigara kullanmayan tip 2 diyabetes mellituslu 108 hastada 24 saatlik idrarda mikroalbuminüri düzeyleri karþýlaþtýrýldý. Hipertansiyon, hiper ya da hipotiroidi, herhangi bir böbrek hastalýðý, enfeksiyonu olan, kalp yetmezliði hastalarý ve yoðun egzersiz yapan hastalar çalýþma dýþarý býrakýldý. Yaþ, cinsiyet, VKÝ, arteryel tansiyon, kolesterol düzeyleri, diyabet yaþlý ve regülasyonunda aralarýnda istatistiksel anlamlý fark olmayan iki grup oluþturuldu.
BULGULAR: Çalýþma gruplarý; sigara kullanýmý yok (n=57) ve var (n=51) olarak kategorize edildi. iki grup arasýnda yaþ ortalamalarý, cinsiyet oranlarý ve VKÝ deðerleri açýsýndan farklýlýk görülmedi. Gruplar arasýnda açlýk kan flekeri, HbA1c, total kolesterol, LDL kolesterol, HDL kolesterol, BUN ve kreatinin ortalama deðerleri arasýnda farklýlýk saptanmadý. Sigara kullanan grupta mikroalbuminürinin
ortalama deðeri (41.66±6.37mg/gün), sigara kullanmayan gruba (28.71±3.10 mg/gün) göre daha yüksek olup, istatistiksel olarak anlamlý derecede farklýlýk saptandý (P=0.003).
TARTIÞMA ve SONUÇ: Sigara kullanýmýnýn tip 2 diabetes mellituslu hastalarda diðer fatörlerden baðýmsýz olarak mikroalbuminüri düzeylerini artýrdýðý görüldü.

INTRODUCTION: To evaluate the effect of smoking on microalbuminuria levels in patients with type 2 diabetes mellitus.
METHODS: Microalbumin levels in urine of 51 smoking and 58 non smoking 108 patients with type 2 DM were compared. The patients with hypertension, hyperthyroidism, hypothyroidism, any kidney disease, congestive heart failure and habit of heavy exercise were excluded from the study. Two groups were composed. Age, gender, BMI, arterial blood pressure, cholesterol levels, diabetes, age, and the regulation of the two groups were not statistically significant difference between them.
RESULTS: Study groups were composed of smokers (group1) and non smokers (group 2). There were no statistically significant difference between groups in terms of age, gender, body mass index, starving glucose levels, HbA1c levels,total cholesterol, LDL, HDL, blood urea nitrogen and creatinine levels. The mean microalbuminuria levels were found to be higher in smokers group (41.66+-6.37 mg/gün) than non smokers group (28.71+-3.10 mg/gün). This was statistically significant (p=0.004).
DISCUSSION AND CONCLUSION: Smoking increases microalbuminuria levels in patients with type 2 diabetes mellitus independently from the other factors.

GÝRÝÞ ve AMAÇ: Dudak kanserleri baþ boyun bölgesi kanserlerinin önemli bir kýsmýný oluþturur. Cilt kaynaklý olmayan baþ-boyun bölgesi kanserlerinin % 12 si dudak kaynaklýdýr. Diðer baþ boyun kanserleri göz önüne alýndýðýnda uygun bir tedaviyle kür saðlanma olasýlýðý yüksektir.
YÖNTEM ve GEREÇLER: 2004 – 2010 yýllarý arasýnda dudak kanseri nedeniyle Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi Plastik Cerrahi Kliniðine baþvuran 51 hastanýn kayýtlarý retrospektif olarak incelenerek yaþ, cinsiyet, lezyon yerleþimi, lezyon büyüklüðü, lokal nüks, kullanýlan yöntem gibi verileri toplandý.
BULGULAR: Hastalarýn yaþ ortalamasý 65,4 olarak hesaplandý. Hastalarýn % 85’inde sigara kullanma hikayesi mevcuttu. %70 hastada tümör 2 cm’den küçük bulundu. % 61 hastada histolojik grade iyi diferansiye karsinom olarak gözlendi. Ameliyat sonrasý uzun dönem takiplerinde lokal nüks tespit edilen 12 hasta evreleri açýsýndan incelendiðinde lokal nüks ile tümör büyüklüðü arasýnda istatistiksel olarak anlamlý bir sonuç bulunamadý.
TARTIÞMA ve SONUÇ: Alt dudak kanserleri konumu itibari ile kolayca farkedilip, taný koyularak tedavi edilebilecek kanserlerdendir. Erken evrede taný, uygun marj ile geniþ eksizyon, gerekli vakalarda boyun diseksiyonu ve tekrar eden olgululara erken müdahalenin tedavi baþarýsýný etkileyen en önemli parametreler olduðu düþünülmektedir.

INTRODUCTION: Lip cancer is a common malignancy of the head and neck region that comprises 12% of all noncutaneous head and neck cancers. It is more curable than other head and neck cancers if it is diagnosed early and treated properly.
METHODS: Medical records of the patients, who were treated between 2004 and 2010 in Plastic and Reconstructive surgery clinic of Haydarpasa Numune Training and Research Hospital, were reviewed retrospectively concerning age, gender, location and size of lesion, cervical metastasis at presentation, histological grade, and reconstruction type.
RESULTS: The mean age was 65,4. Most common histopathological diagnosis was well differentiated (61 %) squamous cell carcinoma. Smoking history was present in 85 % of patients. Local recurrence was observed in 12 patients (23,5 %) there was no statistically significant relation between tumor size and recurrence.
DISCUSSION AND CONCLUSION: Our findings are similar to literature except the relation between tumor size and recurrence rate. Wide local excision, regular follow-up and rapid intervention to local and regional recurrences are crucial to obtain best possible result.

GÝRÝÞ ve AMAÇ: Kalkaneal spur hastalýðý ile metabolik bozuklular arasýndaki iliþkiyi araþtýrmak.
YÖNTEM ve GEREÇLER: Özel Zübeyde Haným Týp merkezi’ne Mayýs 2011 ile Kasým 2011 arasýnda Ortopedi polikliniðine baþvuran, kalkaneal spur tanýsý alan 171 hasta retrospektif olarak tarandý. 171 hastadan kayýtlarýna ulaþýlan 19’u erkek 111’i kadýn toplam 130 topuk aðrýsý olan hasta çalýþmaya alýndý. Tüm hastalarýn lateral ayak grafisi ve açlýk kan þekeri(AKÞ), total kolestrol, trigliserid(TG), LDL, HDL deðerleri incelendi. Kalkaneal spur tanýsý almýþ hastalarýn sonuçlarý 130 hastadan oluþan kontrol grubu sonuçlarý ile kýyaslandý.
BULGULAR: Kalkaneal spur hastalarý ile kontrol grubu arasýnda AKÞ ve HDL düzeyleri açýsýndan anlamlý fark bulunamamýþtýr (p>0.05). Total kollestrol, LDL ve TG düzeyleri kalkanel spur hastalarýnda anlamlý olarak yüksek bulunmuþtur (p<0.05).
TARTIÞMA ve SONUÇ: Kalkaneal spur hastalýðý etyopatogenezinde serum lipid yüksekliðinin rol oynadýðý düþünülmektedir.

INTRODUCTION: The goal of this study is to evaluate the relationship between metabolic disorders and calcanel spur.
METHODS: We evaluated patients retrospectively who were diagnosed calcaneal spur desease between the years of May 2011 and November 2011 in the orthopeadics department of Private Zübeyde Haným Medical Outpatient Center. We were able to find 130 patients records (19 male, 111 female). All patients’ lateral foot x-ray views and detailed blood parameters including fasting glucose level(FGL), total cholestrol, trigliseride(TG), LDL, HDL were evaluated. We compared our study group with the control group patients (130 patients in each group).
RESULTS: Regarding the FGL and HDL there was no significant difference between the study and control group (p>0.05). Whereas; there was a significant increased total cholestrol, LDL, TG levels with the study group (p<0.05).
DISCUSSION AND CONCLUSION: We determined the aetiopatological role of high serum lipid levels in the development of calcaneal spur desease.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý femoral anterior
notching(FAN) ‘in kýrýk oluþumunda diðer
predispozan faktörler ile arasýndaki iliþkiyi
araþtýrmaktýr.
YÖNTEM ve GEREÇLER: 1997-2005 tarihleri arasýnda bölümümüzde total diz protezi uygulanan hastalarýn dosyalarý retrospektif olarak tarandý. Kayýtlarýna ulaþýlabilen 60’ý bayan, 6’sý erkek toplam 66 hasta çalýþmaya alýndý. Dosyalarýnda kýrýk için risk faktörü kabul edilen romatoid artrit zemininde artroplasti, revizyon artroplastisi, osteoporoz ve steroid kullaným öyküsü araþtýrýldý. Tam yan grafilerde FAN olup olmadýðý ayný cerrah tarafýndan deðerlendirildi.
BULGULAR: Risk faktörü olamayan 46 hasta bulunmaktaydý. Romatoid artrit zemini 7 hastada, revizyon artroplastisi 4 hastada, osteoporoz 6 hastada ve steroid kullaným öyküsü 11 hastada olmak üzere risk faktörü toplam 20 hastada mevcut idi. FAN 14 hastada bulunmaktaydý ve bunlarýn 4’ünde ek bir risk faktörü mevcuttu.. Risk faktörü olmayan grup, sadece risk faktörü olan grup, sadece FAN olan grup ve FAN ile birlikte risk föktörü bulunan grup kýyaslandý. Sadece FAN bulunan bir hastada ve sadece risk faktörü bulunan bir hastada kýrýk oluþtuðu görüldü. Her iki hastada da travma hikayesi mevcut idi. Hastalardan biri cerrahi olarak diðeri ise konservatif yöntemler ile tedavi edilmiþtir.
TARTIÞMA ve SONUÇ: Kýrýk oluþma riskinin en yüksek olduðu grup olan FAN ile birlikte risk faktörü bulunan hastalarda kýrýk izlenmemiþtir. Kýrýk oluþan her iki hastamýzda da travma hikayesi bulunmaktaydý. Bu çalýþma sonucunda FAN’in tek baþýna kýrýk oluþumu için predispozan faktör olmadýðý fakat ek risk faktörleri ile femoral kýrýk oluþumunu kolaylaþtýrabileceði düþünülmüþtür.

INTRODUCTION: The aim of this study is to evaluate the relationship between femoral anterior notching(FAN) and other risk factors of fracture.
METHODS: We evaluated patients retrospectively who were performed total knee arthroplasty between the years of 1997 and 2005 in the orthopeadics department of Eskiþehir Osmangazi University. We were able to find 66 patients records(60 female, 6 male) and evaluated risk factors such as arthroplasty due to romatoid arthritis, revision knee arthroplasty, osteoporosis, and steroid use. In order to provide significant study standardization, lateral knee x-ray views were evaluated by the same surgeon.
RESULTS: 46 patients had no risk factors. The risk factors of 20 patients were distributed as fallowed (7 patients had romatoid arthritis, 4 patients had revision knee arthroplasty, 6 patients had steroid use). There were 14 patients with FAN whereas 4 of these patients had additional risk factor. We compared the following groups each other (group without risk factor, group with risk factor, group with FAN and group with FAN and risk factor). We have found two patients with fracture which one of them related to FAN and one of the patient had risk factor, and treated with surgically and conservatively, respectively.
DISCUSSION AND CONCLUSION: There was no reported fracture in the highest risk group which included FAN and risk faktors. However; the two patients who had fracture was thought to be related to trauma. As summary; this study suggests that FAN is not only a predisposan factor for fracture but also additional risk factor could also simplify the development of femoral fracture.

GÝRÝÞ ve AMAÇ: Yaklaþýk 2 yýl boyunca yoðun bakým ünitemizde takip edilen hastalarý, nazokomial enfeksiyon türleri, etken patojenleri, risk faktörleri ve etken mikroorganizmalarýn antibiyotik duyarlýlýklarý açýsýndan retrospektif olarak deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Eylül 2009-Ocak 2012 tarihleri arasýnda hastanemiz yoðun bakýmýnda yatan 506 hasta geriye dönük incelendiðinde nasokomial enfeksiyon tanýsý alan 58 hasta deðerlendirilmiþtir. Mikroorganizma tanýmlamasý ve antibiyotik duyarlýlýk testleri hastanemiz mikrobiyoloji laboratuvarýnda yapýlmýþtýr. Etken mikroorganizmalar mikrobiyolojik yöntemlerle identifiye edilip antibiyotik duyarlýlýklarý ‘National Committee for Clinical Laboratory Standarts (NCCLS)’ önerilerine uygun disk difüzyon yöntemi ile belirlenmiþtir.
BULGULAR: Hastalarda toplam 135 hastane enfeksiyonu geliþtiði görülmüþtür. En sýk geliþen enfeksiyon VÝP iken (84), 30 bakteriyemi, 14 nozokomiyal üriner sistem enfeksiyonu, 5 yumuþak doku enfeksiyonu ve 2 nozokomiyal pnömoni geliþtiði görüldü. Geliþen nozokomiyal enfeksiyonlarda izole edilen gram negatif etken sayýsý 105 iken, acinetobacter spp (36; %34,3) en sýk etken olarak izole edildi. Mikroorganizmanýn direnç paternine göre izole edilen acinetobakterlerden 13’ü XDR 20’si ise MDR olarak belirlendi.
TARTIÞMA ve SONUÇ: Yoðun bakýmlarda nasokomial enfeksiyon etkenleri arasýnda antibiyotik direnci gitgide artmaktadýr. Yoðun bakým ünitelerinde mikroorganizma profilinin yakýn takip edilerek belirlenmesinin amprik tedavide yol gösterici olabileceði kanaatindeyiz.

INTRODUCTION: We aimed to evaluate retrospectively the patients who had been followed in our intensive care unit for 2 years in terms of types of nosocomial infection, effective pathogens, risk factors and antibiotic susceptibility of effective microorganisms.
METHODS: When 506 patients who were in intensive care of our hospital between September 2009 and January 2012 were analyzed retrospectively, 58 patients with diagnosis of nosocomial infection were evaluated. Identification of microorganisms and tests of antibiotic susceptibility were carried out in microbiology laboratory of our hospital. Effective microorganisms were identified through microbiological methods and their antibiotic susceptibilities were determined through disc diffusion method in accordance with ‘National Committee for Clinical Laboratory Standarts (NCCLS)’.
RESULTS: It was seen that 135 nosocomial infections developed in patients. While the most frequently developing infection was Ventilator Associated Pneumonia (VAP) (84), it was seen that 30 bacteremia, 14 nosocomial urinary system infections, 5 soft tissue infections and 2 nosocomial pneumonia developed. While the number of gram negative agents isolated in devoloping nosocomial infections was 105, acinetobacter spp (36;%34,3) was isolated as the most frequent agent.13 out of acinetobacters isolated in accordance with resistance pattern of microorganisms were determined as XDR and 20 of them were MDR.
DISCUSSION AND CONCLUSION: Antibiotic resistance among nosocomial infection agents is increasing in intensive care units. We have the opinion that determination of microorganism profile by following closely in intensive care units might be a guide in empiric treatment.

GÝRÝÞ ve AMAÇ: Obstruktif Uyku Apne Sendromu (OUAS), toplumda oldukça sýk rastlanýlan bir hastalýktýr. Taný için altýn standart yöntem Polisomnografidir.
YÖNTEM ve GEREÇLER: Bu çalýþmada, Erzurum Nihat Kitapçý Göðüs Hastalýklarý ve Göðüs Cerrahi Merkezi Uyku laboratuarýnda Nisan 2011-Nisan 2012 tarihleri arasýnda uyku laboratuarýna baþvuran ve tüm gece polisomnografi tetkiki uygulanan olgularý deðerlendirmeyi amaçladýk. Baþvuran tüm olgulara yaþ, cinsiyet, sigara kullaným durumu, 3 kardinal semptom sorgulamasý (horlama, tanýklý apne, gündüz uykululuk hali), ek hastalýk, Vücut Kitle Ýndeksi (VKÝ), Epworth Uykululuk Skalasý (ESS), Apne-Hipopne indeksi (AHÝ) bilgilerini içeren formlar dolduruldu.
BULGULAR: 28’i (%25) kadýn, 86’sý (%75) erkek olan toplam 114 olgunun bilgileri deðerlendirildi. Olgularýn yaþ ortalamasý 47,6±1.8 (19-83) idi. Apne -hipopne indeksine göre 4 gruba ayrýlan olgulara;6 olguda basit horlama(AHI< 5), 9 olguda hafif OUAS(AHÝ: 5-14), 4 olguda orta OUAS(AHÝ: 15-29), 70 olguda aðýr OUAS (AHI: ≥30), 5 olguda pozisyonel OUAS, 3 olguda REM baðýmlý OUAS, 10 olguda hem REM baðýmlý hem de pozisyonel OUAS tanýsý kondu. Olgularýn 35 tanesi(%30) aktif sigara içicisi idi. 104 olguda(%91) horlama, 56 olguda(%49) tanýklý apne, 61 olguda(%53) gündüz aþýrý uykululuk hali, 34 olguda (%29.8) üç kardinal semptom da mevcuttu. Ortalama Epworth Uykululuk Skalasý 14 (0-24) idi.
TARTIÞMA ve SONUÇ: Olgularýn VKÝ ortalamasý 33,4(21.5-58.6) idi. Ek hastalýklarý deðerlendirdiðimizde, 14 olguda(%12) hipertansiyon, 7 olguda(%6) diabetes mellitus, 4 olguda(%3) KOAH, 3 olguda(%2) astým saptandý.

INTRODUCTION: Obstructive Sleep Apnea Syndrome (OSAS), is a disease that common in the community.
METHODS: Our study is a descriptive study that analyse 114 patients who applied to Erzurum Nihau Kitapçý Chest Hospital and underwent polysomnographic evaluation. Consecutive 114 patients with snoring complaint were included the study. The patients’ personal information, BMI, additional diseases, smoking history, Sleepiness Epworth Scale (ESS), AHI were recorded.
RESULTS: Our study has been conducted on 114 cases 86(75%) of which were male and 28(25%) female. The mean age was 47,6±1.8 (19-83). According to AHI, 6 of them were diagnosed with habitual snoring (AHI< 5),9 with mild obstructive sleep apnea syndrome (OSAS) (AHÝ: 5-14), 4 with moderate OSAS (AHÝ: 15-29), and 70 with severe OSAS ( AHI: ≥ 30), 12 with positional OSAS, 3 with REM dependent OSAS, 10 with REM dependent and positional OSAS together. 35 cases were (30%) smoker.
DISCUSSION AND CONCLUSION: Daytime sleepiness was seemed in 61(53%) cases, apnea in 56(49%) cases and snoring in 104(91%) cases. Three symptoms were seemed in 34 (29.8%) cases. The mean value of ESS was 14. The mean value of BMI was 33.4(21.5-58.6). 7(5%) cases had obstructive lung disease, 14(12%) cases hypertension, 7(6%) cases diabetes mellitus.

GÝRÝÞ ve AMAÇ: Çalýþmamýzda KHDAK tanýsý alan olgularda; operasyon kararý alýnmasýnda en önemli faktörlerden biri olan olan mediasteninal evrelemede PET-BT’nin rolünü araþtýrmayý planladýk. Çalýþmamýza aðustos 2008 ve mart 2010 tarihleri arasýnda 152 olgu alýndý.
YÖNTEM ve GEREÇLER: KHDAK tanýsý alan potansiynuçlarý operabl 76 hastanýn mediastinal lenf nodu deðerlendirilmesi toraks BT, PET-BT ve mediastinoskopi sonuçlarý ile karþýlaþtýrýldý.
BULGULAR: PET-BT’nin mediastinal lenf nodu metastazý için duyarlýlýðý %80, özgüllüðü %78, pozitif prediktif deðeri %57, negatif prediktif deðeri %91 olarak saptandý. Toraks BT’nin mediastinal lenf nodu metastazý için duyarlýlýðý %68, özgüllüðü %82, pozitif prediktif deðeri %57, negatif prediktif deðeri %87 olarak bulundu. Böylece PETBT’nin mediastinal lenf nodu metastazý deðerlendirilmesinde, toraks BT’ye belirgin üstünlüðü olmadýðý görüldü.
TARTIÞMA ve SONUÇ: Çalýþmamýzda, mediasten evrelendirmesinde PET-BT’nin toraks BT’ye üstünlüðü olmadýðýný saptadýk. Yalancý pozitiflik ve yalancý negatifliði nedeniyle; özellikle operasyon planlanan olgularda mediastinal lenf nodlarýnýn deðerlendirilmesinde mediastinoskopi yapýlmasý gerektiðini düþünmekteyiz.

INTRODUCTION: We planned to investigate the role of PET-CT in mediastinal staging that one of the most important conditions deciding surgery. We included in the study 152 patients between August 2008 and March 2010.
METHODS: We comprared the mediastinal lymph node results of 76 potential operable patients with thorax tomography, PET-CT and mediastinoscopy.
RESULTS: We found the sensitivity of PET- CT in detecting mediastinal lamp node metastasis as 80%, the specifity as 78%, positive predictive value as 57 %, negative predictive value as 91%. For thorax tomography the values were (in order) 68%, 82%,57% and 87%. So that we found no distinct supriority of PET-CT than thorax tomography.
DISCUSSION AND CONCLUSION: We detected no distinct superiority of PET-CT than thorax tomography in mediastinal staging. We think that all patienst have to be evaluated with mediastinoscopy to consider mediastinal lymp nodes before surgery because of the false negativity and positivity of PET-CT.

GÝRÝÞ ve AMAÇ: Pseudomonas aeruginosa hastane ortamýnda sýk olarak infeksiyonlara yol açar. Yaygýn antibiyotik direnci göstermesi nedeniyle yüksek oranda morbidite ve mortaliteye sahiptir. Bu nedenle antibiyotik direnç oranlarýnýn ortaya konmasý ve ampirik tedavide bu oranlarýn dikkate alýnmasý önemlidir. Bu çalýþmada hastanemizdeki son iki yýldaki P. aeruginosa suþlarýna karþý antibiyotik direnç oranlarýný ve yýllara göre deðiþimini ortaya koymayý amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2010 – Aralýk 2011 arasýnda hastanede yatan hastalara ait örneklerden izole edilen 289 adet P. aeruginosa izolatý incelendi. Amikasin, seftazidim, siprofloksasin, kolistin, sefepim, gentamisin, imipenem, levofloksasin, meropenem ve piperasilin-tazobaktam dirençleri araþtýrýldý. Ayrýca yýllara göre direnç oranlarý karþýlaþtýrýldý. Sonuçlar istatistiksel olarak deðerlendirildi.
BULGULAR: En duyarlý antibiyotikler kolistin ve amikasin, en dirençli antibiyotik ise piperasilin-tazobaktam olarak tespit edilmiþtir. Ayrýca sefepim direncinde 2011 yýlýnda bir önceki yýla gore gözlenen azalmanýn istatistiksel olarak anlamlý olduðu saptanmýþtýr (p<0.05).
TARTIÞMA ve SONUÇ: Antibiyotik direnç oranlarý hastanelere farklýlýklar gösterir. Bu nedenle her merkez kendi direnç oranlarýný izlemeli ve ampirik tedavide bu verilerden faydalanmalýdýr.

INTRODUCTION: Pseudomonas aeruginosa frequently lead to infections in the hospital settings. They have high rate of morbidity and mortality since they are widely resistant to several antibiotics. Thus, it’s important that reveal the rate of antibiotic resistance and considering this rate for empiric treatment. We aimed to evaluate the antibiotic resistance of P. aeruginosa strains isolated from our hospital during last two years, and it’s changing according to the years.
METHODS: A total of 289 P. aeruginosa specimens isolated between January 2010 and December 2011 were assessed. Resistance to amikacin, ceftazidime, ciprofloxacin, colistin, cefepime, gentamycin, imipenem, levofloxacin, meropenem ve piperacillin-tazobactam were investigated. The rates of antibiotic resistance were compared according to the years. The results were evaluated with statistical analysis.
RESULTS: We found that the most susceptible antibiotics were colistin and amikacin, and the most resistant antibiotic was piperacillin-tazobactam. In addition, decreasing the resistance rate of cefepime in 2011 compared to the previous year was statistically significant (p<0.05).
DISCUSSION AND CONCLUSION: The rate of antibiotic resistance are different from one center to another. Thus, every clinic should follow its own rate of antibiotic resistance, and it should benefit from this data for empiric treatment.

Akciðer kanseri, kanser mortalitesinin baþlýca sebebidir. Cerrahi, radyoterapi ve kemoterapi ile agresif tedavi yapýlsa bile uzun sürvi elde etme þansý az olduðu için tümör karþýtý immünoterapi gibi yeni terapötik stratejiler geliþtirme ihtiyacý doðmuþtur.

Lung cancer is the leading cause of cancer mortality. Despite aggressive treatment with surgery, radiation and chemotherapy, the long-term survival for lung cancer patients remains low which underscored the need to develop new therapeutic strategies like anti-timor immunotherapy.

Koanal stenoz; nazofarengeal kanser nedeni ile görülen radyoterapinin iyi bilinen bir geç komplikasyonudur. Velofarengeal stenoz da radyoterapi sonrasý nazofarenks kanserli hastalarda yüksek restenoz riski ile baþedilmesi gereken nadir fakat önemli bir problemdir (1). Bu sunumda nazofarenks kanseri nedeni ile radyoterapi görmüþ ve koanal stenoz, velofarengeal stenoz geliþmiþ bir hasta bildirilmektedir.

Choanal stenosis is a well known rate complication of nasopharyngeal carcinoma after radiotherapy. The management of velopharyngeal stenosis after radiotherapy for nasopharyngeal carcinoma is a challenging with high risk of restenosis (1). We report a case of choanal stenosis and velopharyngeal stenosis after radiotherapy for nasopharyngeal carcinoma.

Esas olarak ot yiyen hayvanlarýn hastalýðý olan þarbon, insanlara enfekte hayvanlardan bulaþýr. Türkiye’ de insidansý yýllar içinde azalmakla birlikte özellikle hayvancýlýkla uðraþanlarda halen görülmektedir. 3 formu olan þarbonun en sýk görülen formu kutanöz olanýdýr. Kutanöz formda periorbital tutulum tedaviye raðmen geliþebilen skar ve ektropion gibi komplikasyonlar nedeniyle önemlidir (1,2,3). Bu olgumuzda periorbital þarbonu olan 8 yaþýnda bir kýz hasta sunulmuþtur. Hastamýz sað üst göz kapaðýnda þiþlik, kýzarýklýk, el sýrtýnda yara ve ateþ þikâyetleriyle acil polikliniðimize getirildi. Hastanýn el sýrtýndaki ve göz kapaðýndaki lezyonlarý hiperemik, ödemli, yer yer siyah nekrotizan krutlu idi. Anamnez ve lezyonun tipik yapýsý þarbonu düþündürttü. Lezyondan gönderilen örnekte üreme olmadý. Ancak þarbonda negatif kültür hastalýðý dýþlamaz (4).Tedavi olarak 1x800 000 IU IM prokain penisilin ve penisiline dirençli suþlar da olabileceði düþünülerek 60mg/kg. vankomisin baþlandý. Herhangi bir komplikasyon geliþmedi. Bu vakayý çocuklarda, özellikle endemik bölgelerde periseptal selülit ayýrýcý tanýsýnda þarbonun da akýlda tutulmasýný, uygun tedaviye vakit geçirmeden baþlanmasýný hatýrlatmak amacý ile sunduk.

Anthrax, which is the disease of herbivorous animals, is transmitted to humans by the infected animals. In Turkey, although the incidence has been decreased through the last years, it is presented in people who are dealing with animals. The most commonly seen form is cutaneous one. Periorbital presentation seen in cutaneous form is important because of complications scar and ectropion unless treated well. In this case, 8 years old female with periorbital anthracis is presented. The patient was taken to our emergency policlinic with periorbital edema, erythematous lesion in hands and fever. The lesion in hands was seen necrotizing and hyperemic. Typical presentation of lesions reminded the anthrax. No pathogen was isolated in the specimen removed from the lesion. But negative culture results do not keep away the diagnosis of the antrax. Treatment started with Procaine Penicillin 800.000 U intramuscular and Vancomycin (60 mg/kg). No complication was seen. We presented this case, because anthrax should be kept in mind in the differential diagnosis of preseptal cellulitis in endemic regions and appropriate treatment should be managed as quickly as possible.

Akut dissemine ensefalomyelit (ADEM), merkezi sinir sisteminde beyaz cevheri tutan multifokal demiyelizan bir hastalýðýdýr. Altý yaþýnda kýz hasta, aðýzda istemsiz hareket, yutma güçlüðü ve konuþma bozukluðu ile kliniðimize getirildi. Hastaya iki hafta önce aþý yapýlmýþ. Hastanýn 24. saatinde çekilen kranial MR görüntülemesinde sað pariyetal lobda ve sað talamusta hiperintens görünüm tespit edilince hastada ensefalit ya da kitle ön planda düþünüldü. Fokal lezyonlar olmasý nedeniyle ön planda ADEM düþünülmedi. Semptomlarýn devam etmesi üzerine 3. gününde çekilen kranial MR’da beyaz cevherde multifokal lezyonlar görüldü. Biz baþlangýçta, atipik MR bulgularý görülen ancak, iki hafta önce aþý hikayesi olan ve tekrarlanan MR görüntülemesinde multifokal lezyonlarý tespit edilen ADEM olgusu sunduk. Biz burada, hikayesi ve klinik bulgularý ADEM düþündüren olgularda, kranial MR görüntülemesinin tekrarlanmasý gerektiðini vurgulamak istedik.

Acute disseminated encephalomyelitis (ADEM), is an acute inflammatory demyelinated disease of the central nervous system, usually following viral infections or vaccinations. Seven years old girl was admitted to our clinic with dysfunction in talking and swallowing, and focal seizure. She had history of immunization two weeks ago. Cranial magnetic resonance imaging (MRI) revealed acute inflammatory changes but didn’t support ADEM because of focal involvement of brain white matter. However, because of persisting symptoms we repeated cranial MRI in the third day. This cranial MRI revealed multifocal lesions in the white matter. We reported this patient with ADEM after vaccination who showed atypical neuroradiologic finding in the first cranial MRI but persistence of the sypmptoms forced us to serial MRI examination so that there can be a delay in involvement of neuroradiologic findings at the previous stage of the ADEM. It’s important that consecutive neurologic evaluation is necessary if the clinical picture is suggestive for ADEM.