Selçuk Tıp Dergisi Arşiv
Arşiv
Yıl: 1996, Cilt: 12, Sayı: 3 Tüm Sayı(PDF)
Year: 1996, Vol.: 12, No.: 3 Issue Full File(PDF)
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Tıroidektomi Teknıklerının Nervus Rekurrens Paralızisi Oranına Etkisi (on Çalısma)
Osman Güler, Metin Aydın, Muzaffer Kırış
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Tıroidektomi Teknıklerının Nervus Rekurrens Paralızisi Oranına Etkisi (on Çalısma)
The Effects Of ThyroIdectomy TechnIques On The Rate Of Recurrent Laryngeal Nerve ParalysIs (pre-LImInary Study)
Tiroid cerrahisinde, N. Rekurrens yaralanrnast guniirnazde de buyuk bir problerndir. Rekurrens'in hasar gorme olastligt guatrin morfolojisi, fonk-siyonel dururnu ye esas itibariyle rezeksiyon teknigi ile ill kilidir. Bu nedenle tiroidektomi tekniklerinde inodifikasyonlar geli,vtirilmektedir. Ekim 1994 ye Mart 1996 tarihleri arasinda Yiizuncii Ytl Uni-versitesi Tip Faakulesi Hastanesi Genel Cerrahi Kli-niginde bilateral subtotal tiroidektomi yap:Ian 57 guatr olgusu calrFma kapsamtna almmtpr. 27 oi-guda N. Rekurrens operasyon esnasincla goriildii ye inferior tiroid arterler baglandi. 30 olguda ise int-rakapsiiler caltoldr. Operasyon oncesi ye operasyon sonrast indirekt laringoskopi ile kord vocal mu-ayenesi yaprldt. Birinci grupta 1 olguda bilateral (%3.7), 1 olguda tek tarafli (%3_7) sinir paralizisi saptanch. Ikinci grupta ise sadece 1 olguda tek ta-raflt sinir paralizisi (% 3.3) saptandt. Bilateral sinir paralizisi saptanan hasta haric. digerleri ,vifa buldu On calt,saffuzin sonucunda, intrakapsiiler teknigin N. Rekurrens hasartnt azalttigt
Recurrent Laryngeal Nerve injury still remains the major problem in thyroid gland surgery and is influenced both by morphology and function of the goitre and essentially by the resection technique. Therefore, the modifications have been improved in thyroidectomy technique. Fifty-seven goitre patients who underwent bilateral subtotal thyroidectomywere taken into the study in Medicine Faculty of Vie-zancii Yil University, Department of General Sur-gery from October 1994 and March 1996.Recurrent laryngeal nerves were seen in 27 patients and in-ferior thyroid ateries were tied, although int-racapsular thyrodiectorny was performed in 30 pa-tients. The vocal cord examination with indirect laryngoscopy was carried out before the operation and postoperatively. The laryngeal nerve injury was established in 1. grog both bilateral (one patient-3.7%) and unilateral (one patient-3.7%), althought it was established in 2. group unilateral only in one patient (3.3%). Except one patient who was de-termined bilateral nerve inury, others recovered. In conclusion of our preliminary study, it has been seen that decreased the laryngeal nerve injury of int-racapsular technique.
Propofolun Immun Sısteme Etkısının Tıyopental İle Karsılastırılmasp
Mustafa Altındiş, Sadık Özmen, Celalettin Vatansev, Ali Kart
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Propofolun Immun Sısteme Etkısının Tıyopental İle Karsılastırılmasp
The ComparIsIan Of The Effects Of ThI-Opentone WIth Propofol On The Immune System
Aneztetik ajaniarm immiin sisterne etkisinin goz-lemek amactyla, total intravenek anestezi (TIVA) teknigiyle hirinci gruptaki hastalara propofol in-flizyortu (induksiyon kin 2 mglkg. idame it in 6-12 mglkglsaat). ikinci gruptakilere ise tiyopental (in-diiksiyon icin 3-5 inglkg, idame kin 7 mgaglsaat) uygulandi. Anestezik gaz verilmedi. Hastalardan operasyondan 30 dk once. 30 dk ve 24 saat sonra alinan kanlarda immunolojik (IgG, 1gM, IgA, C3, C4, CD4 ye CD8) ye hematolojik tetkikler (LOkosit, Ha, 11b, periferik yayma, lenfosit sayinu) yapildt. imMUll g lobulinler ye komplernan, Radyal im-munodifffizyon tekniki ile, CD4-CD8 ise monokional antikorlar kullantlarak, immunofloresans yon-temiyle araWrildt. Ayrica hastalara anestezi in-diiksiyonundan 2 giin Once ye sonra titherkiilin testi uygulandt. caltymamiz sonucunda, propofol uy-gulanan grupta (1. grup) postoperatif 30. dk'da IgG, IgM, IgA ye C3, tiyopental uygulanan grupta ise IgM, IgA ve C4 dOzeylerindeki azalma anlanth bulundu. Postoperanf 24. saatte 1. grupta IgG, 1gM ve Cneki artma ile IgA'daki azalma, 2. grupta ise IgAsdaki azal-ma anlanilt idi. Gruplar arast lark karplaotrildiginda postoperatif 30, dk ile 24. saat arasmda IgA'daki azal-maw)a farklart anlanth hulundu. Hiicresel im-munitenin etkilepmi gozden gecirildiginde her iki grupta da CD4, lokosit ye lenfosirdeki azalma an-lamhdir. Postoperatif 24. saatte CD4, CD8 ve len-fosit dek-erleri 1. grupta anlamIt artarken 2. grupta sadece lenfosit artmn anlanth bulundu_ Gruplar arast lark aravirikliginda 1. gruptaki liikosit ve len-fnsit degerlerthdeki azalma anlamit idi. Tither kiilin testi postop. 2. gtin Olciint sonuclarmin her iki grup-ta da anlanth derecede azaldigt gorrildii. Gruplar arasi fork yoktu. Sonuc olarak. propofoliin daha be-lirgin olmak iizere, her iki ajanin da immunsupresif etkiye sahip olduku tespit edildi.
The Comparisian Of The Effects Of Thi-opentone With Propofol On The Immune System By using TIVA technique first group patients were infused with propofol (2 mglkg for induction, 6-12 niglkg1hr for maintenance) and second group infused with thiopentone (3-5 mglkg for induction, 7 mglkglhr for maintenance). Anaesthetic gas was not given. Many immunological (IgG. 1gM, IgA, C3-C4, CD4 and CD8) and haematological (leucocyte, het, fib, blood smear and lymphocyte counts) testes were studied on samples obtained 30 min. before. 30 min. and 24 hr after the operation.Thc im-munoglohulin and complement were studied by radial immunodiffusion technique and CD4-CD8 were stu-died by immunoflorescence + monoclonal antibodies technique. The ppd test was also implemented before and after two days of anaesthesia. In the study at pos-toperative 30 WI min decrease of IgG. IgM. IgA and C3 in the group used propofol and decrease of IgM. IgA and C4 in the group used thiopentone were sig-nificant. At postoperative 24 'di hours increase of the IgG, IgM and C3 levels and decrease of IgA level in the first group and decrease of the IgA level
Tavsan Ve Kobay Aortasında A-Adrenerjık Reseptor Agonıst Ve Antagonistlerıne Verılen Cevapların Yas Ate Temperatur Ile İliskisı
Kısmet Esra Atalık, Ekrem Çiçek, Necdet Doğan
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Tavsan Ve Kobay Aortasında A-Adrenerjık Reseptor Agonıst Ve Antagonistlerıne Verılen Cevapların Yas Ate Temperatur Ile İliskisı
InteractIon WIth Age And Temperature Of The Responses To A-AdrenergIc Receptor AgonIsts And AntagonIsts In The RabbIt And GuInea-PIg Aortas
BU in vitro calışmada, 2-3 aylik genc ye 11-12 aylzk er4kin tav§an ye kobay aortasincla fenilefrin (FEN) ye klonidin (KLO) ile olu§un kaszlma ce-vaplarina ye hu cevaplarin prazosin (PRA) veya yo-himbin (YOH) ile inhibisyonuna ya§in ye hi-poterminin etkileri arayirilmlyir. Kfimiilatif tarzda uygulanan FEN ye KLO bu dokularda doza bagtmh kaszlmalar olu.yurmus ve maksimum kasilmalan ta-kihen kiimillatif konsantrasyonlarda ilave edilen PRA veya YOH, yine doza hagtmli gev§emeye neden olmuyur. Eri skin tawin ye kobay aor-tastnda, FEN ye KLO pD2 degerleri, gene gruha layasla anlamlz olarak buyuk hulunurken, PRA ye YOH icin hesaplanan IC50 ve t1,2 degerlerinde an-lamli bir fark gOzlenmemiyir. 28 °C'de ise, ago-nistlere art pD2 degerleri ile antagonistlere art IC50 ye t112 degerleri, her iki ytq grubunda da, normal temperature (37 °C) kiyasla anlamlt olarak azal-mzyir. Aynca, erifkin tav§an ye kobay aortasinda normal temperatiirde, PRA-FEN etkilgmesinde hu-lunan pA2 degeri, beklenildigi gibi, YOH-KLO et-kilemesinde hesaplanan degerden artlamlt olarak hilyilk bulunmuyur. Bit sonuclar, diger birgok do-kuda oldugu gibi, in vitro §artlarda, talqan ye kobay aortasinda da a-adrenerjik reseptor agonistlerine verilen cevaplarzn yaca ve ortam temperatiiriine, soz konusu resept5r antagonistlerine verilen cevaplartn ise, yalnizca ortam temperatiirfine bagli olarak de-giFhilece,Oni gosterMektedir.
In this in vitro study, the effects of maturation and hypothermia on the contractile responses to phenylephrine (PHE) and clonidine (CLO) and on the inhibition of these responses by prazosin (PRA) or yohimbine (YOH) on young (2-3 months old) and mature (11-12 months old) rab-bit and guinea-pig aortas have been in-vestigated. The cumulative addition of PHE and CLO were dose-dependently contracted these tissues and the dose-dependent relaxations were obtained with the cumulative addition of PRA or YOH on maximum contractions. At 37 °C. as the pa2 values of PHE and CLO were significantly greater in the aortas from mature rabbits and guinea-pigs than from young groups, no age-related changes in the IC50 and 11/2 values of PRA and YOH were detected in both aortas. At 28 °C, the pD2 values of agonists, and the IC50 and t11, values of antagonists were significantly lower than of 37 °C. Furthermore, at 37 °C, as its expected, the values for PRA against PHE were significantly greater than the values obtained with YOH against CLO on aortas from mature rabbits and guinea-pigs. In conclusion, as it's seen in many other tissues, in in vitro conditions on rabbit and guinea-pig aortas. the responses to a-adrenergic receptor agonists were altered with age and temperature although the responses to antagonists were altered with the temperature only.
Uc Trimesterde Artıkuler Kıkırdak Gelısımı
Aydan Canbilen, Taner Ziylan, Nurcan Sert, Özden Vural, Refik Soylu
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Uc Trimesterde Artıkuler Kıkırdak Gelısımı
Development Of ArtIcular CartIlage At Three TrImesters
Bu calilmada, tic trimesterde insan artikiiler kt-kirdak gelisimi tcik mikroskobik seviyede incelendi. Artikiiler kikirdak hiicrelerinin sayistnin terme yak-laoldikca azaldigt, ayricaI.E. ye III. zonlartnda daha kolay ayirtedildigi gazlendi.
In this study, development of human articular cartilage has been examined by using light mic-roscope. It has been observed that getting close to term, the number of articular cartilage cells have been reduced, also the zones, I., II. and III are cle-arly distinguishable.
Universıte Ogrencılerın Psıkıyatrık Sıkayet Ye Tanıları Uzerıne Retrospektıf Bır Çalısma
Ali Savaş Çilli, Nazmiye Kaya, Rahim Kucur
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Universıte Ogrencılerın Psıkıyatrık Sıkayet Ye Tanıları Uzerıne Retrospektıf Bır Çalısma
A RetrospectIve Study On College Students PsychIatrIc ComplaInts And DIagnosIs
Bu calqmada Pskivatri klinigine, sekiz pia bir dorzeinde ba§mran iiniversite ög-rencilerinin poliklinik ye yatg kayttlan geriye diinfik olarak araotrildt. Ailesiyle kalanlartn daha az yattrildtklart (p< 0.001); yurtta kalanlarrn icinde krzlann anlanzli de-recede fazla oldugu bulundu (p<0.01). Ogrenciler en cok bedensel (% 37.08). anksiyete (% 33.08) ye uykuyla ilgili (% 25.2) .ikayetlerle ba§- yurdular. Erkeklerde akademiklikayetler (p< 0.01), saptantilt di4fince ye cinsel .ilcczyetler (p<0.05); laz-larda sinirlilik (p<0.05) ye bedensel cikayetler (p<0.01) istatistiksel olarak anlamli daha fazla bulundu. Ogrencilere en sik anksiyete bozuklugu (%30.15) ye depresif bozukluk (%17.38) tarrilart kondu. Er-keklerde psikotik bozukluk (p< 0.01); ktzlarda so-matoform bozukluk (p<0.01) ye uyurn bozukluklarr anlamli daha yfiksek bulundu (p<0.05).
In this study, college students polyclinic and cli-nic documents whom applied to S.U.T.F. Psychiatric Department during eight years period were exa-mined retrospectively. The ones living with their parents were less hos-pitalized (p<0.001); among dwellers at dormitory females were higher than males (p<0.01). Most common complaints were found as somatic (% 37.08), anxiety (%33.08), and sleep related complaints (%25.23). Academic (p<0.01), obsessive and sexual complaints were higher in females (p<0.05); nervousness (p<0.05) and somatic conp-laints were higher in males (p<0.01 ). Most common diagnosis were found as anxiety disorder (%30.15) and depressive disorders (%17.38). Psychosis was higher in males (p<0.01); somatoform disorder (p<0.01) and sleep disorders were higher in females (p<0.05).
Demır Eksıklıgı Anemısınde Hbalc Degerlerı
Süleyman Alıcı, Şamil Ecirli, Özlem Alıcı, Hakkı Polat
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Demır Eksıklıgı Anemısınde Hbalc Degerlerı
Hbalc Levels In Iron DefIcIency AnemIa
Bu calt4ma Selguk Universitesi Tip Fakiiltesi Hastaltklari Anabilim Dali poliklinigine bapuran ye klinikte yatarak takip edilen 30 demir eksikligi ane-mili hasta ile 17 saglikh kii iizerinde yapildt. ca-lqmanin amact demir eksikligi anemisinde HbAlc durumuyla ye demir tedavisiyle olan deg4imleri gOrmekti. HbAlc, hemoglobin ve eritrosit pa-rametreleri kontrol grubunda hir kez calqirken hasta grubunda tedavi ancesi ye tedavinin 6. haf-tasinda olmak iizere iki kez Tedavi sonrasi HbAlc seviyeleri tedavi Oncesine gore istatistiki ola-rak anlamli seviyede di4iik hulunurken (p<0.001). kontrol gruhuyla kiyaslandiginda tedavi oncesinde istatistiki olarak anlamli seviyede yiiksek (p<0.05) ye tedavi sonrasinda ise istatistiki olarak anlamli hir degiikligin olmadigi tesbit edildi (p<0.05). ,Sonuc olarak,- HhAlc'deki bu degiiklik has-talarin telhisinde, tedaviye cevap durumunu de-gerlendirmede ye takihinde diger parametrelerle hirlikte kullanilabilir.
This study was performed on 17 healthy persons and 30 patients with iron deficiency anemia who applied to the department of internal medicine at the Selcuk University medical school. The aim of this study was to investigate HbAlc levels in iron de-ficinecy anemia and to find if there were measured only once in the control group, wherase me-asurements in the patient group were done at the he-gining of iron therapy and after six weeks of tre-atment HbAlc levels after treatment were significantly lower than HbAlc levels before tre-atment (p<0.001). Compering to the control group HbAlc levels were significantly higher before tre-atment in the patient group (p<0.05). Where as there were no statistically significant difference after treatment (p<0.05). Where as there were no statistically significant difference after treatment (p<0.05). As a result these differences in HbAlc le-vels may he used for diagnosis, dedection of res-ponse to treatment and follow up it iron deficiency anemia in conjunction with the other parameters.
Izole Tavsan Detrusor Kasında Karbakol'e Baglı Kasılmanın Kalsıyum Ile Ilıskısı Ve Bazı Muskarınık Antagonıstlerın Inhıbıtor Etkılerı
Ekrem Çiçek, H. İbrahim Karabacak, Kısmet Esra Atalık, Hülagü Barışkaner
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Izole Tavsan Detrusor Kasında Karbakol'e Baglı Kasılmanın Kalsıyum Ile Ilıskısı Ve Bazı Muskarınık Antagonıstlerın Inhıbıtor Etkılerı
The RelatIon Of Carbachol-Induced ContractIon WIth CalcIum And The InhIbItor Effects Of Some MuscarInIc AntagonIsts In Isolated RabbIt Detrusor Muscle.
lzole tavvan detrusor kasinda yapilan hu in vitro calqmada; kalsiyumsuz ortamda karhakol ile kasilan dokular iizerine uygulanan kalsiyumla elde edilen cevaplara, verapamilin inhibitor etkisi ile normal soliisyonlu ortamda ayni agoniste baglt kastlmalar iizerine atropin, arnitriptilin Ye maprotilinin gegetici etkileri arap•ildi. 0.1 mM EGTA iceren kalsiyumsuz ortamda 10-6 M konsantrasyonda karbakole baglt olupn kasilma cevaplari, ortama ilave edilen kalsiyum (10-4 -3x10-3M) ile doza hagtmlt hir vekilde anlamlt olarak anti (p<0.05). Bu artq, 10-6 ye 10-5 M verapamil varliginda kontrole Ore sirasiyla % 69.75 ±5 .52 ye % 42.89±4.13 oraninda hulundu. calqmamn normal soliisyonla ise, aynt konsantrasyonda karhakol ile meydana gelen kasilma cevaplart, kiimiilatif konsantrasyonda (10-9 - 104 M) uygulanan atropin. arnitriptilin ye maprotilin tarafindan inhihe edildi. Bulgular. kullantlan dokuda karbakole bagh kasilmada ekstraseliiler kalsiyum yaninda intraselider kalsiyumun da kullanddigini gostermektedi•. Ayrica kullanilan antagonistlerin karbakole bagli kasilmalari (inland' olarak inhihe ettigini ve IC50 degerlerine Ore guy stralamasinin atropin > amitriptilin > maprotilin ceklinde oldugunu ortaya koymaktadir (p<0.05).
In this in vitro study, the inhibitory effect of verapamil on the responses obtained with calcium on the carhachol induced contractions. In Ca2+ -free medium and the relaxation effects of atropin, amitriptyline and maprotiline on the same contraction in the medium with normal solution in isolated rabbit detrusor muscle. In Cat + free medium with 0.1 mM EGTA, the carhachol-induced contractions were significantly increased by adding of Ca2+ (10-4 - 3x10-3M) dose dependently (p<0.05). This increase was found to he as 69,75±5.52 % and 42.89±4.13 % in the presence of 10-6M and 10-5M verapamil, respectively. In the other part of study carried out using normal solution, the carhachol (10-6M) induced contractions were inhibited by cumulative addition (10-9 - 10-4M) of atropin. amitriptyline and maprotiline. Results suggest that, intracellular calcium was used as well as extracellular calcium for contractions due to carhachol in this tissue. In addition, the antagonists significantly inhibited the contractions induced with carhachol and according to IC50 these antagonists were following order of potency atropin > amitriptyline > maprotiline (p<0.05).
Abdomınal Aort Anevrızmaları
Mehmet Yeşiltay, Kadir Durgut, Ufuk Özergin, Işık Solak, Tahir Yüksek, Hasan Solak
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Abdomınal Aort Anevrızmaları
AbdomInal AortIc Aneursyms
Abdominal aort anevrizmasi hayati tehdit eden bir patolojidir. Anevrizmanin rupture olmastnt en-gellernek kin ilk yakla§intlar ligasyon, elekt-rokoagliisyon, wramping gibi anevrizma ici pihn te-ekkuliine girifimlerdir. 1951 yrItiida Dubost abdominal anti anevrizma vakalarinda ilk kez greft uygulayarak anevrizmayi tedavi etnzigir Bu tarihten sonra sentetik greft interpozisyonu abdominal aort anevrizma tedavisinde tercih edilen metot olniugur. Selcuk Universitesi Tip Fakiiltesi Kalp Damar Cerrahisi kliniginde 1990-1995 yillan arasinda 10 ab-dominal aort anevrizmalt vaka ameliyat edilmigir. 9 hasty elektif olarak, 1 hasta acil ,sartlarda ameliyata Operasyon strasinda I hastcuntz kay-betlilmigir. 9 hastanuzda postopertif donenrde ciddi bir komplikasyonla karplaiivilniamt,sttr.
Abdominal aortic aneurysms have been to life the-ratening a pathologic process. Early aternpts to pre-vent rupture of aneurysm included ligation, wram-ping sac in an attend to induced trombosis. In 1951 Dubost introduced graft replacement of aortic ane-urysm that a reliable method of aneursym repair be-come available. Since then graft interposition for ab-dominal aortic aneursym has been become prefer therapy. Between 1990 and 995, 10 patients underwent operations for abdominal aortic aneurysms at the Sel-cuk University Medical Faculty clinic of car-diovascular surgery patients had elective procedure and 1 patient had urgent procedure. One patient had been died during the operation and in the other pa-tients haden't been seriously a postoperatif cop-lication.
Greft Enfeksıyonları
İslam Kaklıkkaya, Ramis Özdemir, Hakan Filizlioğlu, Neşe Ünal, Fahri Özcan
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Greft Enfeksıyonları
Graft InfectIons
Ocak 1988 - Mart 1996 tarihleri arasinda kli-ni§imizde toplam 167 vakaya otojen yen velveya prostetik materyal (Dacron veya PTFE) kullanilarak vaskiiler rekonstriktif ameliyat yaptimiftir. Aynt ytllar arasinda takip siiresince 6 (%3.56) hustada greft enfeksiyonu gel4migir. Greft en-feksiyonlarinda temel tedavi prensihi ktiltiir an-tibiyogram sonuclanna gore uygun antibiyotik te-davisi ye greftin total olarak clkarilmast olmuour. Morbidite 1 amputasyon olup, mortalitemiz yoktur. Greft enfeksiyonlan vaskiiler cerrahinin en korkulan komplikasyonlanndan biridir ye yiiksek morbidite ye mortalite sebehidir. Degi4ik serilerde %1.3 ile %6 arasinda de,g4en greft enfeksiyonu in-sidanst gorulmu tar.
167 vascular reconstructive operations have been performed in our clinic using a prosthetic vas-cular graft (Dacron or PTFE) and/or autogenous vein graft between the dates of January 1988 -March 1996. During their follow up in this period 6 graft infection (%3.56) have been developed. Our major treatment protocol in graft infections was to remove the infected graft totally and to use app-ropriate antibiotics according to culture results. Our morbidity was I amputation . In different series incidence of graft infections is reported to he between 1.3 - 6%.
Turban İ6nest Aspırasyonu
Sami Ceran, Güven Sadi Sunam, Kazım Gürol Akyol, Ufuk Özergin, Tunç Solak, Hasan Solak
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Turban İ6nest Aspırasyonu
Turban PIn AspIratIon
Ocak 1990 ile Aral& 1995 tarihleri arasinda S. U. Tip fakiiltesi Gages Ka1p Damar Cerrahisi kli-nigine 39 k4i boncuklu igne aspirasvonu nedenivie nitiracaat etmigir. Hastalarin tamanu bavan °hip, 11-20 grubu cogutiluku olugurmaktadir. Te,shis; anamnez ye cekilen PA Akciker grafisinde rad-voopak ignenin gorultnesivle kontilmujtur. 4 has-tada spontan atilim, 2 hastada gastrointestinal sis-tenze Klasik tedavi olarak rijit bronkoskopi uygulannusur. 5 hasta skopi + bron-koskopi teknigi ile komplikasyonsuz olarak tedavi edinilmiş, 4 hastaya da torakotomi uygulanmıştır.
Between January 1990 and December 1995, 39 patients applied to Thoracic and Cardiovascular-Surgery Department, Faculty of Medicine Selcuk University with the complain of turban pin's as-piration. All the patients were female and most of them were between 11 and 20 years age. Diagnosis dependent on anamnesis and posteroanterior chest x ray. Rigid bronchoscopy was performed except 6 pa-tients. 4 of them exhausted their foreign bodies spontaneously and in 2 of them foreign bodies was recognized to swallowed into gastrointestinal tract. Five patients were succesfUlly treated by rigid bronchoscopy together with fluoroscopy without complication.
Çocuklarda Tedavı Amaçlı Laparoskopık Cerrahı Uygulamaları
Adnan Abasıyanık, Ahmet Hamdi Gündoğan, Burhan Köseoğlu, Fatma Çağlayan
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Çocuklarda Tedavı Amaçlı Laparoskopık Cerrahı Uygulamaları
TherapeutIc LaparoscopIc SurgIcal Procedures In ChIldren
Ocak 1994 - Aral& 1995 tarihleri arasinda 39 olgu laparoskopik cerrahi ile tedavi edildi. Bu calqmamizin anzact, laparoskopik cer-rahinin cocuk cerrahisindeki tedavi endikasyonu ve etkinligi konusundaki izlenimlerimizi aktarrnakttr. Olgulartnnz 1 ile 16 ya§. arasindadtr. En stk la-paroskopik cerrahi uygulamalaruntz; apendektomi (13 olgu), over kist drenaji (4 olgu). splenektomi (4 olgu), kolesistektomi (3 olgu) dir. Toplam 4 olguda (%10) teknik zorluktan dolayi actk cerrahiye gecrnek zorunda kalindt. Intraoperatif komplikasyon olarak 2 olguda ekstraperitoneal ensuflasyon, 5 olguda ta-411cardi ye aritmi, 2 olguda gevici hipertermi tespit edildi. Postoperatif dijnemde apendektomi ya-pzlan hit- olguda ileus Ameliyet siireleri actk cerrahiye layasla sple-nektomi ye Swenson uygulamalarmda daha uzun, apendektomilerde aynt, koksistektorni, over kist as-pirasyonu ye travma nedeniyle yaptigimiz mii-dahalelerde daha ktsa siirdugii tespit edildi. 01- gularunizin hastanede kalg siireleri ise actk cerrahiye layasla tiimiinde daha ktsa siireli idi. Laparoskopik cerrahi, actk cerrahiye oranla daha az kornplikasyonlarmzn ()imam ve hu komp-likasyonlarin genellikle kisa siirede gecehilmesi ne-deniyk rahat tolere edilehilen yararh hir yontemdir.
Between January 1994 and December 1995.29 pa-tients were treated with laparoscopic surgery in our department. The aim of this study is to present our ex-perience with the indications and efficacy of la-paroscopic surgery in pediatric surgery. The age of the patients was heteen one and 16 years. The most common procedure that we per-formed was appendectomy (13 patients). The other-common procedures were ovarian cyst drainage (four patients), hemostasis in traumatic int-raabdominal hemorrhage (three patients). sple-nectomy (four patients). Swenson's procedure (three patients), and cholecystectomy (three patients). We had to converse to open surgery for technical reasons in a total of four patients (10%). We observed extra peritoneal insujilation in ma patients, transient tachycardia and arrhythmia in five patients. and tran-sient hyperthermia in another two patients as int-raoperative complications. One patient developed postoperative ileus after appendectomy. The duration of the laparoscopic procedures was longer than that of the open surgery in spknectomy and Swenson's procedure. similar in apendectomy, but shorter in cholecystectomy, ovarian cyst dra-inage, and hemostasis for intraandominal he-morrhage. Hospital stays were shorter in all la-paroscopic procedures comparing with open surgery. Laparoscopic surgerey is a useful method with low incidence of complications which are well to-lerated for the treatment of the surgical pediatric pa-tients.
Karotıs Tumorlerı (bır Vaka Nedenıyle)
Kadir Durgut, Mehmet Yeşiltay, Mehmet Gök, Ufuk Özergin, Ufuk Tütün, Işık Solak, Tahir Yüksek, Hasan Solak
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Karotıs Tumorlerı (bır Vaka Nedenıyle)
CarotId Body Tumors
Karotis tümörIeri kemoreseptor paraganglioma hiicrelerinden menşe alırlar. Bu hücreler crista no-ralisten orijinli embriyolojik hiicrekrdir. DI4iik in-sidanslarindan dolayi giinliik pratikte aliplmq de-illerdir. Biz hu makalede klinik muavene ye anjiografi ile telhis edilen ye bcgarilt bir cerrahi olarak tedavi edilen hir vakayi takdim et-mekteyiz. Bu tiimorlerde günrinruzdeki techis ye tedavi zorlukları tartiplmq ye literatür gozden geçirilmiştir.
Carotid body tumors (synonymus che-modectoma, carotis tumor. glomus carotica) are tu-mors arising from chemoreceptor paraganglioma cells. These cells have proved to have an emb-riyologic origin from neural crests. Due to their low incidence these tumors are not habitually found in daily practices. We present a case of carotid body tumor diagnosed by clinical examination and an-giography which was successfully treated by sur-gery. The diagnostic and therapeutic difficulties pre-sent in these tumors are discussed and literature was reviewed.
Safra Kesesı Adenokarsınomları
Lema Tavlı, Özden Vural, Şakir Tavlı, Serdar Yol
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Safra Kesesı Adenokarsınomları
Adenocarcznomas Of The Gallbladder
Bu yaztda, 17 safra kesesi adenokarsinontunun klinikopatolojik ozellikleri sunuldu. Histolojik tipler ile safra taslart, karaciger invazyonu ye lenf nodiilii metastazlan arasindaki iliskiler incelendi. Lenf no-data metastazlanna ye karaciger invazyonuna en sik, az diferansiye adenokarsinomda rastlandi. Safra taslan papiller adenokarsinomda sik bu-lundu.
In this study, the clinicopathologic cha-racteristics of 17 cases of carcinoma of the gall bladder was presented. The relationship between. histological types, gallstones, liver invasion and lymph node metastasis were investigated. Frequent lymph node metastasis and invasion of the liver, was encountered in the poor differentiated ade-nocarcinoma The presence of gallstones were fre-quent in papillary adenocarcinoma.
Travmatık Arterıovenoz Fıstullerın Cerrahı Tedavı Takıp Sonkları
İslam Kaklıkkaya, Ramis Özdemir, Hakan Filizlioğlu, Fahri Özcan
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Travmatık Arterıovenoz Fıstullerın Cerrahı Tedavı Takıp Sonkları
TraumatIc ArterIovenous FIstulas
Travmatik arterio-venoz (A-V) fistiiller co-gunlukla penetran yaralanmalar sonucu, bazen de iatrojenik nedenlerle olucur. Eyliil 1989 - ubat 1996 yillarz arastnda 8 tray-matik A-V fistiil olgusuna cerrahi tedavi uy-gulanmtwr. Hastalaruntzzn yaVart 1,5 - 44 ara-stnda olup, 2 tanesi kadin, 6 tanesi erkekti. Etyoloji, 5'inde atecli silah yaralanmast, l'nde iatrojenik (kan alma strasinda), 2'sinde kesici alet yaralanmast idi. Travmadan sonra gecen sure I giin ile 10 yll ara-stnda degilmekteydi. A-V fistul ninde sag femoral arter - ven, I 'inde sol popliteal arter - yen, Pinde sag popliteal arter - ven, l'inde sol posterior tibial arter - yen, I 'inde sag karotis- internal juguler ven, I 'inde sol brakial arter - hasilik ven arastnda idi. Fistfil kapatiltrken 5 tanesinde arteriel uc-uca anas-tomoz, 1'inde otojen yen patch anjioplasti, 1 'inde primer arteriel martin, I arteriel suni greft in-terpozisyonu yaptImuttr. Venoz onarun ise, 5'inde primer onartm, I 'inde otojen safen ven in-terpozisyonu, 2'sinde ligasyon yapilmıtır.
Treatment and Follow up Traumatic arteriovenous fistulas are mostly occur as a result of penetrating injuries and so-metimes iatrojenic causes. Surgical treatment was performed on 8 tra-umatic arteriovenous fistula cases between the dates September 1989 and February 1996. Two patients were female and six patients were male ages ranged between 1.5 to 44. Etiology was gun shut wound in 5, stuhing and penetrating wound in 2 and as a re-sult of puncture to vein in I. Time interval after tra-uma was ranged between I day and 10 years. Ar-teriovenous fistulas were ntnd in the localization of right femoral artery - femoral vein in 3, left popliteal artery - vein in 1, left posterior tibial artery - vein in 1, right carotis artery - internal juguler vein and left brachial artery - basilic vein in I. Arterial end to end anastomosis in 5, primary arterial repair in 1. ar-terial prosthetic graft intopozitions in 1 and otojen yen patch angioplasty in I were used for the closure of the arteriovenous fistulas. Venous primary repair in 5, otogen safenous vein graft interposition in I. ve-nous ligation in 2 were used for the closure of the ar-teriovenous fistulas which venous repair.
Unıversıte Psıkıyatrısı (college Psychıatry)
Ali Savaş Çilli, Nazmiye Kaya
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Unıversıte Psıkıyatrısı (college Psychıatry)
Unıversıte Psychıatry (college Psychıatry)
Üniversite cagindaki genç ergenler ve genc erişkinlerin ruhsal problemlerinde, hekim problemin strese bagli beklenen bir tepki mi, nevrotik veya psikolojik bir durumun erken işaretleri mi olduguna dikkat etmelidir (1).
In the mental problems of young adolescents and young adults in university age, the physician should pay attention to whether the problem is an expected reaction to stress or early signs of a neurotic or psychological condition (1).
Acıl Tıp Uzmanlıgı Ye Acıl Departman Çalısmalarında Standardızasyon
Ali Çalıkuşu, M. Ali Uygun
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Acıl Tıp Uzmanlıgı Ye Acıl Departman Çalısmalarında Standardızasyon
Standardızatıon In Emergency Medıcal Expertıse And Emergency Department Work
Günümüzde Ulkemizi ilgilendiren bir sorun olan acil saglik hizmeti iiretimindeki yetersizligin bir cok nedeni sayilabilir. Bunlar arasinda yillardir on plan-da olan ftziki yetersizlikler giiniimiizde &pima a§a-masina gelmi§tir.Yoneticiler acil saglik hiz-metlerinin onemini artik kavrami§lardir. BugUn iilkemizde bircok universite, universite dt i kurum ye devlet hastanesinde, merkezi ve lokal kaynaklar kullanilarak yeni, guzel goriiniimlii ye iyi sa-yilabilecek donanimlara sahip acil departmanlar ku-rulmu§ ye kurulmaktadir. Ancak yeni ye donanimli acil servislerde de yeterli ye gerekli acil saglik hiz-meti ne yazikki uretilememektedir. Bunun nedeni acil servislerin standardize olmamasi, fonk-siyonlannin net olarak belirlenmemesi ye bu hiz-meti iiretecek insan faktorti sorununa bugane degin egilinmemesidir. Bu nedenle acil saglik hizmetleri her iinitede sorumlu saglik personelinin bilgi ye tec-rUbe ye ali§kanliklanna Ore nitelik ve nicelik fark-liliklan gostermektedir. Son yillarda artan toplumsal ye medikal ih-tiyaclara paralel olarak, iilkemiz insaninin acil saglik hizmeti beklentisini gereken §ekilde kar§ilayabilmek iizere film tilke genelinde acil departmanlann re-organizasyonu , guniimUzde encok tartiplan saglik sorunlarimizdan birisidir. BugUn saglik sektorLinde cok katilimli tarti§ma ortamlarinda sik tarti§ilan konulardan birisi acil departmanlann re-organizasyonlannin nasil olmasi gerektigidir .
Many reasons can be considered for the insufficiency of emergency health service management, which is a problem that concerns our country today. Among them, physical inadequacies, which have been in the foreground for years, have come to the fore in our days. The administrators have now realized the importance of emergency health services. Today, in our country, many universities, non-university institutions and state hospitals are being established in the state hospitals, using central and local resources, and emergency departments with new, beautiful appearance and equipment that can be regarded well. However, in newly equipped emergency services, unfortunately, sufficient and necessary emergency health services cannot be produced. The reason for this is that the emergency services are not standardized, their functions are not clearly defined, and the human factor problem that will lead this service is not focused on. For this reason, there are differences in quality and quantity in the knowledge and experience training habits of the health personnel in charge of every unit of emergency health services. In parallel with the increasing social and medical needs in recent years, the re-organization of the emergency departments throughout the film fox in order to meet the expectations of the emergency health service of the people of our country, is one of our health problems that are discussed today. One of the most frequently discussed issues in the healthcare sector today in multi-participatory discussion environments is how emergency departments should be re-organized.
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