AMAÇ: Alt gastrointestinal sistemin (AGÝS) mukozal patolojilerinin teþhisinde ve tedavisinde endoskopik inceleme altýn standart olup, yaygýn olarak kullanýlmaktadýr.
YÖNTEMLER: Çalýþmamýza alt GÝS endoskopisi uygulanan 736 hasta dahil edilmiþtir.
BULGULAR: En sýk kolonoskopik patoloji olarak hemoroid ve polip saptandý.
SONUÇ: AGÝS semptomu olan hastalarýn kolorektal hastalýklarýnýn benign ve malign patolojilerin tespitinde kolonoskopi altýn standart bir yöntemdir. Bunun yanýnda Enterobius vermicularis gibi çevresel faktörlerin ve kötü hijyenin sebep olduðu hastalýklarýn tespitinde faydalý olmaktadýr.

OBJECTIVE: Endoscopic examination, which is the gold standard in diagnosis and treatment of mucosal pathologies in lower gastrointestinal system, is widely used.
METHODS: 736 patients with lower gastrointestinal endoscopy were included in the study.
RESULTS: The most colonoscopic pathologies were hemorrhoids and polyps.
CONCLUSION: Endoscopy is the gold standard technique for detecting benign and malign colonic pathologies. In addition, endoscopy is beneficial determining the pathologies caused by Enterobius Vermicularis and environmental factors.

AMAÇ: Kýsa süreli jinekolojik iþlemler genellikle sedo-analjezi ile yapýlmaktadýr. Bu çalýþmamýzda günübirlik anestezi uygulanan bu küçük cerrahi giriþimlerde sedo-analjezik olarak kullanýlan propofol, etomidat ve ketaminin etkilerinin karþýlaþtýrýlmasýný amaçladýk
YÖNTEMLER: Amerikan Anesteziyoloji Derneði (ASA) I-II risk grubu, 25-50 yaþ arasý toplam 75 hasta çalýsmaya dahil edildi. hastalara operasyondan 30 dakika önce midazolam 0.04 mg/kg im premedikasyon amacýyla uygulandý. Grup P’ deki hastalara 0,5mg/kg propofol, grup E ‘deki hastalara 0,1mg/kg etomidat, Grup K’daki hastalara 0,5mg/kg ketamin IV bolus yapýldý. Hastalarýn Ramsey Sedasyon Skorlarý, uyanma zamaný, derlenmeye alýnma süreleri, ek ilaç dozlarý, total ilaç miktarý, oluþan yan etkiler kaydedildi.
BULGULAR: Propofol grubundaki hastalarýn %60’ýnda apne, %13.3’ünde hipotansiyon, %33.3’ünde bradikardi, %33.3’ünde enjeksiyona baðlý kolda aðrý,Etomidat grubundaki hastalarýn %6.7’sinda apne, %40’ýnde bulantý-kusma, %33.3’ünde myoklonik hareketler, Ketamin grubundaki hastalarýn %6.7 ’sinde myoklonik hareketler, %13.3’ünde bulantý-kusma görüldü.
SONUÇ: Hastalarýn hýzlý ve rahat uyanmasýný en iyi saðlayan etomidat-alfentanil grubu olmakla beraber ek hastalýklarý göz önüne alýnarak ilaçlar tercih edilmesi gerektiðini düþünüyoruz

OBJECTIVE: In general short-term gynaecological operations are performed under sedo-analgesia. In our study, we aimed to compare the effects of propofol, etomidate and ketamine which are frequently used for sedoanalgesia in short-term procedures.
METHODS: 75 patients with age between 25-50 and operation risk of ASA I-II were included. Within 30 minutes before the operation, patients were premedicated with midazolam 0,04 mg/kg. Sedo-analgesia was performed with propofol 0,5 mg/kg in group P, with etomidate 0,1 mg/kg in group E and with ketamine 0,5 mg/kg in group K. Ramsay sedation scale, awakening time, time to being transferred to PACU, additional doses, total doses and side effects were recorded.
RESULTS: In group P 60% of patients had apnoe, 13,3% had hypotension, 33,3% had bradycardia, 33,3% had pain in injection area. In group E, 6,7% of patients had apnoe, 40% had vomiting, 33,3% had myoclonic movements. In group K, 6,7% of patients had myoclonic movements, 13,3% had vomiting.
CONCLUSION: Etomidate-alfentanyl combination was upper when compared with other groups in faster and simplified awakening. In addition to that, we sustaine that additional diseases of patients must be taken in the consideration to make a better drug-combination choice.

AMAÇ: Çalýþmamýzda artroskopik giriþimlerde bir gruba VÝMA (sevofluran ile), diðer gruba TÝVA (propofol ile) indüksiyonu sonrasý LMA uygulamasýnýn solunum fonksiyonlarýna etkisini karþýlaþtýrmayý amaçladýk.
YÖNTEMLER: Bilgilendirilmiþ hasta onamlarý alýndýktan sonra genel anestezi ile operasyonu planlanan ASA 1-2, 18-60 yaþ arasý, artroskopi operasyonu olacak 50 hasta çalýþmaya dahil edildi. Grup 1 sevofluran ile VÝMA (n=25), Grup 2 propofol ve remifentanil infüzyonu ile TÝVA (n=25) olmak üzere 2 gruba ayrýldý. Çalýþmaya dahil edilen tüm hastalara Göðüs Hastalýklarý polikliniðinde preoperatif, postoperatif 2.saat ve postoperatif 24.saat solunum fonksiyon testi yapýldý. Test 3 sefer tekrar edilerek en iyi FVC ve FEV1 deðerleri seçildi. Operasyon odasýna alýndýktan sonra elektrokardiyografi, sistolik kan basýncý, diastolik kan basýncý, ortalama kan basýncý, kalp atým hýzý, periferik oksijen satürasyonu monitorize edildi.
BULGULAR: Postoperatif periyottaki FEV1, FVC, FEF %25-75 deðerleri preoperatif ve taburculuktaki duruma göre anlamlý düzeyde düþük çýkmýþ, ancak preoperatif ve taburculuktaki FEV1, FVC, FEF %25-75 deðerleri arasýna anlamlý fark bulunmamýþtýr. Bunlarýn yaný sýra TÝVA grubundaki FEV1 ve FVC ortalamasý VÝMA grubuna göre her üç ölçüm periyodunda da anlamlý düzeyde düþük bulunmuþtur. FEV1/FVC bakýmýndan yapýlan deðerlendirme sonucunda anestezi gruplarý arasýnda anlamlý fark bulunmamýþtýr. Ayrýca preoperatif, postoperatif ve taburculuk öncesi ölçüm periyotlarý arasýnda da anlamlý fark bulunmamýþtýr.
SONUÇ: Genel anestezi sonrasý her iki grupta da FVC,FEV1, FEF %25-75 gibi solunumsal parametrelerde azalma saptadýk. Deðiþmeyen FEV1/FVC oranýyla beraber akciðer fonksiyonlarýnda azalma her iki grupta da gözlendi.

OBJECTIVE: In this study, our purpose was to compare the effect of LMA appliance after VIMA or TIVA induction on respiratory functions in arthroscopic procedures.
METHODS: The study was performed in operating room and polyclinic on pulmonary disease in Medical Faculty Hospital of the University of Duzce. Fifty patients, who were undergoing arthroscopic surgery under general anesthesia between ages 18-60 and classified as ASA I-II were including after they informed consent was taken. In the operation room ECG, systolic, diastolic and mean blood pressure, heart rate and peripheric oxygen saturation were monitorised. Respiratory function test was performed to all patient included, preoperatively, on 2nd hour postoperatively and on 24nd hour postoperatively in the sitting position, after defined how the test works. The test was performed 3 times each and the highest FVC and FEV1 values were selected.
RESULTS: FEV1, FVC, and FEF %25-75 values postoperatively were significant lower than the values preoperatively and by discharge, but between FEV1, FVC, FEF %25-75 values preoperatively and by discharge were no significant difference. Additionally, FEV1 and FVC values in group VIMA were significantly lower than in group TIVA on every 3 test periods.
FEV1/FVC values were not significantly different between two anesthesia groups. In addition to that, there was no significantly different between test periods preoperatively, postoperatively and by discharge.

CONCLUSION: In conclusion, we determined by each two anesthesia groups that respiratory parameters like FEV1, FVC, and FEF %25-75 were decreased. By each two anesthesia groups were lung functions decreased and FEV1/FVC values remained. More studies on lung functions by different anesthesia techniques are needed.

AMAÇ: Amaç: Yenidoðan döneminde, çocuk cerrahlarý tarafýnda doðumsal anomaliler ve komplikasyonlardan dolayý uygulanan cerrahi iþlemlerin sýklýkla hayati önemi vardýr. Bu çalýþmada, cerrahi giriþim uygulanan yenidoðan olgularýn genel özellikleri ve mortalitesinin deðerlendirilmesi amaçlandý.
YÖNTEMLER: Hasta ve yöntemler: Aralýk 2008 ile Ekim 2012 tarihleri arasýnda iki çocuk cerrahý tarafýndan, yenidoðan döneminde ameliyat edilen 275 hastanýn kayýtlarý geriye dönük olarak incelenmiþtir.
BULGULAR: Bulgular: Toplam 275 yenidoðana 341 ameliyat uygulandý. Hastalarýn ortalama aðýrlýklarý 2508,24 ± 786,82 (950-5500) gramdý. Olgularýn 156 (% 56,7)’i erkekti. En sýk görülen doðumsal anomali % 22,9 oraný (n=63 ) ile özofagus atrezisi idi. Bunu % 22,5 (n=62) anal atrezi, izlemekte idi. Ortalama olarak hastanede kalýþ süresi 9,29±9,78 (1-62) gündü. Olgularýn % 25,1’i (n=69) kaybedildi
SONUÇ: Sonuçlar: Yenidoðan döneminde, uygulanan cerrahi giriþimler hayat kurtarýcýdýr. Yenidoðan hastalarý etkileyen olasý riskler azaltýlmasý ile hayatta kalým oraný artýrýlabilir.

OBJECTIVE: Background: The surgical interventions performed by the pediatric surgeons during the neonatal period are usually life-saving. The aim of this study is to evaluate the factors those may have influence on the mortality of the newborns who required surgical intervention.
METHODS: Patients and Methods: The hospital records of 275 pediatric patients ( age ≤ 1 month), who were opereated during newborn period by two pediatric surgeons between December 2008 and November 2012, were reviewed retrospectively.
RESULTS: Results: Among the 275 neonates underwent 341 operations. The average of weights of the patients were 2508.24 ± 786.82 (950-5500) grams. One-hundred-fifty-six patients (56.7%) were male. The esophageal atresi was the most frequent abnormality (22.9 %, n=63). Sixty-one patients, and (22.5 % n=62) patients had anal atresia. The average time of hospital stay was 10.15±9.97 (1-62) days. The overall mortality rate was 25.1%.
CONCLUSION: Conclusion: Surgical procedures can be life-saving in the neonatal period even if the risks related to the newborns are well determined and prevented. Thus, survival rates of the newborns those undergone surgery can be increased.

AMAÇ: Merkezimizdeki hemodiyaliz hastalarýnýn beslenme bilgi düzeylerini deðerlendirmek ve klinik ve laboratuar bulgularýna yansýmasýný deðerlendirmek
YÖNTEMLER: Çalýþmaya kronik böbrek yetmezliði (KBY) nedeni ile sürekli olarak hemodiyalize girmekte olan 65 hasta ( 31 K, 34 E ) alýndý. Hastalarýn ortalama yaþý 58.01 ±14.25 yýl idi. KBY nin en sýk nedeni hipertansiyon (%45) olarak saptandý. Hastalarýn demografik özellikleri, kan basýncý, laboratuar bulgularý ve diyaliz seansýndaki uygulanan tedaviler dýþýnda beslenme bilgi düzeyleri 22 soruluk anket formu ile deðerlendirildi. Veriler SPSS 17.0 programýnda analiz edildi. P<0.05 istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Hastalarýn %59’unun (n=38) beslenme konusunda eðitim aldýðý, %41’inin (n=27 ) almadýðý saptandý. Albümin (p=0.04) ve kalsiyum (p=0.04) düzeyleri dýþýnda iki grubun klinik ve laboratuar bulgularý arasýnda istatistiksel olarak anlamlý farklýlýk saptanmadý. Hastalarýn %80’inin eðitim düzeyinin ilkokul ve altý olduðu tespit edildi. Hastalarýn % 65’i aile desteði alamadýðýný belirti. Eðitim alan hastalarýn anket sorularýna verdikleri cevaplar incelendiðinde beslenme ile ilgili mevcut bilgi düzeylerinin yeterli olmadýðý saptandý.
SONUÇ: Hastalarýn eðitim seviyelerinin düþük ve yeterli aile desteði almadýklarý dikkate alýnarak anlatýlanlarý anlamadýklarý, unuttuklarý veya uygulamaya dönüþtüremedikleri görülmüþtür. Hemodiyaliz hastalarýnda bireysel farklýlýklar dikkate alýnarak, belirli periyotlarla ve etkili yöntemlerle eðitim tekrarlarýnýn yapýlmasý gereklidir.

OBJECTIVE: The aim of this study was to assess the effect of nutritional eduction level on clinical and laboratory findings in hemodialysis patients.
METHODS: The study group consisted of 65 patients (31 female, 34 male), undergoing routine hemodialysis. The mean age was 58.01 ±14.25 years. The most common etiology of chronic kidney disease was hypertension (%45). The nutritional education level was asssessed by using a survey sheet. Furtheremore, their demographic features, laboratory findings, blood pressure, and medications were obtained from their medical records. SPSS version 17.0 was used to perform the statistical analysis. P<0.05 was accepted to be significant.
RESULTS: It has been found that the nutritional education was given to 59% of patients (n=38), but not 41% (n=27). Clinical and laboratory results were not different between the patients with and without education except for albumin and calcium level (p=0.04 and p=0,04, respectively). The education level in 80% of patients was primary school or unschooled. The family support was not present in 65% of patients. In analysis of the survey sheet, it has been established that the nutritional education level was not sufficient in patients receiving education.
CONCLUSION: We showed that our patients could not understand, remember, or follow the nutritional education given them, along with a low education level and unsufficient family support. We suggest that the nutritional education should be given to patients regularly using by effective methods and that individual differences of patients should be taken into consideration during the educational period.

Koroner bypass cerrahisi sonrasý derin ven trombozu ve pulmoner tromboemboli nadir rastlanan komplikasyonlar olup yüksek morbidite ve mortalite taþýr. Doðru taný ve hýzlý tedavi baþarýlý bir sonuç için hayati önem taþýmasýna raðmen, standart bir tedavi seçeneði yoktur. Trombolitik tedavi, katater embolektomi ve açýk pulmoner embolektomi kullanýlan tedavi seçenekleridir. Bu yazýda, koroner arter bypass ameliyatýndan sonra derin ven trombozuna baðlý massiv pulmoner emboli geliþen vakada etkili bir yaklaþým olarak trombolitik tedavi ve proflaksisi anlatýldý.

Deep venous thrombosis and pulmonary embolism are rarely mensioned as complications of coronary bypass surgery and carry high risk of morbidity and mortality. Although accurate diagnosis and rapid treatment are crucial to a successful outcome, there is no standart treatment option. Thrombolytic therapy, catheter embolectomy and open pulmonary embolectomy are the usual treatment options. This report describes our use of thrombolytic therapy and as an effective therapeutic approach in a case of massive pulmonary embolism that occured after coronary artery bypass grafting.

Blind hemivajina ile birlikte görülen uterus didelfis ve ipsilateral renal agenezi normal menstruel siklusa sahip kadýnlarda görülebilen nadir bir anomalidir. Bu olgu sunumunda çift uterus, unilateral vajinal obstrüksiyon ve ipsilateral renal agenezisi olan iki olgu raporlanmýþtýr. Her iki olguda pelvik aðrý, dismenore ve bununla iliþki olarak pelvik kitle tespit edilmiþ virgin hastalardý. Bu sendromun farkýna varýlmasý ile vajinal septumun açýlmasý reprodüktif kapasiteyi koruyarak semptomlarýn tamamen düzelmesini saðlar.

Uterus didelphys with blind hemivagina and ipsilateral renal agenesis is a very rare anomaly and may be found in a female with normal menstrual periods.We report two cases with a double uterus, unilateral vaginal obstruction and ipsilateral renal agenesis. Both of the patients were virgin and their common clinical presentation was that of the onset of pelvic pain and dysmenorrhea, in association with the presence of a pelvic mass. In both of the patients we accurate the diagnosis by the laparotomic approach. A greater awareness of this syndrome should lead to accurate diagnosis and excision of the obstructing vaginal septum offers a complete relief of symptoms while preserving reproductive capacity.

Perfore apandisite baðlý enfeksiyöz komplikasyonlar sýk görülür. Ýntraabdominal apse, pelvik apse ve yara yeri enfeksiyonu en sýk görüldüðü yerlerdir. Skrotal apse ise nadir görülür. Perfore apandisitle inguinal patolojilerin birlikte bulunduðu durumlarda uygun yaklaþým hala tartýþmalýdýr. Biz bu çalýþmada perfore apandisit için cerrahi uygulanmasýndan sonra hidrosel kesesinde skrotal apse geliþen son derece nadir bir vakayý rapor ettik.

Infectious complications following perforated appendectomy are the most common. Intraabdominal abscess formation, pelvic abscess and wound infection are the most common sites of infection. Scrotal abscess following perforated appendectomy is very rare. The appropriate approach of perforated appendicitis with inguinal pathology is still controversial. We report an extremely rare case of an abscess that developed in the hydrocele sac after surgery for perforated appendicitis, in this study.

Kulak çýnlamasý, baþ dönmesi ve iþitme azlýðý semptomlarý ile kendini gösteren, kokleovestibüler sinirin internal akustik kanala giriþinde veya içerisinde anterior serebellar arter tarafýndan kompresyonu sonucu olan kokleovestibüler nörovasküler kompresyon sendromu, cerrahi tedavisi mikrovasküler dekompresyon olan bir hastalýktýr. Bu yazýda sol kokleovestibüler sinirin vasküler kompresyonu izlenen bir hastada uygulanan mikrovasküler dekompresyonunu rapor edildi.

Neurovascular compression syndrome of cochleovestibular complex is manifested by tinnitus, vertigo, and hearing loss. The cochleovestibular nerve is compressed by the anterior cerebral artery at the entry or within the internal acoustic canal. Surgery by microvascular decompression is the preferred treatment. In this article, a patient with cochleovestibular nerve vascular compression treated by microvascular decompression is reported.

Ektopik karaciðer dokusu nadir bir geliþimsel anomalidir.Ektopik karaciðer dokusu diyafram, hepatik ligaman, omentum, retroperiton ve toraks gibi çeþitli organlarda gözlenebilmesine raðmen en sýk yerleþim yeri safra kesesidir. Safra kesesinde ektopik karaciðer dokusu genelde laparotomi esnasýnda tesadüfi olarak bulunur. 40 yaþýnda bayan hastada laparoskopik kolesistektomi esnasýnda safra kesesinde ektopik karaciðer dokusu tespit edildi ve kolesistektomi ile beraber çýkarýldý. Yapýlan histopatolojik incelemede safra kesesi duvarýnda heterotopik karaciðer dokusu tespit edildi. Sonuç olarak, safra kesesinde heterotopik karaciðer dokusu safra kesesi icerisinde yer iþgal eden kitlelerin ayýrýcý tanýsýnda akýlda tutulmasý gereken bir patolojidir. Eðer safra kesesinde patoloji varsa kese ile beraber çýkarýlmasý önerilmektedir.

Ectopic liver is a rare developmental anomaly. Ectopic liver tissue can occur in several different organs such as the diaphragm, hepatic ligaments, omentum, stomach, retroperitoneum and thorax, but the gallbladder is the commonest site of origin. Heterotopic liver is more often incidentally detected during abdominal operations. Ectopic liver was detected on gallbladder at a 40 years old female patient during laparoscopic cholecystectomy and were taken out together with gallbladder. Histopathology demonstrated heterotopic liver tissue on the gallbladder wall. In conclusion, heterotopic liver tissue should be in mind for the differential diagnosis of masses in the gallbladder. It is recommended that if there is pathology of gallbladder, ectopic liver tissue on gallbladder must be taken out together with gallbladder.

Distrofik epidermolizis bülloza tanýlý temporomandibular eklem tutulumu olan ve her iki elinde pseudosindaktili nedeniyle operasyon planlanan hastaya, minimal monitörizasyon ile propofol indüksiyonu yapýldý ve larengeal maske uygulandý. Postoperatif dönemde EKG elektrodlarýnýn yapýþtýðý bölgeler dýþýnda yeni bül oluþumuna rastlanmadý.
Bu olguda; epidermolizis büllozalý hastalarýn anestezi yönetimini ve basit travmalar sonucu oluþabilecek sorunlarý gözden geçirmeyi amaçladýk.

This presentation includes anesthetic approach to a patient with temporomandibular joint involvement due to dystrophic epidermolysis bullosa, who received larengeal mask with
Prophofol. Minimal postoperative ECG monitoring, there were no new bullae formation was observed except the electrods adhered regions. In this case; we aimed to review the anesthetic management of patients with epidermolysis bullosa and issues that may occur as a result of trauma.

Akut Pankreatit (AP) Karýn aðrýsý ve amilaz ve lipaz gibi pankreas enzimlerinde yükselmeyle seyreden pankreasýn inflamatuar sürecidir