Yıl: 1996, Cilt: 12, Sayı: 1
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Malıgn Plevral Efuzyonlarda Cea Ve Ca 19-9 Duzeylerı
Adil Zamani, Gülden Paşaoğlu, Ümmügülsüm Can, Faruk Özer, Mehmet Gök, Oktay İmecik
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Malıgn Plevral Efuzyonlarda Cea Ve Ca 19-9 Duzeylerı
Cea And Ca 19-9 In MalIgnant Pleural Ef-FusIons
Seljuk Universitesi Ttp Fakiiltesi Gogiis Has-taltklart ye Tiiherkiiloz Anabilim Dalinda 1994-1995 yillart arasinda yattrzlarak tetkik edilen 89 plevral efiizyonlu ve 25 saghkli hirey calqmaya alindi. 01-. gular etyolojik tat-taw-ma gore malign ye benign ola-rak iki gruha ayrildt. Toplam 89 olgudan 35'i ma-lign, 54'il benign gruptaydi. Malign gruhun yac ortalamast 64±10.54 olup 24'ii erkek. kadm be-nign gruhun yac ortalamast 47.94±15.56 olup 34'ii erkek, 20'si kadmdt ye kontrol gruhun yak or-talantast 45.28±11.71 olup 12'si erkek, 1 kadinds. Pleural efiizyonlu hastalarm serum ye plevral si-vtlarinda CEA ye CA 19-9 degerleri ye plevral mil serum oranlart; kontrol gruhunda ise hu tumor be-lirleyicikrinin (TB) serum degerleri okiilerek ma-lign kaynaklt eftizyonlart saptamakta serum ye plev-ral sty, degerleri arasindaki ili ki argttrildt. Malign olgularda CEA'nin serum degerleri benign grup ye kontrol gruhundan istatistiksel olarak anlamIt de-recede yiiksekti (p<0.01 ye p<0.001). Pleural sly, degerleri ye plevral stvilserum oranlari malign grupta anlamh derecede yiiksekti (p<0.01). CA 19- 9'un serum degerleri normal olmastna ragmen plev-ra sty, degerleri malign grupta benign grup ye kont-rol gruhuna gore a►lamli derecede yiiksekti (p<0.005). Sonuy olarak malign efiizyonlart sap-tamada CEA ye CA19-9'un serum degerlerine ha-ktlmadan sadece plevral stvt degerlerinin yeterli olabilecegi sonucuna varildt.
This study was performed in consecutive 89 pa-tients with pleural effusions and in 25 healthy in-dividuals chosen as a control group. The patients were separated in two groups according to their ae-tiologies: malignant pleural effisions and benign pleural effusions. In 35 cases, the cause of pleural effusions was malignancy and in other 54 cases there were benign diseases. The levels of CEA and CA 19-9 were measured in serum and pleural fluid of all patients and in sera of control group. We also investigated the relationship between serum and ple-ural fluid CEA and CA 19-9 concentrations. Mean serum and pleural fluid CEA concentrations was higher in malignant pleural effusions than in benign pleural effusions than in benign pleural effusions and healthy groups (p<0.01 and p<0.001). The lev-els of CA 19-9 in pleural fluid was higher in ma-lignant pleural effusions than in benign elisions (p<0.005). In conclusion, this study demonstrated that CEA and CA 19-9 pleural fluid levels might he useful in differential diagnosis of malignant pleural
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Pektus Ekskavatum Ve Cerrahı Tedavısı
Kazım Gürol Akyol, Güven Sadi Sunam, Sami Ceran, Mehmet Gök, Simsen Avvuran, Aydın Şanlı, Işık Solak, Hasan Solak
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Pektus Ekskavatum Ve Cerrahı Tedavısı
Pectus Excavatum And SurgIcal Treatment
Pektus ekskavatum sternumun en sik gorillen konjeniral deformitesidir. Cerrahi tedavi genelikle psikolojik ve kozmetik nedenlerle yapilmaktadtr. Bu makalede 1983-1996 yrilart arastnda hastanemizde opere edilen 26 vaka incelenmiştir.
Pectus excavatum is the most common deformity of the sternum. Surgical treatment is mostly per-formed by cosmetic and physicologic reasons. 26 cases were evaluated that treated in our hospital from 1983-1996.
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Kardıak Tamponat Olusturan Perıkardıal Effuzyonlarda Subksıfoıdal Perıkardıotom1 Uygulanması Ye Perıkardıosenteze Ustunluklerı
Aydın Şanlı, Sami Ceran, Kazım Gürol Akyol, Mehmet Gök, Güven Sadi Sunam, Simsen Avvuran, Işık Solak, Hasan Solak
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Kardıak Tamponat Olusturan Perıkardıal Effuzyonlarda Subksıfoıdal Perıkardıotom1 Uygulanması Ye Perıkardıosenteze Ustunluklerı
SubxIphoId PerIcardIotomy
Seljuk Universitesi Tip Fakultesi Gogus Ka1p Damar Cerrahisi Kliniginde Aralik 1983 ile Aralik 1995 yillart arasi ileri perikardial efflizyonu olan 50 hastanin 47'sine subksifoidal perikardiotomi uy-gtdandi. Bit yontentin perikardiosenteze oranla eti-yolojik tam ye tedavide olan iistiinliikleri vur-gulandi. Her iki yontem sonrast geliFbilecek ciddi komplikasyonlar nedeni ile preoperatuvar he-modinamik monitorizasyonun onemi belirtildi.
In Patients Have Pericardial Effusion Causing Cardiac Tamponade and A Comparison With Pericardiosynthesis. Between December 1983 and December 1995 fifty patients with severa Pericardial effusion were sed suhxiphoid pericardiotomy is more usufitll than pericardiosyntesis. Preoperative hemodynamic monitorisation sho-uld he performed in every patient since dangereous complications.
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Hırsutızmde Kardıyovaskuler Rısk Acısından Hdl Alt Gruplarının Tayını
Mehmet Gürbilek, Mehmet Aköz, Hüseyin Vural, Mine Kaymakçı, Mahmut ay, Mürsel Gökçen
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Hırsutızmde Kardıyovaskuler Rısk Acısından Hdl Alt Gruplarının Tayını
The DetermInatIon Of Hdl-Cholesterol Levels As CardIovascular RIsk Factor In HIrsutIsm.
Hirsutismus'lu 23 hastada, serum total ko-lesterol, LDL- kolesterol, HDL- Kolesterol, HDL2- kolesierol ye HDL3- kolesterol seviyeleri 18 normal kadinlarazki ile karplavtrildt. Hirsutismus'lu grupta HDL-kolesterol ye HDL-2 kolesterol onemli mik-tai-da diisiiktii (p<0.01). Dugiik HDL- kolesterol ye HDL,- kolesterol seviyeleri hirsutismuslu vakalarda ateroskleroz riskini arttrabilecegi kanaatine varildt.
In this study, the serum total cholesterol, LDL-cholesterol, HDL-cholesterol. HDL2-cholesterol and HDL3- cholesterol levels of 23 hirsutic patient were compared with 18 normal women. HDL-cholesterol and HDL2-cholesterol levels were significantly lower in hirsutic group than in control (p<0.01). It is known that low levels of HDL-cholesterol can he considered as a risk marker for atherosclerozis. We conculuded that low HDL-cholesterol and HDL2- cholesterol leyel.s- in hirsutism may constitute an im-portant risk factor.
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Akcıger Kanserlı Hastalarda Sınır Iletımı Ye Uyarılmıs Kortıkal Cevaplar
Orhan Demir, Mehmet Gök, Nurhan İlhan, Bülent Oğuz Genç
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Akcıger Kanserlı Hastalarda Sınır Iletımı Ye Uyarılmıs Kortıkal Cevaplar
Nerve ConductIon And Evoked PotentIals
Akciger kanserlerinin paraneoplastik pa-lizzoropati sendromlarimn baAca nedenlerinden al-dzigu bilitimektedir. Ancak periferik siniri etkiledigi hilinmesine ragmen santral rzoronal yollarzn et-kilenip etkilenmedigine dair taranan literatiirde hir hilgiye rastlannzamor. Bu calz§mada Akciger kan-serli hastalarda gorse!, icitse1 ve sornatosensoriyel tiyarilmq kortikal cevaplar (VEP,BAEP,SEP) kay-dedilerek santral yollarin etkilenip etkilenmedigi aravirilch. Bilgisayarli tomografi incelemesinde se-rebral inetastaza rastlanmayan 28 Akciger kanserli hastada calima yapildt. Vakalaruz 7sinde (%25.) duysal polinoropati tespit edildi. VEP latanslaruzin (P100) grup olarak normal kontrol gruhu ile kar-stlap`irmasinda hir prkblik goriilmedi(P>0.05). Ancak 4 vakanin VEP latanslarinin patolojik uzadigi goriildii. PNP tespit edilemeyen vakalarda yapilan SEP incelemesinde (median ye posterior ti-bial uvartm) 4 vakada (%19.4) patolojik latans uza-man giir illdu. Bec hastada BAEP bilateral elde edi-lemedi (%17.24). Sonuc olarak Akciger kanserli hastalarda, PNP nishetinde yiiksek olmamakia heraher santral yol-larin da paraneoplastik olarak etkilenebildigi ka-mszna varildi.
In The Patients With Lung Cancer It is well known that lung cancer is one of the main causes of the paraneoplastic neuropathy syn-dromes. Although the lung cancer has remote effect on peripheral nerves, whether it affects central neu-ronal pathways is not clear. In this study visual, auditory and somatosen-soriel evoked evoked potentials (VEP,BAEP,SEP re-spectively) are recorded in the 28 patients with lung cancer in whom no cerebral metastase were found-ed. Nerve conduction study showed sensory neurop-athy in 7 patients (25%). VEP latencies were path-ologically delayed in 4 patients (19.'4%). Frequency in the abnormal delay of SEP (N19 and 131) is also 19.4%. BAEP could not he elicited in 5 patients (17.24%). We concluded that central neuronal path-ways are also he influenced by remote effect of the lung cancer. However its central effect is not so _fre-quent as peripheral one.
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Plorezılerın Ayırıcı Tanısında Ultrasonografı
Faruk Özer, Oktay İmecik, Kemal Ödev, Alaaddin Vural
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Plorezılerın Ayırıcı Tanısında Ultrasonografı
Ultrasonography In The DIfferentIal DIagnosIs Of Pleural EffusIons
Bu calısmada 35 plorezili hastada US bul-gularmin aravirilmast ye aytrict tang(' katkilartrun degerlendirilmesi arnaclanmor. cahlmaya alman hastalarin 25'i erkek ye 101u kadin olup ya4lart 18 ile 66 arasznda deg4mekteydi (ortalama 41). Pleura sivist hastalarm 21'inde sagda ye 137inde sol ta-rafta ve bir olguda ise bilateral yerlevimliydi. Pleura siva' eksiida niteliginde elan olgularin to monde (34 olgu) plevra kahnlapnast saptandt. Plevra kalaralaga tiiberkiiloz plO•ezili olgularda(13 olgu) 3-11 mm (ortalarna 5 mm), maligniteli olgularda (11 olgu) 6-19 mm (ortalama 11 mm) ye pnomonili olgularda (8 olgu) 4-17mm (ortalama 7 mm) arasinda de-giymekteydi. Tiiberkiiloz plorezili olgularin 12'sinde (%92) plevra ditzenli ve diffiiz Sekilde kaltrilaqmzot. Ayrica tiiberkiiloz plorezili olgularin 101unda (%77) pant tarzinda ekojenik fibriler yapilartn varhgt dik-kat cekiciydi. Bu calt,cma tiiherkulaz plorezili al-gularin aylrzcz tamsznda ultrasonografinin yararlz olabilecegini gOstermi,stir.
In this study, we investigated ultrasonographic findings of pleural effusion in 35 patients with ple-urisy as an aid to differential diagnosis. 25 of the patients were male amd 10 female. The mean age was 41 (range 18 tO 66). All the cases except one with transudate had pleural thickening. The mean thickness of pleura was 5 mm (range 3-11 mm) in cases with tuberculous effusion, 11 mm (range 6-19 mm) in cases with malignant effusion and 7mm (range 4-17 mm) in cases with pneumonic effusions. In cases with tuberculous effusion pleural thickening was diffuse and regular in 12 of 13 cases (%92). It was also determined mobile echogenic fibrils on the surface of pleura in 10 (%77) of the tuberculous ef-fusions. This study suggests that ultrasonography may he useful in the differential diagnosis of tu-berculous pleural effitsions.
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Obsesıf Kompulsıf Eozuklukta Okuma Sırasında Elektrookulografik Inceleme
Zehra Akpınar, Rüstem Aşkın, Nazmiye Kaya, Orhan Demir, Süleyman İlhan
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Obsesıf Kompulsıf Eozuklukta Okuma Sırasında Elektrookulografik Inceleme
ElectrooculographIc InvestIgatIon WhIle Re-AdIng In PatIents WIth ObsessIve CompulsIve DI-Sorder
Beyin gorlimillerne cahmalart, obsesif kom-pulsif bozukluklu (0KB) ki§ilerde frontal korteks ye bazal ganglion anomalilerini ortaya koymititur. Bu bolgekrin lezyonlari amaca yonelik sakkadik gdz hareketi peiformansini etkiler: bu aculan biz obsesif kompulsif bozukluk ile okiilomotor peiformans ara-sindaki ilt kiyi aravirdik. 14 obsesif kompulsif bo-zukluklu hasra ile 10 normal hirey, okillomotor be-ceriler ve fiksasyon perfbrmansi aciszndan degerlendirildi. Obsesif kompulsif bozukluklu grup sozkonusu Olciimlerde anlamh olciide daha farkh bulundu(p<0.001). Sonuclar, obsesif kompulsif bo-zukluk ile amaca yonelik sakkadik goz hareketi be-cerilerindeki yetersiz performans arasinda ili cki ol-dugu tezini desteklemektedir.
Neuroimaging studies have shown abnormalities of the frontal cortex and basal ganglia in persons with obsessive compulsive disorder. Since lesions in the frontal cortex and basal ganglia areas affect performance on goal guidid saccadic eye mo-vements, this study investigated the relation between the diagnosis of obsessive compulsive disorder and oculomotor performance. 14 patients with the cli-nical diagnosis of obsessive compulsive disorder-and 10 normal subjects were assessed with respect to their oculomotor tasks and fixations performance. the group with obsessive compulsive disorder were significantly different from normal group on these measures(p<0,001). The results support the hypo-hesis of a relationship between impaired per-formance on goal guided saccadic eye movement tasks and the diagnosis of obsessive compulsive di-sorder.
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Amator Boksorlerde Isıtsel Ve Gorsel Uyarılmıs Kortıkal Cevaplar
Recep Aygül, Orhan Demir, Nurhan İlhan, Bülent Oğuz Genç
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Amator Boksorlerde Isıtsel Ve Gorsel Uyarılmıs Kortıkal Cevaplar
VIsual And AudItory Evoked CortIcal Responses In Amateur Boxers.
52 amatör hoksorde gorsel ye 4itsel tryartlmq kortikal cevaplar kaydedildi. Klinik diizeyde 2 bok-siirde horizontal nistagmus, 2 bokseirde gOz kapah one yiiriiyiiste giivensizlik, I boksorde psikotik re-aksiyon tespit edildi(%9.8).GOrsel tryarrlmq po-tansiyelkrde patoloji tespit edilemedi. 4itsel uya-rrInn§ potansiyel incelemesinde V.dalgarzin latansi 3 boksorde patolojik ol4ude uzamq olarak hulundu. Brr hulgula• kronik t•avmatik ansefalopati sendromu hiyomekanigi ile ilgili literatiir bilgileriyle tartspldr. Ural-ding potansiyel incelemelerinin kronik trav-matik ansefalopati sendromunun erken donemde saptanmasrna katkisznin olanuyacagt kanzszna va-rzldr.
Both auditory and visual evoked cortical po-tentials have been recorded in 52 amateur boxers. It has been clinically found that of these boxers, two had horizontal nistagmus, two had insecurity in do-sed-eye walking, one had psychotic reaction (%9.8). None of the visual evoked potentials has shown pat-hology. In the studies of auditory evoked potentials, it has been found out that the latency of the 5th wave in boxers showed pathological increase. Findings have been discussed in the light of the biome•hanics of chronical traumatic encephalopathy syndrome. It has been concluded that the evoked potential studies do not contruhute to the determination of chronic traumatic encephalopathy syndrome in its early stage.
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Value Of Glutathıon S-Transferase In Dıagnosıs Of Malıgnant Pleural Effusıons
Faruk Özer, Oktay İmecik, Bünyamin Kaptanoğlu, Kürşat Uzun
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Value Of Glutathıon S-Transferase In Dıagnosıs Of Malıgnant Pleural Effusıons
Value Of Gst In DIagnosIs Of MalIgnant Ple-Ural EffusIons
Bu raltmada plorezili 89 hastanin plevra swat ve serumlan ile kontrol grubu olarak secilen 15 sag-hi& bireyin serumlartnda glwathion S-transferase (GST) diizeykri araprildt. Plikezinin nedeni 27 al-guda malignite iken 62 olguda malignite dip has-taliklarch. Maligniteli hasra grubunda elde edilen ortalama serum GST diizeyi 18.39±1.18 UIL olup gerek malignite dtsr plorezi grubu (p<0.01) ve ge-rekse kontrol grubundakikrden (p<0.001) anlamh derecede yiiksekti. Malignite ye malignite dui gruplarmda saptanan ortalama plevra smut GST diizeyleri strastyla 28.46±1.48 UIL ye 10.59±0.87 UIL olup aralanndaki fork istatistiksel olarak anlamh diizeydeydi (p<0.001). Maligniteli hasta gruhunun ortalama plevra stvistiserurn GST orant da diger hasta grubuna gore anlamh derecede viiksek bulundu. Malignite kaynakh plorezilerin ma-lignite dtp nedenlere bash olanlardan apt-- dedilmesinde 20 U1L'yi acan degerler kin plevra st-vist GST dikeyi tayininin spesifitesi % 97 ye sensitivitesi %85 olarak bulundu. Plevra sivesil serum GST orantnin spesifite ve sensitivitesi ise 1.4 stnir deter ile strastyla % 87 ve %78 idi. Bul-gulartmtz plevra mist GST diizeyi tayininin ma-lignite kaynakh plorezilerin tantsinda degerli hir M-celeme oldugunu gostermektedir.
We meauserd pleural fluid and serum glutathion S-tranferase (GST) activity in 89 patients with ple-ural effusion and serum GST activity in IS healthy person choosen as control group. The cause of 27 pleural effusion was malignancy, and nonmalignant diseases were determined as the cause of 62 cases. Mean serum GST activity was 18.39±1.18 UIL in patients with malignant effusions. which was sig-nificantly higher than those in both nonmalignant cases (p<0.01) and control group (p<0.001). Ple-ural fluid GST level of malignant and nonmalignant effusions were 28.46±1.48 U1L and 10.59±0.87 1.11 L. respectively. The difference between the pleural fluid GST values of malignant and nonmalignant ef-fusions was statistically significant (p<0.001). The mean pleural fluid to serum GST ratio of patients with malignant effusion was also significantly hig-her than that of nonmalignant group. The specifity and sensitivity of the determination of pleural fluid GST level in excess of 20 Ull. in distinguishing ma-lignant effusions were 97 percent and 85 percent, respectively. These values for pleural fluid to serum GST ratio with the cutoff level of 1,4 were 87 per-cent and 78 percent. Our findings indicate that de-termination of GST activity in pleural fluid has a di-agnostic value in differential diagnosis of malignant eiliisions.
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Kronık Uremılı Hastalarda Sınır Iletımı, R-R Interval' Ve Sempatık Derı Cevabı
Orhan Demir, Ahmet Yılmaz, Nurhan İlhan, Bülent Oğuz Genç, Cengiz Eser
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Kronık Uremılı Hastalarda Sınır Iletımı, R-R Interval' Ve Sempatık Derı Cevabı
Nerve ConductIon, R-R Intervals And Sympat-HetIc SkIn Responses
Oreminin polinoropati nedenlerinden birisi ol-dugu iyi bilinir. Bu caltimada iirerninin otonomik disfonksiyona ne olc ude sehep olup olmadtgl ara§- nnldr. caltfmaya 38 kronik bobrek yetmezligi olan basic, alrndt. Bu hastalarda sagda. median sinir motor ve duysal iletimi, ulnar sinir duysal iletimi, peroneal motor iletimi ve meal sinir iletimleri 61- ciildii. Istirahatte ve derin inspiryum halinde iken R-R intervali alr rldr. Ayrrca solunum ve guriiltii sti-mulusu ile uyanlan sempatik den cevabt her iki elden simultan olarak kaydedildi. Hastalann %56.75'inde polintiropatiye icaret eden sinir iletim degerleri elde edildi. R-R intervali ile ilgilr (lstirahatte %1=5.58±3.27, Derin ins-piryum halinde %D = 11.3 ± 5.9, %D - 'Vol = 5.47 ± 5.05. %D I %R = 2.19 ± 1.43) degerler kontrol gru-bundan elde ediknlerle karplaittrildt. 1-Kontrol gruhundan elde edilen R-R interval degerleri ve vac arastndaki korelasyonun, iiremili hastalann R-R in-terval degerleri ve ya§lan arasznda kayboldugu go-riildii. 2-%D.%1 re %D-%I degerleri kontrol gnu-bundakinden istatistiki anlamda fat-kb bulundu. Dokuz hastada (%23.68 ) sempatik deri cevabs elde edilemedi. Lawns degerkrthin kontrol gruhuna gore uzamt§ oldugu goriildii. Sontic olarak elde edilen bulgular kronik barek yetmezligi olan hastalarda onemli pa-linoroparinin yantso-a (Muhtemekn otonomik no-ropatiye baglt) otonomik disfonksiyon olduguna i§a-ref ettnektedir.
In Patients With Chronic Uraemia it is well known that uraemia is one of the re-asons for polyneuropathy. The subject of this study was to investigate if and how much the uraemia cases autonomic dysfunction. 38 patients with chronic renal failure have been included in the study. Right median nerve motor and sensory conduction. ulnar nerve sensory conduction, peroneal motor conduction and rural nerve sensory conduction have all been recorded from these pa-tients, R-R intervals have also been studied in both during resting and deep inspirium. In addition to that, the sympathetic skin responses evoked by res-piratioit and noise have also been simultaneously from both hands recorded. 56.75% of the patients showed nerve conduction values which indicate polineuropathy. The data re-levant to the R-R inten►ks (during resting %l = 5.58 ± 3.27, during deep inspirium %D = 11.3 ± 5.9, %D-%1= 5.47 ± 5.05. %Dl%1 = 2.19 ± 1.43) have been compared to the values obtained from the control group.1 .The established correlation between R-R intervals and the age of the control group does not exist in the patients with iiremia.2.11 has been found that the %D,%1 and %D-%1 values are sta-tistically different from the values of the control group.The sympathetic skin response could not have been obtained from nine patients(%23_68)_Longer latency values have been observed as compared to the control group. In conclusion it may he surmised that the pa-tients with chronic renal failure show to an im-portant degree an autonomic disfithction (probably due to the autonomic neuropathy) together with polvneuropathy.
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Spontan Pnomotarakslarda Cerrahı Tedavı
Sami Ceran, Güven Sadi Sunam, Mehmet Gök, Tunç Solak, Hasan Solak
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Spontan Pnomotarakslarda Cerrahı Tedavı
SurgIcal Treatment In Spontaneous Pneumothorax
Klinigimizde 408 spontan pnOmotoraks va-kastrun Maria transaxiller vertikal toratokomi (+) biil, bleb eksizyonu veya ligasyonu, smith parietal plorektomi uygulanmtvir. Primer spontan pnomotorakslarda vakanin du-rumuna gore tthbi gozlem, tiip drenap, torakopik cerrahi veya klasik transaksiller vertikal torakotomi ile bleb eksizyonu ye parietal plorektomi teknigi uy-gulantr. Sekonder spontan pnbmotorakslarda ise tibbi gazlemin genellikle yeri yoktur, direkt tiip dre-najr Tiip drenajz ile solunum fonk-siyonlari diizeltilemeyen ye hava kacagt tsrarlz ola-rak uzun siiren seconder spontan pnOmotorakslarda zorunlu kalmmca cerrahi yol secilir. Genellikk se-konder spontan pniimotoraksh hastalarin solunum fonksiyonlan yetersiz oldugundan cerrahi en-dikasyon swurli tutulur.
408 patients with sontaneous pneumothorax were treated and 26 of them were performed sur-gical bleb excision and limited pleurectomy. The traditional treatments of primary spon-taneous pneumothorax include bed rest, tube tho-racostomy, toracoscopic surgery or bleb excission and parietal pleurectomy. In secondery pneumothorax, tube thoracostomy is used without waiting. If the respiratory functions do not improved by tube thoracostomy and air le-akage continues surgical treatment should be used since the patients whith secondary pnneumothorax have not good pulmonary capacity surgical tre-atment should he tried only is chosen cases.
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Axıdental Toraxa Penetre Komplıkasyona Yolacmayan Delıcı Cısım Yaralanması
Güven Sadi Sunam, Mehmet Gök, Sami Ceran, Ufuk Özergin, Aydın Şanlı, Tunç Solak, Hasan Solak
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Axıdental Toraxa Penetre Komplıkasyona Yolacmayan Delıcı Cısım Yaralanması
A Case Of AxItendal ThoracIc Injury Was Pe-Netreted ForeIgn Body
Gaza sonucu strum 25 cm uzunlugunda orgii mill batan hastanin tan: ve tedavisi takdim edilerek ilgili literatiir ornegi sunuldu.
A case of axidental thoracic injury was pe-netreted foreign body with 25 cm metalic crochet ne-edle. Guidlines for pnemention and management if this rare axidental thoracic injury is presented.
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Parkınsonlularda Gorsel Uyarılmıs Kortıkal Cevaplar Uzerıne Tedavının Etkısı
Ayşe Güvenç, Orhan Demir, Nurhan İlhan
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Parkınsonlularda Gorsel Uyarılmıs Kortıkal Cevaplar Uzerıne Tedavının Etkısı
The Influence Of Treatment On The VIsual Evoked CortIcal Responses In PatIents WIth PorkInson DIsease
Parkinsonlularda Gorse! Uyarilmif Kortikal Po-tansiyelkrin (Visual Evoked Potentials: VEP) amp-litiidiinde ve latansinda degiAlik oldugu bazt ca-limalarda bildirilmektedir. Ozellikle VEP amplitiidiiniin elektrogenezinde Dopaminin roliine ipret edilerek Parkinsonlularda gorielen VEP amp-.litiid diisiikliigzirziin Dopamin yetersizliginden ileri geldigi soylenmektedir. Bu calq-mada bir grup par-kinsonlu hastadan elde edilen VEP degifiklikkri kontrol grubu ile karitlaprilip dopaminerjik tedavi oncesi elde edilen VEP latans ye amplitiidlerinin te-- davi sonrastnda degi§ip degiimedigi araprilmtotr. calt§ma kin 19 Parkinsonlu hastada tedaviye ba§.- lamadan Once ye tedavi ile (Dopa ve/veya Dopamin Agonisti) klinik optimal diizelme halindeyken VEP incelemesi yapildt. Elde edilen tedavi oncesi amp-litiidler (L2-L3: 9,4±4,7 mikrovolt) ye latanslar (112,5±10,9ms), tedavi sonrast elde edilen amp-litiidler (L2-L3:12,4±7,2 mikrovolt) ye latanslar (113,4±9.4 Ins) ile istatistiki olarak karplavirtldt. Tedavi oncesi ye sonrast latanslar arastnda bir lark gliziiltizezken (p>0,05) tedavi sonrast VEP amp-litiidiiniin tedavi oncesine gore farklt oldugu (p<0,05) Bu bulgulann dopaminin VEP amp-litiidiiniin elektrogenezinde rolii oldugu destekledigi katustna varildt.
Several have reported that in patients with Par-kinson disease the amplitude and latency of the vi-sual evoked cortical potentials show some dif-ference. By especially emphasising the role of Dopamine on the electrogenesis of VEP amplitude, it has been suggested that the low amplitude level of VEP seen in patients with Parkinson disease arises from the Dopamine deficiency. This study compares the VEP changes obtained from patients with Par-kinson, with control group and investigates if there has been any difference in VEP latency and amp-litude before and after the dopaminerjik treatment. VEP studies have been carried out on 19 patients with Parkinson optimum healing period. The amp-litudes (12-12:9,4±4.7 mV) and latecies (112,5±10,9ms) obtained before the treatment have been statistically compared with the amplitudes (L2-L3:12,4±7,2mV) and latencies (113 ,4±9,4ms) obtained before the tre-atment. While there has been no changes in la-tencies obtained before and after the treatment (p>0.05), the VEP amplitude obtained after the tre-atment has been recorded appreciable different (p>0.05) than the one recorded before the treatment. These findings therefore gave support to the earlier opinions that the Dopamine treatment has influence on the electrogenesis of the VEP amplitude.
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Cocukluk Donemı Suprakondıler Humerus Kırıklarının Rehabilitasyonu
İsrafil Şimşek, Recep Memik, Fethi Demir, Cafer Ayata, Hasan Oğuz
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Cocukluk Donemı Suprakondıler Humerus Kırıklarının Rehabilitasyonu
RehabIlItatIon Of Supracondylar Fractures Of The Humerus In ChIdden.
cocukluk doneminde cin kolda gorillenterin ar-chndan en cok kamlaplan kinklar suprakondlier humerus km/dal-dlr. Suprakondiler humerus kink', ramstyla ark rediiksiyon ye internal fiksason uy-gulanan 21 hasta calqmaya alrrrdr. Olgularm 311 kJ:. 18'i erkekti ve yap ortalamalan 9.04±3.23 idi. Olgularm 6 haftalik post-op tespiti actldiktan sonra sirasiyla girdaplt su banyosu, su icinde ultrason. varchmh -aktif re aktif eklem hareket avklrgi eg-=ersizleri 10 scans uygulandt. Tedavi eincesine gore tedavi bitiminde p<0.0002 diizeyinde anlanth fonk-sivonel iyileene saglandt. cocuklarm suprakondiler humerus kulklarinda rehabilitasyon,erken komp-likasyonlarm onlenmesinde ye normal fonksiyonlara geri diinmede cok etkili hir yontemdir.
Among the fractures of the extremities in the pe-diatric age group, supracondylar fractures of the humerus are the second most common fracture after that of the forearm. Twenty-one patient, 3 girls and 18 boys, with a supracondylar fracture who had been applied open reduction and internal fixation were enrolled into the study. Their mean age was 9.04 years. After remove! of 6 weeks postoperative casting, the patients were applied wirlpool, ult-rasound under the water active- assistive and active range of motion exercise, for 10 sessions. Func-tional improvement after rehabiltation program was statistically significant (p<0.0002). We concluded that the rehabilitation of supracondylar fractures of the humerus in children is a highly effective method in preventing complications and returning of normal function.
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Ones Isınları Ile Dorudan Temas Halınde Olmayan Vucut Alanlarında Ortaya Cıkan Der' Malıgnıteler
Mehmet Oğuz Yenidünya, Hüseyin Tol, Zekeriya Tosun, Mübin Hoşnuter, Nedim Savacı
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Ones Isınları Ile Dorudan Temas Halınde Olmayan Vucut Alanlarında Ortaya Cıkan Der' Malıgnıteler
SkIn MalIgnancIes Occurred On Unexposed Areas
Stk goriikn deri maligniteleri bazo.veliikr kar-sinom. yassi hiicreli karsinom Ye malign me-lanomdur_ Bunlarin ultraviole ile degi§lk de-recelerde oldugu bilinmektedir. Ancak . bazen ultraviolenin dogrudan etkisi altinda olmayan recut alanlarinda da bu ter malignikkre rast-lanmaktadir. Bu. erg azindan ultraviole difEndaki ha4ka bazi faktorlerin de etyolojide rol aldtgrrcl gas-termektedir. Bu makalede son 5 yrlda takip ettigimiz hastalar arasindan bu c$zelliklere sahip olanlar, li-teratiir iltginda sunulmuftur.
The common skin malignancies are basal cell carcinoma, squamous cell carcinoma and malign melanoma. It is well known that they are more or less related to ultraviolet light. However one may encounter these type lesions on unexposed areas. The cases so far treated and followed -up for at least 5 years showed that apart from ultraviolet light, some other predisposing factors are influential on the onset of the diseases. In this presentation the cases that might prone to these predisposing factors are also discussed.
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Toraks Hıdatık Kıst Hastalıgında Radyolojık Bulgular
Rıdvan Aktitiz, Faruk Özer, Mehmet Gök, Kemal Ödev, Adnan Tekin, Adil Zamani
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Toraks Hıdatık Kıst Hastalıgında Radyolojık Bulgular
Radıologıcal Fındıngs In Thoracıc Hydatıc Cıst Dısease
63 olguda toraksta lokalize hidatik kistlerin radyografi, ultrasonografi (US) ve bilgisayarlı tomografi (BT) bulguları değerlendirildi. Basit, komplike veya rüptüre hidatik kistler düz röntgenogramlara göre BT ile daha iyi görüntülendi.
Radiography, ultrasonography (US) and computed tomography (CT) findings of hydatid cysts localized in the thorax were evaluated in 63 cases. Simple, complicated, or ruptured hydatid cysts were better visualized with CT than plain roentgenograms.
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Travmatık Sag Dıafragma Yırtıgı Ye Total Hepatık Hernıasyon
Sami Ceran, Ufuk Tütün, Güven Sadi Sunam, Kazım Gürol Akyol, Tunç Solak, Sadık Özmen, Hasan Solak
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Travmatık Sag Dıafragma Yırtıgı Ye Total Hepatık Hernıasyon
TraumatIc Total HepatIc HernIa To The RIght Thorax
Konya Devkt Hastanesinden sag 8. interkostal araliktan kapalt su aft' drenajt uygulanarak seek edilen 14 yamda erkek hastantn takibinde ani so-lunum stlantzstntn baylamast uterine yaptlan tet-kiklerinde sag torakstn alt ve orta zorunun ka-panchgt gozlendi. Yap'Ian acil posterolateral sag torakotomi sonrasznda toraks i•ine herniye olufmul karaciger ve kolonun hepatik fleksurast ve bu barsak anst uzerinde daha once uygulanan kapalr tip dre-najina baglz iki perforasyon gozlendi. Yaptlan ult-rasonografi ye akciger grafisinin herni wrist kin yeterli olmayacagt kantszna varildr. To-rakoabdominal kiint travmalar sonrast intratorasik herni olabileceginden miidahale etmeden once blintz'? ekarte edilmesi gerekmektedir.
A 14 - year-old boy was admitted to the in-tensive care unit (ICU) of the Seljuk University Hos-pital because of a traffic accident. He had a chest tube in the middle axiller line of his right thorax on the 8 th. intercostal space. Pulmonary parenchym of the right lung had closed at his chest roentgenogram and ultrasonografi. This patient required an emer-gency operation with his symptoms and laboratory findings. Emergency thoracotomy was performed in the patient which had led to a tear in the right side of diaphragm and intrathoracic migration of the liver, hepatic filexura of the colon and the omentum were seen. Hepatic flexura of the colon had got two perforations. They have to he attentive for diagnosis and treatment after thoracoabdominal blunt trauma. Never forget that some manipulations to diagnosis or treatment may make abdominal viscera destroy in the chest.
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Erken Gebelıkte Akut Mıyokart Infarktusti
Yahya Erdoğan
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Erken Gebelıkte Akut Mıyokart Infarktusti
Acute MyocardIal InfarctIon DurIng Early Preg-Nancy
37 ya§inda harm. anteroseptal bOlgede akut mi-yokart infarktiisii (AM!) lie koroner yogun bakim iinitesinde yattrrldr. Son adet kanamasunn 01- madrgou burada farketti. Yaptirrlart test sonunda ge-belik oldugu anlapich. Gebeligin ilk aymdaydr. in-farktusiin akut doneminde komplikasyon olmadt. Sonraki aylarcla yaprlan takiplerinde rahattr. drizenli kullanrldi. Gebeligin sekizinci ayinda 1800 gr dogum agirlikli vaginal yoldan prernatiir dogum oldu. Gehe hammlarm gogiis agrilarr miyokart in-farktiisli yOniinden iyi degerlendirilmeli, yac, hi-pertansiyon, sigara igme, fazla kilo, wile oykiisii gihi risk faktorleri araorrilmaltchr.
A 37 - year old woman was admitted to the co-ronary care unit (CCU) with the diagnosis of acute anteroseptal myocardial infarction. Three days post admission to the coronary care unit upon history of her menstrual status a pregnancy test was done and found to he positive. Her CCU care was continued and discharged without any complications. Her later phases of pregnancy was uneventful and underwent premature vaginal delivery at 8 months. This re-inforces the idea of close follow up of pregnant women with respect to possible angina pectoris if history reveals hypertension, diabetes. SMDking. overweight and other risk factors of myocardial in-farction.
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Intratorasık Extrapulmoner Neurofibroma
Güven Sadi Sunam, Mehmet Gök, Sami Ceran, Ufuk Özergin, Aydın Şanlı, Tunç Solak, Hasan Solak
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Intratorasık Extrapulmoner Neurofibroma
IntrathoracIc Extrapulmonary NeurofIbroma
Bu makalemizde neurofibrornalt bir kadui hasta takdini edildi. Radyolojik incelemede sol hemitoraks apexinde kenarlart diizgiin. homojen kitle goriilmesi fizerine neural tumor olabilecegi on tarusi ile sal thorakotomi uygulandi. Sol apexte ektrapulmoner olarak tespit edilen kitlenin histopatolojik tet-kiklerinin sonucu neurofibrorna olarak geldi. Postop herhangi !fir komplikasyon goriilmedi.
Ion our artichle, afamale women with ne-urofibroma was presented. Radiological and Cli-nical diagnosis could not been made preoperatively. Neurofibroma has been diagnosed with his-topathological examination of specimen taken at operation. Complication was not seen during the postoperative period.
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Pelvık Kıtle Ayırıcı Tanısında Dusunulmesı Gereken Bır Pelvık Renal Ektopı Olgusu
Talat Yurdakul, Kadir Karabacak, Mehmet Özeroğlu
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Pelvık Kıtle Ayırıcı Tanısında Dusunulmesı Gereken Bır Pelvık Renal Ektopı Olgusu
A PelvIc EctopIc KIdney Case WhIch Must Be Throught At DIfferansIonal DIagnosIs Of PelvIc Mass.
Bel. kasik agrisi ve pelvik kitle lie incelenen vapidaki hir kiz hastada ektopik bobrekte tacit hid-•opyonefroz saptandi. Bu hastalar seyrek olmayarak balka klinikiere hamirmaktathrlar.
In a fifteen years old girl compleining from lom-her and inguinal pain hydropyonephrosis with sto-nes in pelvic kidney has been determined after an in-vestigation with pelvic mass. Not very seldom this sort of patients apply to other clinics.
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Sol Atrıal Mıksoma Ye Perıferık Embolı
Ufuk Tütün, Ufuk Özergin, Kadir Durgut, Tahir Yüksek, Tunç Solak, Hasan Solak
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Sol Atrıal Mıksoma Ye Perıferık Embolı
Left AtrIal Myxoma And ArterIal EmbolIsm
60 yavnda bir kadrn pasta bilateral femoral ar-teriel emboli nedeni cerrahi tedavi altina almdi. Ilea tetkikinde sol atriumdan koken alan mik-somanIn emholiye neden oldugu tespit edildi. Kar-diak miksoma te§his edildi§inde cerrahi mildahale ile kitlenin eksizyonu endikedir. Hastalar ope-rasyonunu bile beklerken emboli komplikasyonlari nedeni ile % 8-10 oramnda Oldiiklerinden genellikle acilen operasyona alormalithrlar.
A 60 year old woman was referred because of bi-lateral femoral arterial embolism. On examination a diagnosis of cardiac myxoma is made on the left side. Surgical removal is indicated whenever a di-agnosis cardiac myxoma is made. Generally it is concidered an urgent procedure, particulary if the patient has a history of embolism since it has been noted that 8% to 10% patients die from embolic complications while waiting for operation.
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Bir Vaka Nedenıyle Pulmoner Sekestrasyon
Güven Sadi Sunam, Mehmet Gök, Sami Ceran, Ufuk Özergin, Tunç Solak, Hasan Solak
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Bir Vaka Nedenıyle Pulmoner Sekestrasyon
Pulmonary SequestratIon
Normal trakeobronyial agar la it ikisi olmayan, pulmoner arter yerine sisternik arterden kan alan segment veya lob dokusudur. Extralober ve int-ralober formlarl mevcut olup embriyolojik orijinli oldukuna inantlrnaktadir.
A pulmonary sequestration is a segment or lobe of lung tissue that has no bronchial communication with the normal tracheobronchial tree. The arterial blood supply is from a systemic vessel. Both ext-ralober and intralober varietes have been re-cognised and while believed to have a common emb-ryologic origin.
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Pulmoner Tromboembolızm
Mehmet Gök, Güven Sadi Sunam, Sami Ceran, Ufuk Özergin, Kazım Gürol Akyol, Tunç Solak, Hasan Solak
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Pulmoner Tromboembolızm
Pulmonary Thromboembolısm
Pulmoner arterin ve dallannin kan yolu ile gelen trombus hava, yag, tumor parcast gibi bir cisimle ani olarak tikanmasidir (1). ABD'lerinde her yil yakla§ik 630 bin ki§i pulmoner emboliye maruz kalmakta yakla§ik 200 bin ki§i ise olmektedir. Te§his edi-lebilen ve tedavi altina alinanlarda mortalite % 8 ci-vartnda iken, to his edilemeyenlerde % 30'a yak-la§maktadir (2). Vakalann % 331inde derin den trombozu tespit edilmi§tir (3,4). Pulmoner tromboembolizm 19. assn ba§lanndan bed bilinen bir komplikasyondur. Onceleri trom-bils'Un arterin icinde oldugu du unulmu ancak daha sonralan embolik oldugu tammlanmi§tir. 1858`de Wirchow ilk defa pulmoner trombils diye isim-lendirilen hadisenin emboli oldugunu deneylerle ispat etmi§ ve bir triad tanimlarni§nr. Buna gore damar duvannda lokal travrna, kanin pihtila§maya egilimi ye stazdrr (5). Bu faktorler etyolojide hala gegerliligini korumaktadir. ETYOLOJI Pulmoner tromboemboliye yol acan nedenler, ba§ta trombusler olmak lizere:yag, hava, amnion tumor dokusu, parazit yumurtalan, kateter gibi yabanci cisimlerdir. Mitral stenozunda ye de-kornpanze vakalarda olmak iizere ortalama 3 kardiak otopsinin l'inde pulmoner arterde emboli bu-lunmu§tur. Ka1p yetmezligi olan atrial fibrilasyonlu veya myokard infarktusii gecirmi§ vakalarda sag kalp trombiis kaynagi olabilir. Aynca ventiz trom-bozu kolayla§tiran faktorlerde pulmoner enribolinin risk faktorleri arasindadir. Pulmoner emboli riskinin arttigi durumlar.
It is the sudden occlusion of the pulmonary artery and its branches by an object such as thrombus air, fat, tumor parcast coming through the bloodstream (1). In the USA, about 630 thousand people are exposed to pulmonary embolism every year and about 200 thousand people are exposed to it. While the mortality rate is 8% in those who can be diagnosed and are treated, it approaches 30% in those who cannot be felt (2). Deep thrombosis was found in 33% of the cases (3,4). Pulmonary thromboembolism is a known complication from the beginning of the 19th pain. Previously, the thrombus was thought to be inside the artery, but later it was defined as embolic. In 1858, Wirchow first demonstrated that the so-called pulmonary thrombosis was an embolism, and he described a triad. Accordingly, local travnia at the wall of the vessel stays with the tendency of the blood to clot (5). These factors still maintain their validity in etiology. ETIOLOGY The reasons leading to pulmonary thromboembolism are mainly thrombi and lysis: fat, air, amnion tumor tissue, parasite eggs, foreign bodies such as catheters. Pulmonary artery embolism was found in 1 out of 3 cardiac autopsies on average, with mitral stenosis being in de-cornized cases. The right heart may be the source of thrombi in cases with atrial fibrillation or past myocardial infarction. In addition, factors that facilitate ventricular thrombosis are among the risk factors for pulmonary enriboli. Situations where the risk of pulmonary embolism is increased.
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Gogus Cerrahısınde Preoperatıf Pulmoner Ye Kardıak De6erlendırmenın Onemı
Güven Sadi Sunam, Sami Ceran, Mehmet Gök, Ufuk Özergin, Tunç Solak, Hasan Solak
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Gogus Cerrahısınde Preoperatıf Pulmoner Ye Kardıak De6erlendırmenın Onemı
The Importance Of Preoperatıve Pulmoner And Cardıac Assessment In Gogus Surgery
Cerrahi girişim uygulanacak hastalann operasyon oncesi degerlendirilmesi once zarar vermerne ilkesine dayanir (1). Gips cerrahisinde morbidite ye mortaliteyi etkileyen en onemli faktiirler put-. moner ve kardiak sistemin fizyolojik ve fonksiyonel durumudur (2). Operasyon Oncesi incelemeler, mor-talite yOniinden inoperabilitenin belirlenmesine mor-bidite actstndan ise hastalan yiiksek ya da di.i§iik risk gruplanna ayirmaya yoneliktir
Preoperative evaluation of patients who will undergo surgical intervention is based on the principle of doing harm first (1). The most important factors affecting morbidity and mortality in gypsum surgery are put-. It is the physiological and functional status of the moner and cardiac systems (2). Preoperative examinations are directed towards separating the patients into high or low risk groups, since they cause purple-bidite to determine inoperability from the direction of mortar and thalite.
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Adlı Tıp Acısından Av Tufeklerının Onemı
Akif İnanıcı, Bülent Üner, İshak Gürsel Günaydın
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Adlı Tıp Acısından Av Tufeklerının Onemı
Importance Of Shotguns ConcernIng ForensIc MedIcIne
Tüm dünyada oldugu gibi, iilkemizde de atecli si-lahlarla iclenen surlar onemli bir yere sahiptir. Ate li silahlarla iflenen suclar arastnda ise ozellikle ktrsal kesimde av tiifeginin kullantldtgt olaylar °I-thaca biiyia bir orandathr. Bu tiir olaylartn ori-jininin saptanmast kin av tufegi ye filegi yapistnin iyi hilinmesi gerekmektedir. Boylelikle meydana ge-tirilen yarantn yorumlanmast ile olaytn orijininin sap. tanmast miimkan olacakttr. Bu califmada, av tii-fegi ve hakkinda genet bilgiler verildigi gibi, olaytn orijinini saptama •alltmalaruun temelini olu§turan att§ mesafesi saptanmastnda gikoniinde bulunduritIntast gereken kriterler de actklanmtotr.
As all over the world, crimes commited with fi-rearms are widely spread in Turkey. Particulary in the rural areas, crimes commited by shotguns are common. To have accurate knowledge about a shot-gun and a shotgun shell is essential for judicial pro-ceedings. Correct investigation of wound will help the origin of case. In this study not only general in-formation about shotgun and shotgun shell but also fundamentals off ring distance which may help for-ming the criterias of case have been given.
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Plastık Ve Rekonstruktıf Cerrahıde Laser
Selim Çelebioğlu, Ramazan Erkin Ünlü, Uğur Koçer, A. Sina Mengi, Ömer Şensöz
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Plastık Ve Rekonstruktıf Cerrahıde Laser
Plastıc And Reconstructıve Surgery Laser
Laser günümüzde sanayi ye teknoloji başta olmak üzere, tıbbın da dahil oldugu bircok alanda aktif olarak kullanilmaktadir. Tipta dermatoloji ye cerrahi bran§larda akirlikh olarak kullanilan laserin ozellikle plastik ve rekonstruktif cerrahide kul-lanimi giin gectikce artmaktadir. Bu yazimizda laser hakkinda genel bilgiler ve laserin plastik ye rekonstruktif cerrahi branşindaki kullanım alanları anlatılacaktir.
Today, laser is actively used in many fields including medicine, especially industry and technology. The use of laser, which is used in dermatology and surgical branches as acrylic, is increasing day by day, especially in plastic and reconstructive surgery. In this article, general information about laser and usage areas of laser in plastic and reconstructive surgery will be explained.
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