GÝRÝÞ ve AMAÇ: Transvezikal prostatektomi (TVP) ve transuretral prostatektomi (TURP)’ de çýkartýlan doku miktarlarýyla PSA düzeylerindeki düþüþ arasýndaki iliþkinin incelenmeyi amaçladýk
YÖNTEM ve GEREÇLER: Patoloji sonuçlarý adenomyomatoz hiperplazi gelen TVP yapýlan 79 hasta ve TUR-P yapýlan 135 hasta çalýþmaya dahil edildi. Hastalarýn ortalama yaþý TVP grubunda 68.2, TURP grubunda 65.7 idi. Tüm hastalara operasyon öncesi PRM, serumda total ve serbest PSA, TRUS, üroflovmetre ve IPSS yapýldý. Postoperatif 3. ayda PSA tekrar ölçüldü ve total ve serbest PSA deðerlerindeki azalma ile rezeke edilen doku miktarý arasýndaki korelasyon araþtýrýldý.
BULGULAR: TVP de prostat dokusunun % 81.4’ ü çýkarýlarak total PSA da % 79, serbest PSA da %58 düþüþ saptanýrken; TURP grubunda prostat dokusunun %52’ si çýkarýlarak total PSA da %47, serbest PSA da %42’lik bir düþüþ izlenmiþtir (p<0.001). Rezeke edilen 1 gr prostat kütlesine karþýlýk TVP grubunda total PSA’ da 0.145 ng/ml, serbest PSA’ da 0.03 ng/ml azalma; TURP grubunda total PSA’ da 0.103 ng/ml, serbest PSA’ da 0.013 ng/ml azalma bulundu.
TARTIÞMA ve SONUÇ: BPH nedeniyle TURP yapýlan hastalarda, çýkartýlan doku miktarýna paralel olarak total ve serbest PSA deðerlerinde azalma olur.

INTRODUCTION: To investigate the correlation between extracted tissue amount and prostate specific antigen (PSA) decline in patients treated with transvesical prostatectomy (TVP) and transurethral resection of prostate (TURP).
METHODS: A total of 79 patients who underwent TVP and 135 patients who underwent TUR-P with histopathologically, diagnosis of BPH was confirmed were enrolled to the study. The mean age of patients was 68.2 years in TVP group and 65.7 years in TURP group. All patients had DRE, serum total and free PSA, TRUS, uroflowmeter, and IPSS before the operation. In the postoperative 3rd month, the PSA measurement was repeated, and the correlation between the decrease in total and free PSA levels and the amount of tissue resected during the procedure was investigated.
RESULTS: In TVP group mean enucleated prostate volume was 81.4%. The decrease in total and free PSA levels was 79% and 58%, respectively. In TURP group mean resected prostate volume was 52%. The decrease in total and free PSA levels was 47% and 42%, respectively (p<0.001). For 1 g of prostate mass enucleated in TVP group, the total and free PSA levels decreased 0.145 ng/ml and 0.03 ng/ml, respectively. In TURP group for 1 g of prostate mass resected, the total and free PSA levels decreased 0.103 ng/ml and 0.013 ng/ml, respectively.
DISCUSSION AND CONCLUSION: Total-free PSA levels decrease with the amount of tissue extracted during TURP in BPH patients.

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Paratiroid hormon (PTH) paratiroid bezden sekrete edilen polipeptid yapýda bir hormondur. PTH serum kalsiyum ve fosfor dengesinin düzenlenmesinde önemli role sahiptir. Kronik böbrek hastalýðý (KBH) olan kiþilerde böbrek fonksiyonlarýndaki azalmaya baðlý olarak kalsiyum ve fosfor dengesi bozulur. Mineral dengesindeki bu bozulma PTH düzeyinde artýþa yol açar. KBH’ da PTH ve mineral dengesindeki bozuklukla giden geniþ spektrumlu klinik patolojilere kronik böbrek hastalýðýnýn mineral ve kemik bozukluðu (KBH-MKB) adý verilir. KBH-MKB’ nun takibinde paratiroid hormon kullanýlýr. Ancak yapýlan çalýþmalar PTH sonuçlarý arasýnda standardizasyonun olmadýðýný göstermiþtir. PTH sonucunda farklýlýklara yol açan nedenler arasýnda kullanýlan metodlarýn farklýlýðý, serumda bulunan PTH yýkým ürünleri, kiþinin Vitamin D durumu, ýsý, numune alma ve iþlemeye yönelik faktörler sayýlabilir. PTH ölçümlerinde sayýlan bu faktörlerin standardize edilmesine ihtiyaç vardýr. Ayrýca ölçüm yapýlan yönteme özgü klinik karar limitlerinin belirlenmesi gerekmektedir. Bunlara ek olarak; PTH ölçüm sonuçlarý rapor edilirken ölçüm yapýlan yöntem, numune alma ve iþleme ile ilgili faktörler ve doðru bir referans aralýk sonuç raporunda belirtilmelidir. Bu þekilde sonuçlarýn yorumlanmasýna ek katký saðlanabilir. Bu yazýda kronik böbrek hastalarýnda paratiroid hormon ölçüm sonucunu hastanýn kliniði haricinde etkileyecek faktörler irdelenmiþ ve PTH ölçüm sonuçlarýnda deðiþkenliklere yol açabilecek faktörlerle ilgili güncel bilgi sunulmuþtur.

Parathyroid hormone (PTH) is a polypeptide hormone produced and secreted by parathyroid glands, which plays a central role in calcium-phosphorus homeostasis. Calcium and phosphorus metabolism deteriorates in patients with chronic kidney disease (CKD) as a consequence of impairment in renal function. Deterioration in renal functions lead to an increase in serum PTH levels. Wide clinical spectrum pathologies of PTH and mineral metabolism disorders occurred in CKD is so called mineral and bone disorder of CKD (CKD-MBD). CKD-MBD is diagnosed and followed up by measurement of serum PTH. However, PTH assays are not been standardized. Causes of variations in PTH measurements include different methods, PTH derived products in serum, vitamin D level, heat, factors contributing sample obtaining and processing. Therefore, there is need for standardization of PTH measurements. Also assay-specific decision limits are required.The clinical laboratories must inform nephrologists of the actual assay method in use and report any change in methods, sample source, and handling specifications to facilitate an appropriate interpretation of biochemistry data.It clearly shows a large variability among PTH measurement kits and potential limits of this measure. Moreover, the report must indicate the correct reference values. This paper summarizes the current state regarding the PTH measurement in CKD.

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Amaç: GnRH veya Gonadotropin yetmezliðine baðlý ortaya çýkan tablo Hipogonadotropik Hipogonadizm (HH) olarak adlandýrýlýr. Bu derlemenin amacý, hipogonadotropik hipogonadizmin ortaya çýkýþ nedenleri, taný ve tedavi prensiplerini irdelemektir.
Gereç ve Yöntem: Bu derleme, PubMed ve Scopus bilgi toplama merkezlerine ‘hipogonadotropik hipogonadizm, infertilite, anovulasyon’ anahtar sözcükleri girilerek konu ile ilgili makalelerin toplanýp, elde edilen bilgilerin sistematik olarak özetlenmesi suretiyle elde edilmiþtir.
Bulgular: Hipogonadotropik Hipogonadizm’ de hipotalamustan gonadotropin salýverici hormonda (GnRH) azalma veya GnRH uyarýsýna hipofizin yanýtsýz kalmasý söz konusudur. Anovulasyon görülen kadýnlarýn %5-10’ u bu gruba dahildir. Primer ve sekonder olarak iki gruba ayrýlýr. Primer HH’ de genetik etiyoloji üzerinde durulmaktadýr. HH olgularýnda uygun taný ve gonadotropin destek tedavisi ile fertilite saðlanabilir.
Sonuç: HH tipik olarak düþük veya uygunsuz gonadotropin seviyelerine baðlý olarak dolaþýmdaki sex steroidlerinde düþüklükle karakterizedir. HH’ in dikkatli ve erken tanýsý olumsuz fiziksel ve psikolojik sekelleri ortadan kaldýrarak normal kemik kitlesinin korunmasýna ve fertilitenin restorasyonuna olanak tanýr.

Purpose: Hypogonadotropic Hypogonadism (HH) is a condition of GnRH or Gonadotropin deficiency. The aim of this study was consideration of the reasons, mechanisms, diagnosis and management of HH.
Material and Methods: The key words of ‘hypogonadotropic hypogonadism, infertility and anovulation’ entered to PubMed and Scopus database centers. The related articles summarized in this review.
Results: HH is the situation of the lessens of the Gonadotropin Releasing Hormone (GnRH) release from hypothalamus or the inadequate response of the hypophys to the GnRH stimulation. HH comprises 5-10% of the anovulatory women. Two subgrupes defined as primary and secondary types. The genetic basis is important for he primary type. Fertility is possible with proper diagnosis and gonadotropin supportive treatment.
Conclusion: HH is characterised by the low blood levels of sex steroids resulted from the low or improper levels of gonadotropins. Attentive and early diagnosis of HH could prevent the negative psychological and physical sequeles and facilitates the normal bone mass and the restoration of fertility.

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Kliniðimize sað alt kadran ve kasýk aðrýsýnýn yaný sýra ele gelen kitle þikayeti ile baþvuran 85 yaþýnda erkek hastada sað ana iliyak arteri tutan rüptüre olmamýþ dev anevrizma ve her iki ana femoral arteri tutan femoral arter anevrizmasýnýn dacron greft ile cerrahi onarýmýný sunduk.

In this case report we reported that the patient who was 85-year-old man with pain in the right lower quadrent and groin, as well as presented with a complaint of a palpable mass. We performed surgical repair to the right common iliac artery and bilateral femoral artery aneurysms by using dacron graft.

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Safra kesesi tümörü gastrointestinal sistemin 5. sýklýkta görülen patolojilerindendir. Genellikle komþu organlara direk yayýlým, lokal lenf nodu metastazý ya da yaygýn metastatik hastalýk þeklinde saptanabilir. 74 yaþýndaki kadýn hasta semptomatik taþsýz kolesistit nedeniyle kolesistektomi ameliyatýna alýndý. Hastaya, ameliyat sonrasý patolojik incelemede safra kesesinin adenokarsinomu tanýsý konuldu. Hasta 2. kez ameliyata alýnarak radikal kolesistektomi yapýldý.
Hasta þikayetleri ve klinik muayene bulgularý nonspesifik olduðundan taný ve tedavideki altýn standart öncelikle þüphelenmektir. Yazýmýzda safra kesesinde adenokarsinom teþhis edilen bir olgunun, nadir görülmesi nedeniyle tartýþýlmasý amaçlandý.

Primary carcinoma of the gallbladder is the fifth most common tumor of the gastrointestinal tract. It is usually detected by directly spreading to adjacent tissues, lymphatic spreading to regional lymphnodes or dissemine metastases. A 74year-old female patient underwent cholecystectomy because of symptomatic acalculous cholecystitis. Postoperative pathologic examination of the specimen led to a diagnosis of adeno carcinoma in the wall of gallbladder. After diagnosis, this patient underwent a second operation, which was a radical cholecystectomy.
Because complaints of the patient and the physical findings are nonspesific, the gold standart in diagnosis and treatment is to be always suspicious about it. In this study, our aim was to discuss adenocarcinoma in gall bladder which is encountered rarely.

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Hidatik hastalýk Echinococcus granulosusun sebep olduðu parazitik bir enfeksiyondur. Türkiye kist hidatik açýsýndan endemik bir bölgedir. Echinococcus kisti en sýk karaciðer ve akciðerde yerleþir,ancak vücudun herhangi bir bölgesinde de saptanabilir. Pelvik bölge ve kemik tutulumu nadirdir. Radyolojik yöntemler ile serolojik testlerin kombinasyonu özellikle endemik bölgede yaþayan hastalarda tanýda oldukça yararlýdýr. Biz pelvik aðrýnýn nadir bir sebebi olarak kist hidatik saptanan olguyu sunmayý amaçladýk.

Hydatid disease is a zoonotik parasitic infection caused by Echinococcus granulosus. Hydatid disease is an endemic disease in Turkey. Echinococcus cyst are found mostly in the liver and lung,but they can be located in any part of the body. Pelvic and bone involvement of echinococcosis is rarely occurs. The combination of radiologic and serologic test especially in patients living in he endemic areas contribute to the diagnosis. We describe a case of hydatid disese as a rare cause of pelvic pain

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Çocuklarda alt gastrointestinal sistemin en sýk kanama nedeni Meckel Divertikülüdür. Taný için en önemli yöntem klinik bulgular ve Nükleer görüntülemedir. 99mTc perteknetat sintigrafisi diðer deyimle Meckel divertikülü sintigrafisi taný için kullanýlan en önemli noninvaziv yöntemdir. Ancak Meckel divertikülünün mide mukozasý içermesi gerekmektedir. Çünkü Meckel divertikülü sintigrafisi mide mukozasýnýn gösterilmesini saðlar. Hastamýz 3 yaþýnda erkek hasta, abondan parlak kýrmýzý rektal kanama þikayeti ile baþvurdu. Hastaya aktif kanama sýrasýnda Meckel divertikülü sintigrafisi yapýldý. Ýnceleme sýrasýnda aralýklý lumen içi aktif kanama izlendi. Sintigrafik inceleme aktif kanama sýrasýnda yapýldýðýnda mide mukozasý ve aktif kanama gösterilebilir.

Anahtar Kelimeler: Meckel Divertikülü, Meckel divertikülü sintigrafisi, aktif kanama

The most common cause of massive lower gastrointestinal hemorrhage is Meckel’s diverticulum in children. Clinical examination and nuclear imagine are main topics for diagnosis. 99mTc pertechnetate scintiscan, or so-called Meckel’s scan is the best noninvasive method used to diagnosis this condition when heterotopic gastric mucosa is present. Because Meckel’s scan is used for detecting gastric mucosa. We described the case of 3 years old boy, complained with abundan bright rectal bleeding. Meckel’s divericulum scintigraphy was made during active bleeding. Intermittant intraluminal extravasation was seen during procedure. Scintigraphic study should been performed during active bleeding. So ectopic gastric mucosa and active bleeding should be shown.
Key Words: Meckel’s diverticulum, Meckel’s scan, active bleeding

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Herniler en sýk kasýk bölgesinde bulunur ve inguinal herniler olarak adlandýrýlýr. Herni kesesinin içerisinde sigmoid kolon, çekum, apendix ve omentum baþta olmak üzere çeþitli karýn içi organlar bulunabilir. Ýlk olarak 1735 yýlýnda Claudius Amyand tarafýndan tarif edilen amyand herni, fýtýk kesesi içersinde apendix vermiformisin bulunduðu nadir görülen bir durumdur. Genellikle sað inguinal herni nedeniyle operasyona alýnan hastalarda intraoperatif olarak tanýnýr. Kasýk fýtýklarý içersinde % 1 oranýnda ve erkeklerde daha sýk görülür. Biz bu olgumuzda inkarsere sað inguinal herni nedeniyle operasyona alýnan ve fýtýk kesesi içersinde blastrone apendisit saptadýðýmýz hastayý literatür bilgileri ýþýðýnda sunmayý amaçladýk.

Hernias most commonly occur in the inguinal area and it is named as inguinal hernia. The sac of an inguinal hernia may contain intraabdominal organ such as the sigmoid colon, cecum, omentum and the appendix. An Amyand’s hernia, was first reported by Claudius Amyand in 1735, is a rare occurrence where the vermiform appendix is found in an inguinal hernia sac. It is most commonly found intra-operatively during a right-sided inguinal hernia repair. The incidence of an Amyand’s Hernia is 1% of inguinal hernias occurring most often in male patients. We present a case of incarcerated right inguinal hernia containing the plastrone appendicitis and we review the literature on this rare condition.

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