AMAÇ: Diabetes mellitus tüm dünyada yaygýn olarak izlenen kronik bir hastalýktýr. Üriner inkontinans bu hastalarda sýk olarak eþlik eden önemli bir saðlýk problemidir. Bu çalýþmamýzýn amacý Tip 2 Diabetus mellitus tanýlý kadýnlarda üriner inkontinans ve alt gruplarýnýn insidansýný belirlemek ve yaþam kalitesine etkisini deðerlendirmektir.
YÖNTEMLER: Çalýþmamýzda 290 kadýnda üriner inkontinansýn varlýðý ve derecesini belirlemek ve hayat kalitesi üzerine etkilerini deðerlendirmek üzere UDÝ-6 ve IIQ-7 anketleri uygulanmýþtýr. Çalýþma grubunda 143 olgu Tip 2 diabetes mellitus hastalýðýna sahip iken kalan olgular normal glukoz deðeri olan kadýnlardý.
BULGULAR: Diabetes mellituslu kadýnlarla normal kan glukoz deðerlerine sahip kadýnlar karþýlaþtýrýldýðýnda, üriner inkontinansýn alt tipleri olan urge üriner inkontinans ve stress üriner inkontinans için hafif/orta düzeydeki þikayetler benzer bulunurken, ciddi derecede þikayetler diabetes mellituslu kadýnlarda normal kan glukoz seviyeleri olan olgulara göre daha yüksek oranda izlenmiþtir (sýrasýyla, %15.4 vs % 6.8 ve %19.6 vs %6.1). Ayrýca IIQ-7 sonuçlarý diabetes mellituslu kadýnlarda anlamlý olarak daha yüksek bulunmuþtur (21±30 vs 8.5±17.1, p<0.01).
SONUÇ: Diabetes mellituslu kadýnlarda üriner inkontinans þikayetleri daha ciddi derecede bulunmuþtur ve hayat kalitesi anlamlý derecede daha kötü etkilenmiþtir.

OBJECTIVE: Diabetes mellitus is a chronic disease with high prevalence worldwide. Urinary incontinence is a major health problem in these patients. The aim of this study was to evaluate the prevalence of urinary incontinance and its subtypes in women with type 2 diabetes mellitus and to assess their effects on quality of life.
METHODS: 290 women were included in this study. The UDI-6 and IIQ-7 questionnaires were self-administered by the participants in order to determine the presence and degree of urinary incontinence and effects on quality of life. Type 2 diabetes mellitus was diagnosed in 143 women and the remainder had a normal blood glucose levels.
RESULTS: When compared with women with normal glucose level for urge urinary incontinence and stress urinary incontinence, women with diabetes mellitus had similar rate for mild/moderate complaints and a higher rate of severe complaints (15.4% vs 6.8% and 19.6% vs 6.1%, respectively). Mean IIQ-7 scores were also significantly higher in patients with diabetes mellitus (21±30 vs 8.5±17.1, p<0.01).
CONCLUSION: The urinary incontinence complaints were more severe and quality of life was negatively affected in women with diabetes mellitus.

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AMAÇ: Remisyondaki ülseratif kolit ve Crohn hastalarýnda otonom sinir sistemi tutulumu olup olmadýðýný deðerlendirmek ve bu tutulumun hastalarýn demografik özellikleri, hastalýðýn süresi, tutulum þekli, sigara kullanýmý ile olan iliþkisini incelemektir.
YÖNTEMLER: Çalýþmaya Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi Gastroenterohepatoloji bölümünden en az 12 aydýr takipli olan, 18-65 yaþ aralýðýnda remisyonda, 20 ülseratif kolit ile 20 Crohn hastasý ve yaþ ve cins açýsýndan bu hastalarla eþdeðer 20 adet saðlýklý kontrol alýnarak tüm katýlýmcýlara standart otonom testler uygulandý.
BULGULAR: Kontrol grubunun otonom skor ortalamalarý Crohn ve ülseratif kolit gruplarýndan istatistiksel olarak anlamlý derecede düþük bulunurken,Crohn ve ülseratif kolit gruplarý arasýnda ise istatistiksel farklýlýk gözlenmemiþtir. Pankoliti olan ülseratif kolit hastalarýnda otonom skor olmayanlara göre anlamlý olarak yüksek bulunmuþtur.
SONUÇ: Çalýþmamýzda, ülseratif kolit grubunun otonom skoru, Crohn hastalýðý grubunda olduðu gibi, kontrol grubuna gore istatistiksel olarak anlamlý derecede yüksekti. Bu etkilenme hastalýðýn direkt sinir sistemi üstüne etkisine baðlý olabileceði gibi, ekstraintestinal bir manifestasyonu veya hastalýðýn etiyolojisinde rol oynayan faktörlerden biri olabilir.

OBJECTIVE: The aim of this study is to identify whether autonomic nervous system involvement is present in patients with remitting ulcerative colitis and Crohn’s disease who were followed-up by the authors and to examine the relationships between autonomic nervous system involvement and the patient demographical characteristics, disease duration, involvement pattern and smoking habit.
METHODS: This study included 20 patients with ulcerative colitis and 20 patients with Crohn’s disease with the ages of 18-65 years who had been followed up for minimum 12 months at Haydarpaþa Numune Education and Research Hospital, Gastroenterohepatology Clinic. Twenty age- and sex-matched healthy controls were also included in the study. All patients underwent standard autonomic tests.
RESULTS: Mean autonomic scores of the control group were significantly lower than the scores of the Crohn’s disease and ulcerative colitis groups, whereas no statistically significant difference was found between groups with Crohn’s disease and ulcerative colitis. Autonomic score was significantly higher in ulcerative colitis patients with pancolitis compared to those without pancolitis.
CONCLUSION: Autonomic scores of the ulcerative colitis group, as in the Crohn’s disease group, were significantly higher compared to the control group. This result may be associated with the direct effect of the disease on the nervous system but may also be an extraintestinal manifestation or a factor involved in the etiology of the disease. It should always be born in mind that symptoms associated with autonomic neuropathy may develop during the course of inflammatory bowel disease.

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AMAÇ: Karýn ameliyatlarý sonrasý barsak yapýþýklýklarý ciddi morbidite ve mortaliteye neden olmaktadýr. Çalýþmamýzda insizyonel hernilerde defektin kapatýlmasýnda kullanýlan primer kapama, Poliprolen mesh, Prolen mesh - strech filmin adhezyon etkileri karþýlaþtýrýldý.
YÖNTEMLER: Çalýþmada 10 aylýk 250–300 gram beyaz Wistar Albina cinsi 30 adet sýçan kullanýldý. Grup I; Primer tamir, Grup II; Prolen mesh, Grup III; Prolen mesh - strech film kullanýldý. Denekler 20 mg/kg Ketamin Hidroklorür (Ketalar) ile uyutuldu. Karýn duvarýnada yarýçapý 1cm olan defekt oluþturuldu. Defekt Grup I’de primer olarak 3/0 prolen ile tek tek, Grup II’de poliprolen mesh, Grup III’te prolen mesh - strech film ile kapatýldý. Denekler 21. gün sakrifiye edildi. Yapýþýklýklar Makromorfolojik ve histopatolojik olarak deðerlendirildi.
BULGULAR: Makromorfolojik evrelendirme kriterlerine göre elde edilen yapýþýklýk skorlarý Grup I’de ortalama 1.3 ( 0-3), Grup II’de ortalama 3.4 (2-4), Grup III’de ise ortalama 0.9 (0-2) idi. Yapýþýklýklar arasýndaki fark istatistiksel olarak deðerlendirildiðinde Grup I ile II ve Grup II ile III arasýnda anlamlý fark saptandý (P<0.05). Histopatolojik incelemede Mezotel geliþimi, Vasküler proliferasyon, Kollojen oluþumu, Dev hücre oluþumu, Granülasyon oluþumu, Ýtihabi hücre oluþumu, ve fibroblast proliferasyonu Grup II’de en yüksek, Grup III’te ise en düþük saptandý.
SONUÇ: Strech film prolen mesh ile karýn duvarý defektlerinde yapýþýklýðý önlemek amacý ile kullanýlabilir, sentetik bir materyaldir.

OBJECTIVE: Postoperative adhesions may result in important serious morbidity and mortality. In this study, adhesive effects of primary closure, prolene mesh and prolene mesh-stretch films were compared in closure of incisional hernias.
METHODS: Thirty white Wistar Albino type rats were used. They were randomized into 3 groups as following: primer repair as group I, repair with prolen mesh as group II, and repair with prolen mesh-stretch film as group III. Rats were anaesthesized with ketamin hydroclorur. An artificial defect with 1 cm diameter was formed on abdominal wall. It was repaired with 3/0 prolene in group I, with prolene mesh in group II and with prolen mesh-stretch film in group III. Rats were sacrificed on 21st day. Histopatholocical and macromorphological staging criteria, proposed by Mazuji et al, were evaluated.
RESULTS: Mean adhesive scores according to macromorphological stating were 1.3 (0-3) in group I, 3.4 (2-4) in group II, and 0.9 (0-2) in group III. Adhesiveness was statistically different betweeen group I-II, and group II-III (p<0.05). Histopathologic examination revealed scores for group I, II and III consecutively as mesotelial growth of 0.7, 1.9, 0.5, vascular proliferation of 1.7, 2.8, 0.7, collagen formation of 1.5, 2.8, 0.8, giant cell formation of 1.1, 2.3, 0.4, granulation of 0.3, 1.9, 0.3, inflammatuary reaction of 1.7, 3.0, 0.7, and fibroblast proliferation of 1.7, 2.8, 0.7.
CONCLUSION: Prolen mesh - strectch film is a cheap and suitable synthetic material which can be used to prevent adhesions when repair of abdominal wall defects is considered.

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AMAÇ: Omuz aðrýsý hemiplejik hastalarda %16-72 oranýnda saptanan cidi bir problemdir. Üst ekstremite fonksiyonlarýný ciddi þekilde etkiler, yaþam kalitesini kötüleþtirir, motor fonksiyonlarýn iyileþmesini maskeleyebilir. Bu nedenlerle hemiplejik hastalarda üst ekstremite komplikasyonlarýnýn iyi bilinmesi ve erken dönemde taný konulup tedavi edilmesi gerekmektedir. Hemiplejik hastalarda omuz aðrýsýna sýkça rastlandýðý halde etiyoloji ve tedavisi konusunda tartýþmalar sürmektedir.
YÖNTEMLER: Bu çalýþma son 6 ay içinde hemipleji geçirmiþ, omuz aðrýsý tanýmlayan 28 ve omuz aðrýsý tanýmlamayan 32 hemiplejik hasta üzerinde hastalarýn aydýnlatýlmýþ onamý alýnarak yapýlmýþtýr. Tüm hastalarýn ayrýntýlý fizik muayeneleri ve demografik sorgulamasý yapýlarak, demografik verileri, üst ekstremitedeki spastisite, hemipleji motor evresi, pasif eklem hareket açýklýðý kaydedildi. Radyolojik subluksasyon; kol desteklenmeden 45 derece anterior oblik pozisyonda çekilen direkt grafiler kullanýlarak, vertikal subluksasyonu esas alan Van Langenberghe yöntemi ile, omuzdaki yumuþak doku patolojileri ise Magnetik Rezonans Görüntüleme ile deðerlendirildi.
BULGULAR: Omuz aðrýsý olmayan grupta üst ekstremite ve el brunstrom evrelemesi diðer gruba göre istatistiksel olarak daha yüksekti (p═0,048). Her iki grupta üst ekstremite spastisitesi ve radyolojik subluksasyon açýsýndan istatistiksel olarak anlamlý bir fark yoktu (p>0.05). Magnetik Rezonans Görüntüleme bulgularýndan bursit (p=0.00), supraspinatus kasýnda impingemet (p=0,009), infraspinatus tendiniti omuz aðrýlý grupta istatistiksel olarak anlamlý oranda yüksek bulunmuþtur (p=0,026).
SONUÇ: Çalýþmamýzda motor fonksiyonlardaki iyileþmesi düþük olan hastalarda omuz aðrýsýnýn daha sýk olduðu, subluksasyonun aðrýya eþlik etmeden de var olabileceði saptanmýþtýr. Hemiplejik hastalarda omuz aðrýsýnýn nedenleri çok çeþitlidir. Çalýþmamýzda da saptandýðý gibi hemiplejik omuz aðrýsýnda özellikle bursit, tendinit ve rotator cuf patolojilerinin sýklýkla görüldüðü göz önünde bulundurulmalýdýr. Yumuþak doku patolojilerinin ayrýntýlý olarak tespiti için Magnetik Rezonans Görüntülemeden yararlanýlabilinir.

OBJECTIVE: Shoulder pain is a serious problem in hemiplegic patients with an incidence of 16-72%. It substantially affects the function of the upper extremity, worsens quality of life and may mask motor recovery. Therefore, the complications of the upper extremity should be well-known, and diagnosed and treated in the early stages in hemiplegic patients. Although shoulder pain is frequently encountered in hemiplegic patients, the etiology and treatment are still controversial.
METHODS: This study included 28 hemiplegic patients who had shoulder pain and 32 hemiplegic patients who did not have shoulder pain with hemiplegia within the previous six months. All patients underwent a detailed physical examination and demographic questioning, and demographic data, upper limb spasticity, motor stage of hemiplegia and passive range of motion were recorded. Radiographic subluxation was evaluated with the Van Langenberghe method based on vertical subluxation by using plain radiographs taken at the degree anterior oblique position, and soft tissue pathologies of the shoulder were evaluated with Magnetic Resonance Imaging.
RESULTS: In the group without shoulder, upper extremity and hand pain, Brunstrom’s stages were statistically higher than in the group with shoulder pain (p = 0.048). No statistically significant difference was found in upper limb spasticity and radiological subluxation between the two groups (P <0.05). Among Magnetic Resonance Imaging findings, the bursitis (p = 0.00), impingement of supraspinatus muscle (p = 0.009) and infraspinatus tendinitis (p = 0.026) were statistically significantly higher in the group with shoulder pain.
CONCLUSION: Our study showed that shoulder pain is more common and subluxation may be present without pain in patients with low motor recovery. Shoulder pain has many and various causes in hemiplegic patients. As reported in our study, it should be considered that bursitis, tendinitis and rotator cuff pathologies in particular are frequently seen in patients with hemiplegic shoulder pain. Magnetic Resonance Imaging can be used for detailed identification of soft tissue pathologies.

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AMAÇ: Migren hastalarýnda gündüz uykululuk durumu sýklýðýnýn migren ataklarýnýn sýklýðý ile iliþkisi ve uyku bozukluðuna yol açan bir faktör olup olmadýðýnýn araþtýrýlmasý amaçlanmýþtýr.
YÖNTEMLER: Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi 2.Nöroloji Kliniði Baþaðrýsý polikliniðine baþvuran, 2004 Uluslararasý Baþaðrýsý Birliði tarafýndan oluþturulan kriterlere göre migren tanýsý konan, 60 bayan hasta çalýþmaya alýndý. Kesin migren tanýsý alan hastalara Epworth uykululuk skalasý (EUS) uygulandý. Hastalarýn aylýk baþaðrýsý sýklýðý sorgulandý.
BULGULAR: Hastalarýn yaþ ortalamasý 35,45 (alt sýnýr: 17, üst sýnýr: 50), aylýk atak ortalamasý 7,38 ( alt sýnýr: ayda 1 atak, üst sýnýr: ayda 20 atak ) olarak bulunmuþtur. 19 hastada (%31.99) EUS 10 ve üstünde ( p<0,05) saptanýp anlamlý bulunmuþtur. Yaþ ve EUS arasýnda iliþki saptanmazken (p>0,05), atak sýklýðý ve EUS arasýnda anlamlý iliþki saptanmýþtýr(p<0,05).
SONUÇ: Migrenli hastalarda genel popülasyona oranla gündüz uykululuk hali daha yüksek oranda görülmektedir ve atak sýklýðý arttýkça artmaktadýr. Bu hastalarda günlük yaþam kalitesini atak sýklýðýna ek olarak gündüz uykululuk hali de negatif yönde etkilemektedir.

OBJECTIVE: The aim of the study was to investigate the relationship between migraine frequency and daytime sleepiness in migraine patients and to evaluate whether daytime sleepiness were related to sleep disorder.
METHODS: We evaluated 60 female migraine patients (according to 2004 International Headache Society criteria) at our headache clinic. The patients underwent Epworth Sleepiness Scale (ESS). Migraine days per month in patients were investigated.
RESULTS: The migraine patients were aged between 17 and 50 (mean 35.45 years) and the frequency of migraine per month was 7.38 (from 1 to 20). ESS score was found higher than 10 in 19 patients (31.99%) and it was statistically significant ( p<0,05). Significant relationship was found between ESS score and migraine frequency (p<0,05), but there was not significant relationship between age and ESS score (p>0,05).
CONCLUSION: The daytime sleepiness ratio was found to be significantly higher in migraine patients when compared with normal subjects and also it was found to be higher in patients with frequency migraine. We conclude that the existence of daytime sleepiness and frequent migraine can worsen the quality of life.

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Bu olguda ankilozan spondilit ve takibinde Behçet hastalýðý kliniði geliþen 35 yaþýnda erkek bir olgu sunulmuþtur. Olgu modifiye Newyork kriterlerine göre ankilozan spondilit tanýsý almýþtýr. Oküler tutulumda hipopiyonlu iridosiklit ve retinal vaskülit geliþen olguda HLA-B27 pozitif, HLA-B5 negatif olarak bulunmuþtur. Bu olguda ankilozan spondilit ve Behçet hastalýðý bir arada gözlenmiþ ve birlikteliði literatür eþliðinde tartýþýlmýþtýr.

We presented a 35 year old case who was diagnosed as ankylosing spondylitis (AS) and developed clinical features of Behcet’s disease (BD) during his follow-up. He fullfills the Modified NewYork criteria for AS. He had an ocular involvement which was diagnosed as iridocyclitis with hypopyon and retinal vasculitis. His phenotype was positive for HLA-B27 and negative for HLA-B5. In this case, a combination of AS and BD has been observed and discussed.

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Künt diafragma rüptürü nadir olmayan bir yaralanma türüdür. Bu vakalarda taný güçlük göstermekte ve gecikmiþ vakalarda mortalite ve morbidite oranlarý yükselmektedir. Bu yazýda künt abdominal bir yaralanmaya sekonder diafragma rüptürü ve dalak yaralanmasý meydana gelen nadir bir hemotoraks vakasý sunulmaktadýr. Otuz bir yaþýnda erkek hasta iþ kazasý nedeniyle acil servise baþvurdu. Fiziksel incelemede kan basýncý düþüklüðü, solunum güçlüðü, karýnda defans ve rebound hassasiyet tespit edildi. Akciðer grafisinde sol diafragmada yükselme ve sol akciðer boþluðunda gaz gölgesi gözlendi. Bilgisayarlý tomografi incelemesi sol akciðer boþluðunda hemotoraks ve intestinal yapýlarda bu alana fýtýklaþma olduðunu gösterdi. Acil laparotomi uygulanan hastada sol diafragmanýn posterosentral alanýndan rüptüre olduðu ve buradan transvers kolon, mide ve dalaðýn fýtýklaþtýðý tespit edildi. Sol hemotoraks 5. derece dalak yaralanmasýndan kaynaklanýyordu. Cerrahi müdahaleden üç ay sonra hasta tam olarak iyileþerek normal vücut fonksiyonlarýný kazandý.

Blunt diaphragmatic rupture is not an uncommon injury. It is often difficult to diagnose, and both mortality and morbidity rates increase in delayed cases. We here present an uncommon case of hemothorax which was originated from diaphragmatic rupture and splenic injury secondary blunt abdominal injury. A 31-year-old man was admitted to emergency service because of a work related accident. On physical examination at admission, moderate hypotension, respiratory distress, abdominal defence and rebound tenderness was determined. On the chest x-ray of the patient left hemidiaphragm elevation and gas shadow in the left hemithorax was defined. A computed tomograpy scan showed hemothorax, herniation of intestinal segments through the left hemithorax. On laparatomy it was observed that posterocentral muscular part of the left hemidiaphragm was ruptured and transverse colon, stomach and spleen was herniated through the thorax. Left hemothorax,that was originated from Grade 5 splenic injury. Three months after the surgery the patient made a full recovery and all body functions went back to normal.

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Aksiller arter yaralanmasý humerus kýrýðý sonrasý nadir görülür ancak hipovolemik þoka götüren kanama ve ekstremite iskemisine sebep olduðu için acil hemostaz ve revaskülarizasyon gerektirir. Aksiller arter revaskülarizasyonunda çoðunlukla primer onarým veya safen ven greft interpozisyonu yeterli olmaktadýr. Yaralanmanýn arterin geniþ segmentini içerdiði veya arterde diseksiyon olduðu durumlarda anatomik veya ekstra-anatomik bypass uygulamalarý gerekli olur. Ekstra anatomik bypass karotis arter, karþý taraf subklavyan veya aksiller arterden yapýlabilir. Bu olgumuzda patolojik humerus baþý kýrýðý nedeniyle oluþan, primer onarýmý mümkün olmayan aksiller arter yaralanmasýna ekstra-anatomik sol aksillo-kontrbrakial arter bypass operasyonu uyguladýk.

Axillary artery injury rarely occurs after humeral fracture but requires emergency hemorrhage control and revascularization because it causes hemorrhage leading to hypovolemic shock and limb ischemia. Primary repair or saphenous vein graft interposition is mostly sufficient for axillary artery revascularization. If the injury includes a large segment of the artery or arterial dissection occurs anatomic or extra-anatomic bypass procedures become necessary. Extra-anatomic bypass can be performed from the carotid artery or contralateral subclavian or axillary artery. In this case, extra-anatomic left axillary-contralateral brachial artery bypass was performed for axillary artery injury which was caused by pathological humeral head fracture and in which primary repair was not performable.

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Ýlacýn indüklediði psödolenfoma olgularýna oldukça fazla rastlanmaktadýr. Ancak bu olgular daha çok ilacýn sistemik kullanýmý sonucu geliþmektedir. Ajanlarýn lokal kullanýmýna baðlý psödolenfoma olgularý da bildirilmiþtir. Bu çalýþmada subkutan insülin ve interferon enjeksiyonuna baðlý; enjeksiyon bölgelerine lokalize, eritemli patch þeklinde lezyonlarla kendini gösteren iki psödolenfoma olgusu sunuyoruz. Literatür bilgilerine göre olgularýmýz insülin ve interferon enjeksiyon bölgelerinde lokalize gözlenen ilk psödolenfoma olgularýdýr.

Drug-induced pseudolymphoma cases are frequently seen. However, these cases usually develop as a result of systemic use of the drug. Pseudolymphoma cases due to the use of local agents have also been reported. We are also presenting localized cutaneous pseudolymphoma, with erythematous patch and plaque lesions on injection sites; due to subcutaneous injection of insulin and interferon. According to our literature knowledge our cases are the first pseudolymphoma cases that seemed on insulin and interferon injection sites.

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Sternal yara enfeksiyonlarý ve özellikle mediastinitler açýk kalp cerrahisi sonrasý karþýlaþýlan ölümcül komplikasyonlar arasýnda yer almakta ve görülme sýklýklarý çoðu rapora göre % 0,4 ile %4 arasýnda deðiþmektedir. Bunlarýn bir kýsmý antibiyoterapi ile tedavi edilebilirken çoðunlukla ek olarak cerrahi uygulamalara ihtiyaç duyulur. Genelde cerrahi olarak o bölgenin rezeksiyonu ile birlikte sternal çelik teller çýkartýlýr. Biz CABG sonrasý geliþen kronik sternum osteomyelitli bir olguda tedavide pektoral major kas flebi uygulanmasýný sunuyoruz.

Sternal wound infections, especially mediastinitis are among the lethal complications of open heart surgery. They have been observed with the incidence of 0,4–4% following open heart surgery. Some of them can be treated by antibiotics but usually surgical approach is required. Surgical approach is based on resection of the infected area and removal of the sternal steel wires. In this paper we presented treatment of a patient with chronýc post-CABG sternal osteomyelitis by pectoralis major muscle flap implantation.

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Postpartum vajinal hematomlar doðumun az rastlanan ( 1/1000) hayatý tehdit edici komplikasyonlarýndandýr. 39 haftalýk gebe hasta epizyotomi ile doðum yaptýktan 5 gün sonra 6.4 × 6.2 × 6.2 cm’lik vajinal hematom tanýsý ile hospitalize edildi. Lineer vajinal insizyon yapýldý ve operasyondan 2 gün sonra þifa ile taburcu edildi. Puerperal hematomlarýn yönetiminde erken teþhis ve tedavi mortalite ve morbiditeyi azaltmak için önemlidir.

Postpartum vaginal haematomas are one of the rare complication( 1/1000) of delivery, and this complication can be life-threatening. We report a case a pregnant woman with 39 weeks delivered with episiotomy and developed 6.4 × 6.2 × 6.2 cm vaginal hematoma after fifth day of delivery. She was hospitalized with the diagnosis of vaginal hematoma. It was successfully drained with lineer vaginal incision and discharged from hospital two days following operation without any complications. Early diagnosis and management is essential to reduce morbidity and mortality of puerperal hematomas.

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Pilor stenozu sýklýkla biyokimyasal ve elektrolit bozukluklarý ile ortaya çýkmaktadýr. Kusma ve mide içeriðinin atýlmasý hafif orta derecede metabolik alkaloz ve prerenal azotemiye yol açabilmektedir. Böbrek yetmezliði sýklýkla metabolik asidoz ile birliktedir. Böbrek yetmezliði olan hastalarda ciddi metabolik alkalozun varlýðý pilor obstrüksiyonu açýsýndan hekimi uyarmalýdýr. Burada akut böbrek yetmezliði ve ciddi metabolik asidoz þeklinde ortaya çýkan pilor stenozu olan üç olgu sunulmuþtur.

Pyloric stenosis often presented with biochemical and electrolyte changes. Vomiting and gastric drainage can lead to mild or moderate metabolic alkalosis and prerenal azotemia. It is also known that renal failure often associated with a metabolic acidosis. The presence of severe metabolic alkalosis in patients with renal failure should alert the clinician the possibility of pyloric obstruction. We report here three case of pyloric stenosis presenting as severe metabolic alkalosis and acute renal failure.

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Oftalmik arter, karotis arterinin ilk dalýdýr ve gözün birincil arteriyel kaynaðýdýr. Karotis arterdeki herhangi bir darlýk veya týkanýklýk sonucu gözde hipoperfüzyona neden olabilir ve oküler iskemik sendrom oluþabilir. Oftalmolojik belirtiler amorozis fugakstan santral retinal veya oftalmik arter týkanýklýðýna baðlý tam körlüðe dek geniþ bir aralýkta yer alýr. Sonuçta internal karotis arter patolojisi neovasküler glokom, oküler hipotoni, iskemik retinopati, retina arter oklüzyonlarý, iskemik optik nöropati ve katarakt gibi komplikasyonlar yoluyla potansiyel olarak kör edici bir hastalýða yol açabilir. Oküler iskemik sendromu ve karotis arter hastalýðý olan hastalarýn çoðunda hipertansiyon, diyabet, iskemik kalp hastalýðý, ya da bilinen diðer sistemik hastalýklar vardýr. Hastalarda görme kaybý ve göz aðrýsý yanýnda beyinde ve miyokarda enfarktüs riski de eþ zamanlý olarak yüksektir.

The ophthalmic artery is the first branch of the carotid artery and the primary arterial source to the eye. Any stenosis or obstruction of the carotid artery may cause ocular hypoperfusion and as a result ocular ischemic syndrome may occur. Ophthalmological manifestations range from amaurosis fugax to complete blindness due to central retinal artery or ophthalmic artery occlusion. Therefore carotid artery pathology may be the reason of a potentially blinding condition secondary to complications such as neovascular glaucoma, ocular hypotony, ischemic retinopathy, retinal arterial occlusions, ischemic optic neuropathy and cataract. Most patients with ocular ischemic syndrome and carotid artery disease have a history of hypertension, diabetes, ischemic heart disease, or other known systemic diseases. Besides visual loss and ocular/orbital pain, affected patients are also at risk for developing cerebral and myocardial infarction.

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