GÝRÝÞ ve AMAÇ: Endoskopik giriþimlerde; hemodinamik parametrelerin yanýnda solunumsal parametrelerin monitorizasyonu da önemlidir. Özellikle gastroskopide uygulayýcý ile anestezist tarafýndan kontrol edilen havayolu ortak alanda olduðundan sedasyona baðlý geliþebilecek solunum yetmezliðinin gözlenmesi çok önem taþýmaktadýr. “Integrated Pulmonary Index” (IPI) algoritmasý; dört solunum parametresini [end-tidal CO2, solunum sayýsý (RR), nabýz sayýsý (PR) ve parsiyel oksijen basýncý (SpO2)], gerçek zamanlý devamlý ölçümlerin solunum profilinin temsil edildiði tek bir deðere indirgenmesidir. IPI hastanýn solunumsal durumunu hýzlýca deðerlendirerek; müdahale ihtiyacý olup olmadýðýný belirlemek için yol gösterir.
YÖNTEM ve GEREÇLER: Çalýþmamýzda gastroskopi/kolonoskopi için sedasyon uygulanan 30 hastada kapnograf (Capnostrem 20p Covidien) monitorü nazal probu ile ETCO2 ve RR, parmak probu ile SPO2, PR ölçüldü. IPI skoru, ETCO2, SPO2, PR, RR, gözlenen solunum yetmezliði ve maske ventilasyon endikasyonlarý tartýþýldý.
BULGULAR: Klinik gözlem, kapnograf monitorizasyon deðerleri ve IPI skoru, 25 hastada birbirine benzerdi. Solunum yetmezliði gözlenen beþ hastada IPI deðeri düþük olmasýna raðmen bu hastalardan 3’ünde SPO2 deðeri hala normal sýnýrlardaydý.
TARTIÞMA ve SONUÇ: Çalýþmamýzda solunum yetmezliði gözlenen 5 hastanýn 3’ünde SPO2 normal iken; IPI düþüktü. IPI skoru, standart SPO2’ye göre; daha erken uyarý yaparak hasta güvenliðini saðlamakta klinisyene yardýmcý bir monitorizasyondur.

INTRODUCTION: In the endoscopic procedures, monitorization of respiratory parameters is important as well as hemodynamic parameters. As the area which is used by the operator and the airway controlled by the anesthetist particularly are in a common location in gastroscopy, observation of the apnea which might take place due to sedation is highly important. “Integrated Pulmonary Index” (IPI) algorithm analyses four respiratory parameters [end-tidal CO2 (ETCO2), respiratory rate (RR), peripheral pulse rate (PR) and SpO2 values] to a single value that represents the respiratory profile as real time continue measurements. IPI leads the assessment of the respiratory condition of the patient and whether any intervention is required.
METHODS: In our study ETCO2 ve RR was monitorized via nasal probe of caphnography monitor (Capnostrem 20p Covidien) and SPO2, PR was monitorized via finger probe in 30 patients who had been subjected to sedation for gastroscopy colonoscopy. The IPI value and ETCO2, SPO2, PR, RR as well as observed apnea and mask ventilation indications were all discussed.
RESULTS: Clinical observations, capnography monitorization values and IPI values were similar for 25 patients. SPO2 value was within normal limits in 3 of the 5 patients whose IPI values had been low.
DISCUSSION AND CONCLUSION: While SPO2 was normal in 3 of 5 patients who had been observed to have respiratory deficiency, IPI value was low (1-3). IPI score, by way of giving an early warning, is a monitorization method which helps clinician to ensure patient safety.

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GÝRÝÞ ve AMAÇ: Hem glikoz deðiþkenliði (GD) hem de artmýþ ortalama trombosit hacmi (OTH) diyabetes mellitusu (DM) olan hastalarda artmýþ kardiyovesküler komplikasyonlarla iliþkilendirilmiþtir. Biz tip 2 DM hastalarýnda bu iki deðiþken arasýndaki iliþkiyi araþtýrdýk.
YÖNTEM ve GEREÇLER: 54’ü kadýn, ortalama yaþý 59,59 ±9.12 yýl olan toplam 100, tip 2 DM hastasý çalýþmaya alýndý. Tüm hastalarýn takip eden 2 gün boyunca ve günde 7 kez SBGM ile kan þekerleri ölçüldü. Glikoz deðiþkenliðini ölçen formüllerde self blood glucose monitoring (SBGM) verileri kullanýldý. Gün içi glikoz deðiþkenliði standart sapma (SD) ve varyasyon katsayýsý (CV), günler arasý glikoz deðiþkenliði ise ortalama günlük farklar (MODD) formülleri ile deðerlendirildi. Ortalama trombosit hacmi (MPV) SBGM ölçümlerinin tamamlandýðý üçüncü günde alýnan kanda bakýlan tam kan sayýmý sonuçlarýndan elde edildi. Ýlaveten hastalarýn total kolesterol, trigliserit, HDL ve LDL kolesterol deðerleri ile HbA1c deðerleri ölçüldü.
BULGULAR: SD, CV ve MODD formüllerine göre en alt ve en üst glikoz deðiþkenlik çeyrek dilimlerinde yer alan hastalarýn MPV deðerleri arasýnda istatistiki olarak anlamlý fark bulunmadý. (sýrasýyla 8,26±1,18 ve 8,15±1,26; p>0,05; 8,2±1,21 ve 8,39± 1,1; p>0,05; 8,01±0,97 ve 8,39±1,3; p>0,05). MPV ile lipid parametreleri ve HbA1c deðerleri arasýnda anlamlý korelasyon saptanmadý. Diyabetin makro ve mikrovasküler komplikasyonlarý (Koroner iskemisi, retinopati, nefropati ve nöropati) olan ve olmayan hastalarýn MPV deðerleri arasýnda da anlamlý fark saptanmadý ( Sýrasýyla 8,20±1,12 ve 7,78±1,09; p>0,05; 8,25±1,18 ve 8,12±1,11; p>0,05; 8,23±1,08 ve 8,05±1,14; p>0,05; 7,99±1,25 ve 8,11±1,09; p>0,05).
TARTIÞMA ve SONUÇ: Glikoz deðiþkenliði ortalama trombosit hacmini etkilememektedir

INTRODUCTION: Both glucose variability (GV) and increased mean platelet volume (MPV) have been linked to increased cardiovascular complications in patients with diabetes mellitus (DM). We investigated the relationship between these two variables in patients with type 2 DM.
METHODS: A total of 100 patients (54 women, the mean age of 59.59±9.12 years) with type 2 DM were recruited in the study. All patients measured the blood glucose on successive two days at home by self-monitoring of blood glucose (SMBG). Seven points SBGM data were used for GV formulas. Intra-day GV with standard deviation (SD) and coefficient of variation (CV), day-today GV with mean of daily differences (MODD) was assessed. MPV values derived from automated cell counting on the third day when collecting the SMBG results. Also; total cholesterol, high and low-density cholesterols, triglyceride and hemoglobin A1C (HbA1C) were measured.
RESULTS: There were no statistically significantly differences between the MPV values of patients with lower and upper quartiles for SD and CV (8.26±1.18 vs 8.15±1.26, p>0.05, 8.2±1.21 vs 8.39± 1.1, p>0.05, respectively), and also with the lower and upper quartiles for MODD (8.01±0.97 vs 8.39±1.3, p>0.05). No correlation found between MPV and HbA1c and lipid parameters. There were
no significantly differences for MPV values between patients with coronary ischemia, diabetic retinopathy, neuropathy, nephropathy and those without these complications (8.20±1.12 vs 7.78±1.09, p>0.05; 8.25±1.18 vs 8.12±1.11, p>0.05; 8.23±1.08 vs 8.05±1.14, p>0.05; 7.99±1.25 vs 8.11±1.09, p>0.05; respectively).
DISCUSSION AND CONCLUSION: Glucose variability does not affect the mean platelet volume.

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GÝRÝÞ ve AMAÇ: Orta þiddetli aðrý ile karakterize kasýk fýtýðý onarýmlarý sonrasýnda, lokal anestezik ile yapýlan yara yeri infiltrasyonu analjezi süresini uzatabilir. Bu sayede opioid ve/veya steroid olmayan yangý giderici ilaç (SOYGÝ) gereksinimi azalýr ve hastalar bu ilaçlarýn olasý yan etkilerinden korunmuþ olur. Çalýþmamýzda, kasýk fýtýðý onarýmý sorasý hasta kontrollü rejyonel bloðunun etkinliðini araþtýrdýk.
YÖNTEM ve GEREÇLER: Çalýþmaya, 20-70 yaþ arasý, ASA I-II, genel anestezi altýnda inguinal herni onarýmý yapýlacak 30 hasta alýndý. Hastalar randomize olarak eþit iki gruba ayrýldý. Grup I’de ameliyatta ilioinguinal iliohipogastrik sinir komþuluðuna minivak dren kateteri kullanýlarak hazýrlanan bir aparat yerleþtirildi. Kateter, bupivakain içeren bir aðrý pompasýna baðlandý. Hasta düðmeye basýnca 25 mg bupivakain gidecek ve 2,5 saat kilitli kalacak þekilde pompa ayarlandý. Grup II’de ise intravenöz 50mg tramadol’ü takiben tramadol 14mg/saat sürekli gidecek þekilde verildi. Hastalarda 30. ve 60. dakikalarda, 2, 4, 8, 12 ve 24. saatlerde vizüel aðrý skoru (VAS), hemodinamik parametreler, varsa yan etkiler ve ek analjezik gereksinimi kaydedildi.
BULGULAR: Gruplar arasý VAS’lar karþýlaþtýrýldýðýnda VAS 30 ve VAS 60 Grup I için anlamlý olarak düþüktü (p=0,024 ve p=0,030). VAS 2, 4, 8, 12, 24. saatler, hemodinamik parametreler, yan etkiler ve ek analjezik gereksinimi açýsýndan gruplar arasý anlamlý fark saptanmadý (p>0,05).
TARTIÞMA ve SONUÇ: Ýnguinal herni ameliyatlarýnda, hasta kontrollü ilioinguinal-iliohipogastrik blok analjezisi etkilidir. SOYGÝ ve opioidlerin sistemik yan etkilerinden sakýnýlmasý gereken hastalarda yan etkisi az, düþük maliyetli bir alternatif olarak uygulanabilir

INTRODUCTION: Postoperative pain of the inguinal hernia repair is characterized as moderate. Intraoperative wound infiltration with local anesthetics prolongs the duration of postoperative analgesia. Opioid and /or nonsteroidal anti-inflammatory drug requirement and their possible systemic side effects can be reduced by wound infiltration. In this study we aimed to compare the effectiveness of patient-controlled inguinal nerve block and patient controlled intravenous opioid infusion.
METHODS: 20-70 years old, ASA I-II, 30 patients who underwent inguinal hernia repair were included to study. Patients were randomized into two equal groups. In Group I, a system produced from a minivac drain catheter was placed near ilioinguinal-iliohypogastric nerve at the end of the operation. Catheter was connected to a pump which was set to infuse 25mg bupivacaine and locked for 2,5 hours. In Group II, after giving a bolus of 50 mg tramadol, a pump was set to continuous intravenous infusion of 14mg/hour tramadol. At 30. and 60.
minutes; 2, 4, 8, 12 and 24. hours, data including visual analog score (VAS), hemodynamic parameters, side effects and amount of required additional analgesic were collected.
RESULTS: In Group I, VAS 30. and 60. minutes were significantly lower when compared to Group II (p=0,024, p=0,030). In terms of VAS there were no significant differences between groups after the first hour. Hemodynamic parameters, side effects and extra analgesic requirement were similar between groups.
DISCUSSION AND CONCLUSION: Patient-controlled analgesia by ilioinguinal- iliohipogastrik block is an effective method after inguinal hernia repair. Patients for whom adverse effects of NSAIDS and opioids must be avoided, the method could be used as having less side effects and cheaper alternative.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý Konka Bülloza (KB) ve Septum Deviasyonu (SD) arasýndaki iliþkinin deðerlendirilmesi ve septal deviasyonu olan hastalarda preoperatif Paranazal Sinüs Bilgisayarlý Tomografisi (PNSBT) gerekliliðinin gözden geçirilmesidir.
YÖNTEM ve GEREÇLER: Bu çalýþmaya septoplasti operasyonu yapýlan 93 erkek, 40 kadýn hasta dahil edildi. Hastalarýn retrospektif olarak anterior rinoskopik muayene, endoskopik nazal muayene ve PNSBT sonuçlarý deðerlendirildi. Septum deviasyonu ve deviasyon derecesi ile konka bülloza (KB) iliþkisi ve PNSBT mevcut olan hastalarda septum deviasyonu dýþýndaki nazal týkanýklýða sebep olabilecek patolojiler deðerlendirilerek septoplasti öncesinde PNSBT’nin deðeri araþtýrýldý.
BULGULAR: PNSBT’si mevcut olan 60 hastanýn 23 (%38)’ünde KB, 2 (%3)’inde nazal polip tespit edildi. PNSBT deðerlendirmesine göre hafif derecede deviasyon tespit edilen hastalardan 2’sinde, ileri derecede deviasyon tespit edilen hastalardan 21’inde KB tespit edildi. Hafif derece (1-10°) deviasyonu olan gruptaki konka büllozalardan biri deviasyonla ayný tarafta, diðeri bilateral iken, ileri derece (>10°) deviasyonu olan grupta konka büllozalardan 3’ü ayný taraf, 13’ü karþý taraf, 5’i bilateral yerleþimli idi.
TARTIÞMA ve SONUÇ: Ýleri derecede deviasyonu olan hastalarda hafif derecede deviasyonu olan hastalara göre KB görülme sýklýðý daha fazladýr ve bunlarýn çoðunluðu deviasyonun karþý tarafýndadýr. Septoplasti planlanan hastalarda anterior rinoskopik muayene ve endoskopik muayenenin yanýnda seçilmiþ olgularda preoperatif PNSBT ile yapýlacak deðerlendirme faydalýdýr.

INTRODUCTION: The aim of this study is to evaluate relationship between concha bullosa (CB) and septum deviation and reviewe the necessity of preoperative paranasal sinus computed tomography (PNSCT) in patients with septal deviation.
METHODS: 93 male and 40 female patients underwent septoplasty were included in this study. Anterior rhinoscopy, nasal endoscopic examination and PNSBT results were evaluated retrospectively. Septal deviation, relationship between degree of deviation and CB and the reasons of nasal obstruction other than septal deviation were evaluated. The value of PNSCT before septoplasty was investigated.
RESULTS: CCB and nazal polyps were detected in 38% (23/60) and 3% (3/60) of the patients with PNSCT respectively. CB was detected 2 of the patients with mild deviation and 21 of the patients with severe deviation according to PNSCT evaluation. While one of CB in mild deviation group (1-10°) was at the same side of septal deviation, the other one was bilateral. On the other hand, three of CB was at the same side, 13 of CB was at the contralateral side of the septal deviation and 5 of CB was bilateral in the severe deviation group (>10°).
DISCUSSION AND CONCLUSION: The incidence of CB in severe deviation group is higher than mild deviation group and the majority of them are at the contralateral side of the deviation. Preoperative PNSBT evaluation is useful in selected septoplasty planned patients.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý ankilozan spondilitli hastalarda bel aðrýsýnýn nöropatik komponent içeriðini ve iliþkili faktörleri araþtýrmaktýr
YÖNTEM ve GEREÇLER: Çalýþmaya modifiye New York kriterlerine göre ankilozan spondilit (AS) tanýsý konulan 30 hasta ve 30 saðlýklý kontrol alýndý. Hastalýk aktivitesi (Bath Ankylosing Spondylitis Disease Activity Index) (BASDAI), ve fonksiyonel durumun (Bath Ankylosing Spondylitis Functional Index) (BASFI) yaný sýra Ankilozan spondilit yaþam kalitesi (Ankylosing Spondylitis Quality of Life) (ASQoL) anketi ile yaþam kalitesi deðerlendirildi. Bel aðrýsýnýn þiddetinin deðerlendirilmesi için görsel analog skala (visual analog scale) (VAS) kullanýldý. Hasta grubunun sedimantasyon hýzý ve C-reaktif protein (CRP) ölçümleri yapýldý. Nöropatik aðrý, varlýðýný deðerlendirmek amacý ile painDETECT anketi kullanýldý. Her iki grupta sakroiliak eklem üzerinden ve eldeki kontrol noktasýndan elektriksel duyusal eþik ile elektriksel aðrý eþiði ölçümleri yapýldý.
BULGULAR: Hastalarýn 3’ünde (%10) painDETECT skoru 19 ve üzerinde olup, 13 ve üzerinde olan hasta sayýsý 9 (%30) olarak saptandý. AS grubunda gerek sakroiliak eklem, gerekse eldeki kontrol noktasýndan elde edilen duyusal eþik ve aðrý eþiði deðerleri kontrol grubuna göre yüksek bulundu. Hastalarýn bel aðrýsý þiddetini deðerlendirdikleri aðrý VAS deðerleri, BASFI skorlarý ve CRP düzeyleri ile pain- DETECT skorlarý arasýnda anlamlý düzeyde pozitif korelasyon saptandý (p<0,05). BASDAI skorlarý (p<0,01), eritrosit sedimantasyon hýzý (p<0,01) ve yaþam kalitesi (p<0,001) skorlarý ile painDETECT arasýnda da belirgin pozitif yönde iliþki olduðu görüldü.
TARTIÞMA ve SONUÇ: Ankilozan spondilitli hastalarda bel aðrýsýnýn nöropatik bileþeni bulunmaktadýr. Nöropatik aðrý hastalýk aktivitesi ve düþük fonksiyonel kapasite ile iliþkili olup, yaþam kalitesinde azalmaya neden olmaktadýr.

INTRODUCTION: The aim of this study was to investigate the presence of a neuropathic pain component in low back pain and associated factors among patients with ankylosing spondylitis.
METHODS: Thirty patients diagnosed with ankylosing spondylitis (AS) according to the modified New York diagnostic criteria and 30 healthy controls were enrolled in this study. Along with disease activity (Bath Ankylosing Spondylitis Disease Activity Index) (BASDAI) and functional status (Bath Ankylosing Spondylitis Functional Index) (BASFI), the quality of life was assessed using
the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Visual analogue scale (VAS) was used to evaluate low back pain. Sedimentation rate and C- reactive protein measurements were obtained in the patients. The painDETECT questionnaire was used to determine the presence of neuropathic pain.. Electrical sensation threshold and electrical pain threshold measurements were obtained from the sacroiliac joint area and a control point on the hand for both groups.
RESULTS: PainDETECT scores were equal to or greater than 19 in 3 (10%) patients and ≥13 in 9 (30%) patients. Threshold values for electrical sensation and pain recorded from both sacroiliac joint area and hand were greater in AS group compared to those in control group. Pain VAS (used for assessment of the severity of low back pain) ratings, BASFI scores and CRP levels of patients showed a significant positive correlation with painDETECT scores (p<0.05). Significant positive associations were also found between painDETECT scores and BASDAI scores (p<0.01), erythrocyte sedimentation rate (p<0.01) and ASQoL (p<0.001) scores.
DISCUSSION AND CONCLUSION: Low back pain has a neuropathic pain component in patients with ankylosing spondylitis. Neuropathic pain is associated with disease activity and reduced functional capacity and diminishes quality of life.

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Amaç: N-metil-D-aspartat (NMDA) reseptör antikorlarý ile iliþkili ensefalit seyrek görülen otoimmün ensefalitlerden biridir, Burada fatal seyirli bir anti-NMDA reseptör ensefaliti olgusu sunulmaktadýr.
Olgu: Karýn aðrýsý ve bulantý yakýnmalarý ile acil servise baþvuran 22 yaþýndaki tkadýn hasta dalgýnlýk ve apati hali nedeniyle istenen konsultasyon sonrasý görüldü. Nörolojik muayenede bilinç açýk, orientasyon tamdý, ancak apati hali vardý. Ýyi koopere olmuyordu. Fundus normaldi. Taraf bulgusu yoktu ve TDR’ler fleksördü. Adýmlamada zorlanýyordu. Kranial MR’da sol parahipokampal girusta hafif intensite deðiþikliði saptandý. Kontrast tutulumu izlenmedi. BOS incelemesinde 80/mm3 PNL vardý. Ensefalit ön tanýsý ile yatýrýldý ve antiviral ve antibiyotik tedavisi baþlandý. 4. günde somnolans geliþmesi ve kooperasyonun bozulmasý sonrasý kontrastlý MR tekrarlandý. Lezyonun sol temporal ve oksipital loblara yayýldýðý, giral tarzda ve hafif leptomeningeal kontrast tuttuðu izlendi. 10.günde epileptik bir nöbet geçirmesi sonrasýnda valproat baþlandý. 12.günde çekilen MR’da lezyonun geniþlediði ve sað hemisferde de daðýnýk odaklarýn eklendiði görüldü. 13.günde yapýlan BOS incelemesinde hücre görülmedi. Herpes PCR sonucu negatifti. Otoimmün ensefalitler yönünden istenen antikor panelinde NMDA reseptör antikoru pozitif bulunarak hastaya anti-NMDA reseptör ensefaliti tanýsý kondu. Tedaviye yüksek doz metilprednizolon eklendi. Over teratomu yönünden yapýlan PET-CT de malignite lehine bulgu saptanmadý. ÝVÝG, plazmaferez ve immün adsorbsiyon da yapýlan hastada klinik yarar izlenmedi. Yatýþýnýn 68. gününde eksitus olan hastada postmortem overektomi yapýldý. Patolojik incelemede teratom saptanmadý.

Objective: Anti-NMDA (N-methyl-D-aspartate) receptor antibodies related encephalitis is a rare form of autoimmune encephalitis. We report a case of anti- NMDA receptor encephalitis with fulminant course.
Case: A 22-year-old female patient who had abdominal pain and vomiting was seen in the emergency department because of her apathy. On neurological examination she was awake and oriented, but mildly apathic. Cooperation was poor. Fundus examination was unremarkable. There were not any findings for lateralization. She had difficulty in tandem walking. Plantar responses were flexor. Cranial MR showed mild intensity changes on the left parahippocampal gyrus without contrast enhancement. CSF analysis revealed the presence of 80/mm3 polymorph lymphocytes. Antiviral and antibiotic therapies were started. Cranial MR was repeated after development of somnolence on 4. day. Extension of the lesion into the left temporal, and occipital lobes with a gyriform, and mild leptomeningeal contrast enhancement was observed. On 12. day, enlargement of the lesion on the right hemisphere was observed on cranial MR. There was no cell in CSF analysis on 13.day. Herpes PCR result was negative. Antibody panel requested for autoimmune encephalitis revealed NMDA receptor antibody positivity and she was diagnosed as anti-NMDA receptor encephalitis. High dose methylprednisolone added to the treatment. PET-CT performed for investigation of ovarian teratoma did not demonstrate any evidence for malignancy. IVIG, plasmapheresis, and immune adsorption were applied without any clinical benefit. She died on 68. day of her hospitalization, and postmortem oophorectomy was performed. Histopathological examination did not reveal any evidence of teratoma.
Conclusion: Although prognosis generally better, anti- NMDA receptor encephalitis can be fatal course.

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Dermoid kistler, sýklýkla hayatýn 2. ve 3. dekatlarýnda taný konulan geliþimsel kistik lezyonlardýr. Vücudun her yerinde görülebilmesine raðmen, baþ-boyun bölgesinde ve nadiren de aðýz tabanýnda yerleþebilirler. Klinikte çoðunlukla yavaþ büyüyen, aðrýsýz, asemptomatik kitleler olarak görülürler, ancak disfaji, disfoni ve hatta dispneye sebep olabileceði de bilinmelidir. Anatomik olarak geniohyoid ve milohyoid kaslarla olan iliþkisine göre sýnýflandýrýlabilir. Tedavi kistin intraoral veya ekstraoral yaklaþýmla cerrahi olarak çýkartýlmasýdýr. Prognoz son derece iyidir ve cerrahi sonrasý relaps insidansý oldukça düþüktür. Biz bu olgu sunumunda, biri ekstraoral yaklaþýmla, diðeri intraoral yaklaþýmla çýkartýlan iki dermoid kist vakasýný ele alýyoruz.

Dermoid cysts are developmental cystic lesions that were commonly diagnosed in the second and third decades of life. Although they can be seen at all parts of the body, they can appear at head and neck region and rarely in the floor of the mouth. Clinically they usually present as slow growing, painless, asymptomatic masses, but they also can cause dysphagia, dysphonia and dyspnea. Anatomically they can be categorized as their relationship with geniohyoid and mylohyoid muscles. The treatment is surgical excision of the cyst by intraoral or extraoral approach. Prognosis is very good and incidence of relapse is very low. In this case report, we present two dermoid cyst cases: One of them is excised by extraoral approach and another one is excised by intraoral approach.

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Priapizm herhangi bir cinsel istek veya uyarý olmadan ereksiyon geliþmesidir. Çoðu zaman idiyopatik olsa da bazen altta yatan sebep ortaya konabilmektedir. Oral yoldan alýnan ilaçlar nadiren priapizme neden olabilirler. Burada tek doz ketiapin ve olanzapin kullanýmýna baðlý geliþen bir priapizm olgusunu sunuyoruz.

Priapism is an erection without any sexual desire or stimulation. It is often idiopathic but sometimes underlying cause may be revealed. Drugs taken orally can rarely cause priapism. Here we present a case of priapism induced by single dose quetiapine and olanzapine.

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Yüksek çözünürlüklü ultrasonografinin geliþmesi ve ince iðne aspirasyon biyopsisi sonrasý sitolojik sýnýflamalarýnýn yeniden tanýmlanmasý ile
beraber tiroid kanser cerrahisinde, hasta deðerlendirilmesi ve yapýlacak cerrahinin planlanmasý güncel tartýþmalara konu olmuþtur. Tiroid kanserlerinin yaklaþýk %85’i papiller kanserlerdir ve papiller kanserleri de %30 ile % 56 arasýnda deðiþen oranlarda papiller tiroid mikrokanseri (PMK) oluþturmaktadýr. 1980’li yýllarýn sonunda adlandýrýlan PMK, en geniþ çapý 1 cm ve altýndaki papiller tiroid kanseri (PTK) olarak tanýmlanýr. Uluslararasý kullanýlan tiroid kanseri taný ve tedavi kýlavuzlarýnda PTK ve PMK tanýlarý yapýlacak cerrahi tedaviyi etkileyen ana faktörlerdir. Papiller tiroid kanserindeki tedavinin basamaklarý primer tümörün, tiroid kapsül dýþýna taþan hastalýðýn ve etkilenen lenf gangliyonlarýnýn cerrahi olarak çýkarýlmasý ile baþlar. Ana prensip cerrahi yaparken yapýlacak cerrahinin geniþliði ve cerrahi tecrübeye baðlý olarak morbiditeyi en az oranda tutmaktýr. Hasta takip ve tedavi devamýný belirleyen en önemli etken hastalýðýn doðru evrelenmesidir. Doðru evreleme tamamlayýcý cerrahi ve radyoaktif iyot (RAI) ablasyon tedavisi endikasyonu, nüks takibi protokolü ve tiroid stimülan hormon (TSH) baskýlama tedavisinin derecesi gibi bir çok konu üzerinde önemli bir etkendir. Metastatik lenf gangliyonlarý, hem doðru evrelemede hem de hastalýðýn nüksünde en önemli etken olduðu için yapýlacak olan cerrahi giriþimin geniþliði PTK’da günümüzde tartýþýlan konulardan biridir. Bu derlemede Amerikan Tiroid Birliðinin (ATA) yetiþkin hastalar için son olarak yayýnlanan tiroid nodüllerinde ve diferansiye tiroid kanserinde tedavi kýlavuzu ve güncel literatür eþliðinde papiller tiroid kanseri taný ve tedavi basamaklarýný özetlemek amaçlanmýþtýr.

The planning of surgery methods and patient evaluation in the thyroid cancer surgery has been subjected to up to date discussions with the over again description of cytological classification after the development of high-resolution ultrasound and fine needle aspiration biopsy. Papillary carcinomas consist of nearly 85% of all thyroid cancers and of them papillary thyroid microcarcinomas (PTM) constitute 30-56%. At the late 1980s, PTM defined as the papillary thyroid carcinomas (PTC) those are ≤1 cm at the largest diameter. In the international guidelines of thyroid cancer diagnosis and management, PTM and PTC diagnosis are the main factors that effect the surgical method. The management steps of papillary thyroid cancer begin with surgical removing of the primary tumor, the part overspilling from thyroid capsule and affected lymphoid ganglions. The main principle is retaining the morbidity in minimal during surgery with the extent of surgery according with
experience of the surgeon. The main determinant for deciding continuation of treatment and follow up of the patient is making true staging. This true staging is important for many parameters as the indication of supplementary surgery and radioactive iodine ablation therapy (RAIT), recurrence follow up protocol, the degree of thyroid stimulating hormone (TSH) supression treatment. The metastatic lymphoid ganglions are the most important factors in both true staging and relapse of the disease, so one of the current controversial subject in PTM is the extent of surgery. In this review, we want to summarize the main headings of diagnosis and management of papillary
thyroid cancer in the guidance of current literature and American Thyroid Association Guideline relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer.

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