AMAÇ: Bu çalýþmada yoðun bakým ünitemizde Griggs tekniði ile gerçekleþtirdiðimiz perkütan dilatasyonel trakeostomi (PDT) uygulamalarýmýzý sunmayý amaçladýk.
YÖNTEMLER: Griggs tekniði ile PDT uygulanan 38 hasta retrospektif olarak deðerlendirildi. Hastalarýn demografik verileri, mekanik ventilasyon süresi, iþlem süresi, erken komplikasyonlar (minör kanama, cerrahi kanama, subkutan amfizem, pnömotoraks, yanlýþ pasaj, hipoksi ve mortalite), yatýþ tanýlarý, yoðun bakým yatýþ süresi ve hastaneden çýkýþ durumu kaydedildi.
BULGULAR: Ýþlem süresi ortalama 10.26±3.7 dk olarak tespit edildi. PDT’ye baðlý erken komplikasyon olarak 2 (%5.2) hastada minör kanama, 1 (%2.6) hastada cerrahi kanama ve 1 (%2.6) hastada aritmi geliþti.
SONUÇ: PDT düþük komplikasyon oranýna sahiptir ve yatak baþý uygulamada yoðun bakýmlarda güvenli olarak uygulanabilir.

OBJECTIVE: In this study we aimed to present our percutaneous dilatational tracheostomy (PDT) practices by using Grigg’s technique in our intensive care unit.
METHODS: The data of 38 patients who were performed PDT by using Griggs tecnique were analyzed retrospectively. Demographic data of patients, mechanic ventilation time, the procedure time, the early complications (minor bleeding, surgical bleeding, subcutaneous emphysema, pneumothorax, false passage, hypoxia and mortality), diagnosis of patients, intensive care unit stay time and the patient status at the hospital discharge were recorded.
RESULTS: The mean procedure time was 10.26±3.7 min. The early complications of the procedure were found as a minor bleeding in two patients (%5.2), surgical bleeding in one patient (%2.6) and arrhythmia in one patient (%2.6).
CONCLUSION: PDT has a low complication rate and can be applied safely in intensive care unit bedside practice.

AMAÇ: 45-60 yaþ arasý kadýnlarda D vitamini eksikliði ile diz osteoartriti arasýndaki iliþkiyi belirlemeyi amaçladýk.
YÖNTEMLER: Çalýþmada diz osteoartritli 110 kadýn hasta yer aldý. Hastalar vitamin D seviyesine göre iki gruba ayrýldý: 1. grup düþük D vitamini seviyesine sahip (< 20 ng/ml) 65 hasta ve 2. grup ise normal D vitamini seviyesine sahip (≥20 ng/ml) 45 hastayý içerdi. Osteoartritin þiddeti Kellgren-Lawrence (KL) derecelendirme skalasý ile deðerlendirildi. Aðrý, tutukluk ve fonksiyonel durum Western Ontario and McMasters Üniversiteleri Osteoartrit Ýndeksi (WOMAC) ile ölçüldü.
BULGULAR: Vitamin D eksikliði oraný % 59,09 idi. Ortalama vitamin D seviyesi 1. grupta 9,09 ±3,82; 2. grupta 27,84 ±6,42 idi. Vitamin D düzeyi 1. grupta anlamlý derecede düþüktü (p=0,00). K/L evre 1 (%28,89) ve K/L evre 2 (%64,44) sýklýkla grup 2’de daha fazla iken, evre 3 (%38,46) ve evre 4 (%15,38) grup 1’de fazla bulundu. 1. grup, 2. gruba göre anlamlý derecede yüksek radyografik evrelere sahipti (p=0,00). 1. gruptaki hastalarýn WOMAC skorlarý anlamlý derecede yüksekti (p=0,00). K/L skorlarý, VAS-aðrý ve WOMAC skorlarý ile korele bulundu (p=0,00). K/L skorlarý vücut kitle indeksi (VKÝ) ile anlamlý korelasyon göstermedi (p=0, 82).
SONUÇ: Vitamin D eksikliði aðrý, tutukluk, fonksiyonel ve radyolojik durum açýsýndan diz osteoartriti ile iliþkilidir.

OBJECTIVE: We aimed to examine the relationship between vitamin D deficiency and knee osteoarthritis in women aged 45-60.
METHODS: 110 female patients with knee osteoarthritis were included. Patients were divided into two groups according to vitamin D level: group 1 included 65 patients with low vitamin D (< 20 ng/ml), and group 2 included 45 patients with vitamin D in normal ranges (≥20 ng/ml). Severity of osteoarthritis was evaluated by Kellgren-Lawrence (KL). Pain, stiffness and functional status were measured by Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC).
RESULTS: Rate of vitamin D deficiency was 59.09%. Mean vitamin D level was 9.09±3.82 in group 1 and 27.84±6.42 in group 2. Vitamin D was significantly lower in group 1 (p=0.00). K/L grade 1(28.89%) and 2(64.44%) were most frequently found in group 2, whereas grade 3(38.46%) and 4(15.38%) were found in group 1. Group1 had significantly higher radiographic grades than group 2 (p=0.00). Patients in group 1 scored significantly higher in WOMAC (p=0.00). K/L scores were correlated with VAS-pain and WOMAC scores (p=0.00). K/L scores showed no significant correlation with body mass index (BMI) (p=0.82).
CONCLUSION: Vitamin D deficiency is associated with knee OA in terms of pain, stiffness, functional and radiological status.

AMAÇ: Bu çalýþmada, mitral kapak hastalýðý nedeni ile mitral kapak replasmaný uygulanmýþ hastalarda pulmoner fonksiyonlardaki deðiþikliklerin geri dönüþümlü olup olmadýðýný deðerlendirmeyi amaçladýk.
YÖNTEMLER: Kliniðimizde Ocak 2008 ile Haziran 2011 tarihleri arasýnda mitral kapak replasmaný uyguladýðýmýz 26 hasta deðerlendirildi. Aort yetersizliði, koroner arter hastalýðý, kronik obstrüktif akciðer hastalýðý olan hastalar çalýþmaya alýnmadý. hastalarýn demografik özellikleri, ekokardiyografi bulgularý, spirometrik solunum fonksiyon test sonuçlarý kaydedildi. Ýstatistiksel analiz için SPSS for Windows 10.0 (statistical package for social sciences) programý kullanýldý.
BULGULAR: Çalýþmaya alýnan hastalar retrospektif olarak deðerlendirildi. FVC, FEV1, FEV1/FVC, FEF 25-75 %, PEF deðerleri pre ve postoperatif olarak karþýlaþtýrýldý. p<0,001 deðerini istatistiksel olarak anlamlý kabul ettik. Deðerlendirmeye aldýðýmýz tüm veriler istatistiksel olarak anlamlý idi.
SONUÇ: Mitral kapak hastalýðýna baðlý olarak ortaya çýkan pulmoner fonksiyonlardaki bozulmanýn önemli bir kýsmýnýn geri dönüþlü olduðunu düþünmekteyiz.

OBJECTIVE: In this study, we aimed to evaluate the reversibility of the alterations of pulmonary functions in the group of patients who underwent mitral valve surgery due to mitral valve disease.
METHODS: In this study, 26 of patients were evaluated who underwent mitral valve replacement in our clinic between January 2008 and June 2011. The patients with aortic regurgitation, coronary artery disease, chronical obstructive lung disease were excluded. Patients’ demographic characteristics, echocardiographical findings and spirometrical pulmonary function test results were recorded. SPSS (statistical package for social sciences) for Windows 10.0 programme was used for statistical analysis.
RESULTS: Study group of patients were evaluated retrospectively. FVC, FEV1, FEV1/FVC, FEF 25-75 %, PEF values were compared pre and postoperatively. We considered p<0,001 as statistically significant. All measures we evaluated were statistically significant.
CONCLUSION: We concluded that the important part of the pulmonary dysfunctions due to mitral valve disease are reversible.

AMAÇ: Gastrointestinal sistem hastalýklarý demir esikliðinin önemli nedenlerinden biridir. Bu çalýþmada demir eksikliði olan hastalarda gastrointestinal endoskopi bulgularý tanýmlanmasý amaçlandý.
YÖNTEMLER: Sakarya Üniversitesi Eðitim ve Araþtýrma Hastanesi Ýç Hastalýklarý Kliniðinde demir eksikliði anemisi tanýsýyla takip edilen hastalar retrospektif olarak deðerlendirildi. Hastalarýn demografik verileri, üst ve alt endoskopik bulgularý ve varsa biyopsi sonuçlarý kaydedildi. Veriler istatistiksel olarak analiz edildi.
BULGULAR: Çalýþmamýza demir eksikliði anemisi nedeniyle takip edilen yaþ ortalamasý 63,8±17 (67 Erkek, 66 Kadýn) toplam 133 hasta alýndý. 129 (%96.9) hastaya üst gastrointestinal endoskopi, 63 (%47.3) hastaya alt gastrointestinal sistem endoskopisi yapýldý. 59 (%44.3) hastaya üst ve alt gastrointestinal sistem endoskopisi birlikte yapýldý. Üst GiS endoskopi yapýlan hastalarýn %26,3’ ü normal deðerlendirildi. Hastalarýn % 6,9’unda kanser, %10 olguda gastrik ülser tespit edildi. Endoskopik olarak mide kanseri saptanan hastalarýn tümü ve gastrik ülser tespit edilen 1 hastanýn patoloji sonucu adenokarsinom olarak raporlandý. Alt GÝS endoskopi yapýlan hastalarýn %57.1’inde herhangi bir patolojiye rastlanmazken, %6,3 kolon kanseri ve %3,1 rektum kanseri tespit edildi. Her iki iþlemin birlikte yapýldýðý hastalarda %18.6 patoloji saptanmadý.
SONUÇ: Demir eksikliði gastrointestinal sistem patolojilerinin önemli bir bulgusudur. Üst ve alt gastrointestinal endoskopi bu bulguyu ortaya çýkaran nedenleri araþtýrrmada önemli ve gerekli tanýsal yöntemlerdir.

OBJECTIVE: Gastrointestinal system diseases are one of the most significant cause of iron deficiency. Aim of this research is to define gastrointestinal endoscopy findings on iron deficiency anemia patients.
METHODS: At the internal medicine clinic of Sakarya University hospital; iron deficiency anemia patients retrospectively evaluated. Patients’ demographic data, upper and lower endoscopic findings and if available biopsy results have been recorded. All of data statistically analyzed.
RESULTS: 133 patients (67 men, 66 women) of iron deficiency anemia participated to our research. Average age was 63,8±17. Upper gastrointestinal endoscopy has been done to 129 (96.9%) patients and lower gastrointestinal endoscopy has been done to 63 (47.3%) patients. 26.3% of patients that upper gastrointestinal endoscopy applied, rated as normal. 6.9% of patients diagnosed with cancer and 10% of patients diagnosed with gastric ulcer. All gastric cancer patients and a gastric ulcer patient who endoscopic diagnosed was reported patologicaly as adenocarsinom. 57.1% of patients that lower gastrointestinal endoscopy applied, resulted as no traces of patalogy. Beside of this, 6.3% diagnosed with colon canser, 3.1% diagnosed with rectum canser. Upper and lower gastrointestinal system endoscopy were done together to 59 (44,3%) patients. Any pathology wasn’t traced on %18,6 of the patients who the both procedure were done.
CONCLUSION: Iron deficiency is substantial symptom of gastrointestinal tract disease. Upper and lower gastrointestinal endoscopy is essential for research and diagnose of those patients.

Giriþ: Subklavian arter trombozu damar içindeki kan akýmýnýn aniden kesilmesi durumudur. Tromboz akut ya da kronik olabilir. Subklavian stenoz insidansý popülasyonda genel olarak %3-4 arasýndadýr. Bu durumun en sýk nedeni aterosklerozdur. Kimi otörler üst ekstremite arteryel hastalýðýný el ve kol semptomlarýna yol açmasýndan çok belirgin nörolojik ve kardiyak sekelle iliþkili olabileceði için önemli olarak deðerlendirmektedir.
Olgu: Bu vakada sol kolundan tansiyon ölçemediði için acil servise baþvuran 64 yaþýnda bir erkek hastayý sunduk. Hastaya Subklavian arter trombozu tanýsý konulmuþ ve trombektomi yapýlmýþtýr.
Acil servise sersemlik, vertigo, senkop, ataksi, bulantý, kolda aðrý ve güçsüzlük, kolda soðukluk veya duyu kaybý ile baþvuran tüm hastalarda subklavian arter trombozu ayýrýcý tanýda mutlaka akýlda tutulmalýdýr.

Introduction: Subclavian artery thrombosis is a condition in which the blood flow through the vessel is suddenly obstructed. Thrombosis may be acute or chronic. The incidence of subcla¬vian stenosis in the general population ranges from 3% to 4%. Atherosclerosis is the most common cause of this condition. Few practitioners consider the importance of upper extremity arterial disease; which, besides causing hand and arm symptoms, can be associated with significant neurologic and cardiac sequelae.
Case Report: We describe a 64 year old male patient who admitted emergency department while he couldn't measure blood pressure from the left arm. Subclavian artery thrombosis was diagnosed and he was treated with thrombectomy.
Conclusion: In the emergency department, light-headedness, vertigo, syncope, ataxia, nausea, arm pain and weakness, coldness or loss of sensation in the arm for all patients with subclavian artery thrombosis should be considered in the differential diagnosis.

Dyke-Davidoff-Masson sendromu (DDMS), dirençli konvülziyon, serebral hemiatrofi, fasial asimetri, hemipleji veya hemiparezi, mental retardasyon, paranazal sinüslerde aþýrý geniþleme ve havalanma artýþý, tek taraflý kafatasý kalýnlaþmasý ile karakterize bir sendromdur. Ýlk kez 1933 yýlýnda Dyke ve arkadaþlarý tarafýndan tanýmlanan bu sendrom, konjenital ve kazanýlmýþ birçok nedene baðlý olarak ortaya çýkabilmektedir. Bu olgu bildirisinde, DDMS tanýsý almýþ ve epilepsi nedeniyle takip edilen, 36 yaþýnda mental retarde kadýn hastanýn tanýsal kranial magnetik rezonans görüntüleme bulgularýný sunmayý amaçladýk.

Dyke-Davidoff-Masson syndrome is characterized with drug resistant epileptic seizures, cerebral hemiatrophy, facial asymmetry, contralateral hemiplegia or hemiparesis, mental retardation, unilateral thickening of the skull, extensive widening of paranasal sinuses and increase in air levels. The syndrome was first described in 1933 by Dyke et al. and both congenital and acquired factors are involved in the etiology. In this case report, we aimed to present the diagnostic magnetic resonance imaging findings of a 36-year-old mentally retarded female patient with Dyke-Davidoff-Masson syndrome.

Pek çok farklý nedene baðlý olarak geliþen ses bozukluklarý iletiþim bozukluðuna yol açabilmektedir. Çocukluk dönemindeki iletiþim bozukluklarý ise sosyal, akademik ve kiþisel faaliyetleri olumsuz bir þekilde etkileyerek çocuklarýn geliþimlerinde birtakým aksaklýklara neden olabilir. Bu sebeple çocukluk dönemindeki ses bozukluklarýnýn en etkin þekilde tedavisi son derece önemlidir. Ses bozukluklarýnda cerrahi müdahalenin çok az düþünüldüðü bu dönemde ses terapisi ses bozukluklarýnýn tedavisinde son derece etkili bir tedavi yöntemidir.

Voice disorders induced by many different causes can lead to communication disorders. Communication disorders in childhood can affect the social, academic and personal development of the children in a negative manner. For this reason, the most effective treatment of voice disorders in childhood is extremely important. Surgical intervention is not a common treatment in childhood voice disorders but voice therapy is an extremely effective treatment method.

Subaraknoid kanama,dünya nüfusu göz önüne alýndýðýnda en önemli morbidite ve mortalite nedenlerinden biridir.Geç komplikasyonlarýn (tekrar kanama,hidrosefali,geç iskemik nörolojik defisit,elektrolit imbalansý) yönetimi,sonuçlarýn daha iyi olmasýný saðlayabilir.Fakat,serebral hemodinamiðin bozulmasý,vasküler-nöronal apopitoz geliþmesi,genetik faktörler gibi patofizyolojik süreçler, önlenemeyen erken heyin hasarýna yol açmaktadýr.Bu makalede,subaraknoid kanama sonrasý serebral kan akýmýnýn önemi ve erken beyin hasarýna yol açan patofizyolojik mekanizmalar özetlenmiþtir.

Subarachnoidal hemorrhage is one of the most important causes of mortality and morbidity among the world’s population. Management of late complications (including rebleeding, hydrocephaly, late ischemic neurological deficit, or electrolyte imbalance) can improve outcomes. However, pathophysiological processes, such as deterioration of cerebral hemodynamics, development of vascular-neuronal apoptosis, and genetic factors that occur with the hemorrhage, lead to early brain injury that cannot be prevented. In this review, the significance of the cerebral blood flow after subarachnoidal hemorrhage and pathophysiological mechanisms that lead to early brain injury are summarized.