GÝRÝÞ ve AMAÇ: Araþtýrmanýn amacý, iki kamu hastanesinde çalýþan saðlýk personelinin mobbing davranýþý ile karþýlaþma durumlarýný ve mobbing karþýsýnda baþ etme yöntemlerini belirlemektir.

YÖNTEM ve GEREÇLER: Araþtýrma tanýmlayýcý nitelikte planlanmýþtýr. Araþtýrma örneklemini 04.11.2012 ve 30.05.2013 tarihleri arasýnda Marmara Bölgesi’nde
kolayda örneklem yoluyla seçilen bir kamu hastanesi ve aðýz ve diþ saðlýðý merkezinde çalýþan saðlýk personelleri oluþturmaktadýr. Verilerin toplanmasýnda sosyodemografik özellikleri, mobbing davranýþý ile karþýlaþma durumlarýnýným ve mobbing davranýþýna maruz kalan personelin nasýl tepki gösterdiklerinin yer aldýðý üç bölümden oluþan anket formu kullanýlmýþtýr.
BULGULAR: Çalýþmada kamu hastanesi ve aðýz ve diþ saðlýðý merkezindeki tüm çalýþanlarýn en az bir defa mobbing davranýþýna maruz kaldýðý ve mobbing davranýþý ile karþýlaþtýklarý görülmüþtür.
TARTIÞMA ve SONUÇ: Mobbing davranýþý özellikle saðlýk hizmeti verilen kamu kurumlarýnda oldukça sýk görülmektedir.

INTRODUCTION: The research has been planned in the nature of comparative descriptive with the aim of determining the circumstances of encounter with mobbing behavior of State Hospital’s health staffs and assistants.

METHODS: All health care workers and assistants working in public hospital and Oral Health Care Center are in this research sample on between 04 November 2012 and 30 May 2013. A questionnaire form consisting of 3 parts was used so as to designate.
RESULTS: In the study it was seen that all employees in the public hospital and oral and dental health center were exposed to mobbing behavior at least once and met with mobbing behavior.
DISCUSSION AND CONCLUSION: Consequently, mobbing behavior is frequently seen especially in the public institutions serving as health care service.

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GÝRÝÞ ve AMAÇ: Ýlaç ve ilaç dýþý maddelerle oluþan zehirlenmeler günümüzde hala önemli bir saðlýk sorunu oluþturmaktadýr. Bu çalýþmada, suicid amaçlý ilaç intoksikasyonu tanýsý ile baþvuran hastalarýn yaþ, cinsiyet, ilacýn cinsi gibi demografik özelliklerinin tespiti, ve alýnan ilacýn serum düzeyi ile klinik takip sonucu arasýndaki iliþkiyi araþtýrmak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya suisid amacýyla ilaç aldýðý saptanan ve serumda düzeyi tespit edilebilen ilaç zehirlenmesi olan 18 yaþ üstü hastalar alýndý. Hastalarýn yaþ, cinsiyet, geliþ vital bulgularý kayýt altýna alýndý. Taburcu edilen ve yoðun bakým ünitesine kabul edilen hastalar olarak 2 grup oluþturuldu. Böylelikle serum ilaç düzeyine göre klinik korelasyon arasýndaki iliþki incelendi.
BULGULAR: Þubat 2013-Aðustos 2013 arasýnda acil servisimize baþvuran çalýþma normlarýmýza uygun 60 hasta incelenmiþtir. Hastalarýmýzýn %71,7 si bayan (n=43), %28,3 ü erkekti (n=17). Yaþ ortalamasý 26,88±8,88 tespit edildi. Klinik seyire göre daðýlýmda hastalarýn 38’ i (%63,3) acil serviste en az altý (6) saat, en fazla 24 saat gözlendikten sonra taburcu edildiði, 22’sininde (%36,7) yoðun bakýma nakledildiði görülmüþtür. Trisiklik antidepresanýn (TSA) yüksek serum düzeylerinin artmýþ yoðun bakým yatýþý ile iliþkili idi. Her 2 gruptaki parasetamol seviyeleri birbirine yakýn deðerde idi ve bu seviyelerin yoðun bakým yatýþý üzerinde anlamlý bir etkisi yoktu. Ve yine, çalýþmamýzda vital bulgular ile ilaçlar arasýndaki iliþki de tespit edildi. Bununla birlikte, TSA alan grup, istatistiksel olarak anlamlý düzeyde düþük ortalama arteryal basýnç (OAB), artmýþ kalp hýzý ve solunum hýzýna sahipti.
TARTIÞMA ve SONUÇ: Sonuç olarak aldýðý ilaç miktarý tam olarak bilinmeyen veya ifade edemeyen hasta grubunda taburculuk veya yatýþ kararýnýn verilmesinde serum ilaç düzeylerinin yanýnda klinik bulgularýn özellikle OAB, nabýz gibi vital parametrelerin de beraber deðerlendirilmesi gerektiði kanaatindeyiz.

INTRODUCTION: Intoxications due to drugs and other substances are still an important health issue. In this study we want to investigate the correlation between serum drug levels and demographic properties of patients who present to the emergency department with suicide attempts with drugs.
METHODS: Patients over 18 years of age who presented to emergency department (ED) with drug intoxication due to suicide attempt and whose blood drug levels could be obtained are included in our study. Age, gender, vital signs on presentation are all recorded. Two major groups were formed, patients who are discharged and who were admitted to intensive care unit (ICU). By this data, correlation between the drug levels and clinical progress is observed.
RESULTS: Between February 2013 and August 2013, 60 patients who met our inclusion criteria were studied. 71,7% were female (N=43), %28,3 were male (n=17). Mean age was 26.88±6.2. 38 patients (63,3%) were monitored in ED for 6 to 24 hours and were discharged. 22 patients(36,7 %) needed ICU admission. The higher blood levels of tricyclic antidepresants (TCA) correlated with higher incidence of ICU admission. Paracetamol levels in both groups were nearly same, and these levels proved no importance in ICU admission. And, we also observed the correlation between the drugs and vital signs in our study. In addition to this, The group who had TCA, had statistically significant low mean arterial pressures, faster heart rate and faster respiratory rate.
DISCUSSION AND CONCLUSION: We conclude that clinical decision making of patients with unknown or undetermined amounts of drug intake should be made not only according to their blood drug levels but also to their clinical states and their vital signs especially mean arterial pressure (MAP), heart rate.

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GÝRÝÞ ve AMAÇ: Bu çalýþma; sezaryen doðum operasyonunda kombine spinal-epidural anestezide (KSEA) intratekal levobupivakaine eklenen fentanil ve morfinin etkilerini deðerlendirmek amacýyla yapýldý.
YÖNTEM ve GEREÇLER: Hastane etik kurul onayý ve olgularýn yazýlý onaylarý alýndýktan sonra elektif sezaryen doðum operasyonu geçirecek ASA I-II grubunda, rejyonel anestezinin kontrendike olmadýðý, 18–45 yaþlarý arasýnda 40 gebe kadýn çalýþmaya dahil edildi. Hastalar rastgele randomizasyonla Grup LF (n: 20); 7,5 mg % 0.5 levobupivakain + 25 µg fentanil ve Grup LM (n: 20); 7,5 mg % 0.5 levobupivakain + 100 µg morfin olarak çalýþmaya dahil edildi.
BULGULAR: Her iki grupta bütün bireylerin “cilt inzisyonu” VAS skorlarý “0” olarak tespit edilmiþtir. Gruplar arasýnda yapýlan karþýlaþtýrmalarda, gruplarýn “uterus inzisyonu” ve “postop 30. dakika” VAS skorlarý daðýlýmlarý arasýnda anlamlý bir farklýlýk bulunmamýþtýr. Ancak gruplarýn “periton kapatma” ve “postop 60. dakika” VAS skorlarý daðýlýmlarý arasýnda anlamlý bir farklýlýk olduðu görülmüþtür (p<0,05). “Periton kapatma” ölçümünde, Grup LM’de VAS skorlarý 3, 4 ve 5 deðerlerinde yoðunlaþýrken, Grup LF’de VAS skoru 0 deðerinde önemli sayýda hastanýn olduðu tespit edilmiþtir. “Postop 60. dakika” ölçümünde ise Grup LM’de hastalarýn çok büyük bölümünün VAS skoru
0 iken Grup LF’de hastalarýn 0, 2, 3, 5 ve 6 deðerlerine daðýldýðý görülmüþtür. Grup LF’nin “en üst motor bloða ulaþma” süresinin ortalama deðerinin Grup LM’ den anlamlý düzeyde yüksek olduðu tespit edilmiþtir. Grup LM’ nin “ilk analjezik ihtiyacý” süresinin ortalama deðerinin ise; Grup LF’den anlamlý düzeyde yüksek olduðu belirlenmiþtir. Grup LM’de duysal blok seviyesi deðerlerinin T2, T3 ve T4’e dengeli daðýldýðý, Grup LF’de ise; T2 ve T4’te önemli bir yoðunlaþmanýn olduðu tespit edilmiþtir Gruplar arasýnda yapýlan karþýlaþtýrmalarda, gruplarýn görülen yan etkiler daðýlýmý açýsýndan anlamlý bir farklýlýk göstermediði tespit edilmiþtir.
TARTIÞMA ve SONUÇ: Levobupivakaine kardiyovasküler ve santral sinir sistemine düþük yan etki profili nedeniyle gebelerde sezaryan doðumda güvenle kullanýlabilecek bir lokal anestezik olup % 0,5 lik levobupivakaine eklenen 25 µg fentanyl ve 100 µg morfin ile anne ve bebekte düþük yan etki profili oluþturup diðer çalýþmalara göre daha kýsa sürede bir motor bloðun geliþmesiyle birlikte levobupivakaine eklenen morfin daha uzun süreli bir analjezi saðlamakta ve postop dönemde hastalarýn analjezi ihtiyacýný azaltmaktadýr.

INTRODUCTION: This study was conducted with the aim of evaluating the effects of fentanyl and morphine used in addition to intracethecal levobupivacaine in combined spinal-epidural anesthesia (CSEA) in cesarean section operations.
METHODS: After approval of the hospital’s ethical board and written approvals of the patients, 40 pregnant women undergoing elective cesarean section delivery, aged 18 to 45, ASA group I-II, in whom regional anesthesia is not contraindicated were included. Included patients (n: 40) were randomized into two groups with first group LF (n: 20) to receive 7,5 mg %0.5 levobupivacaine + 25 mcg fentanyl and second group LM (n: 20) to receive 7,5 mg %0.5 levobupivacaine + 100 mcg morphine. Patients’ motor block initiation time, motor and sensory block levels at minutes 1, 3, and 5, blood pressure and heart rates, time needed for sensory block to reach T4, time needed for motor block to reach highest level, highest levels of motor and sensory block, time of first required analgesic, motor block reversal time, intrathecal injection to delivery and intrathecal injection to end of operation time, blood pressure, heart rate, and spO2 levels of the mother every 5 minutes, umbilical vein blood gases of the baby, Apgar scores at minutes 1 and 5, side effect profile (hypotension, nausea-vomiting, bradycardia, ephedrine requirement, itching, postoperative headache), peroperative and postoperative VAS scores (VAS score 0 for no pain, 5 for moderate, 10 for severe pain) were recorded.
RESULTS: In both groups all individuals’skin incision VAS score was accepted to be “0”. When groups were compared no significant difference was found in “uterine incision” and “postoperative 30 min” VAS scores. However a significant difference was observed between “peritoneal closure” and “postoperative 60 min” VAS scores of the groups (p<0.05). In “peritoneal closure” measures Group LM VAS scores concentrated around 3,4,5 while Group LF had a significant amount of patients at 0 score. In “postop 60 min” measures Group LM patients had a large portion at VAS score 0 while Group LF had patients distributed at values 0, 2, 3, 5, and 6. Group LF’s “time needed to reach highest motor block” mean was significantly higher than that of Group LM. Group LM’s “time of first required anesthetic” mean was significantly higher than that of Group LF. Group LM’s sensory block levels were distributed rather equally among T2, T3 and T4 while in Group LF there was a concentration at levels T2 and T4. There was no significant difference between groups concerning seen side effects.
DISCUSSION AND CONCLUSION: Levobupicavaine is a local anesthetic that can be used safely in cesarean section of pregnant women due to its low side effect profile in cardiovascular and central nervous systems. 25 µg fentanyl and 100 µg morphine added to %0,5 levobupivacaine has a low side effect profile in the mother and the baby, and results in a shorter time motor blockage than previous studies. Morphine added to levobupivacaine provides a longer analgesia duration and reduced analgesia requirement in the postoperative period.

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GÝRÝÞ ve AMAÇ: Aðrý kas iskelet sistemi bozukluklarýnda en belirgin semptomdur. Aðrýya karþý genel aþýrý duyarlýlýk sýklýkla kronik aðrý koþullarýyla iliþkilidir. Bu çalýþmada, farklý kas-iskelet sistemi hastalýk gruplarýnýn aðrý derecelerini, aðrý basýnç eþiði ve görsel analog skala ile karþýlaþtýrdýk.
YÖNTEM ve GEREÇLER: Çalýþmaya ankilozan spondilit (n = 34), fibromiyalji (n = 30), miyofasiyal aðrý sendromu (n = 33), osteoporoz (n = 34), jeneralize osteoartrit (n = 34) ve romatoid artrit (n = 34) tanýsý alan hastalar ve saðlýklý kiþiler (n = 30) dahil edildi. Psikolojik deðerlendirme için
Beck depresyon envanteri, klinik aðrýyý ölçmek için görsel analog skala (VAS) kullanýldý. PPT ölçümleri hastalýk tutulumu göstermeyen alanlardan yapýldý: orta deltoid, orta ulna, hipotenar belirginlik, baþparmak, orta tibia ve kuadriseps femoris.
BULGULAR: Klinik aðrý için VAS skoru, ankilozan spondilitte 4.76 ± 3.15, fibromiyaljide 7.44 ± 2.42 idi. Fibromiyalji, aðrý duyarlýlýðýnýn arttýðýný gösteren tüm ölçüm yerlerinde tutarlý olarak en düþük PPT’ye sahipti. Miyofasyal aðrý sendromu ve ankilozan spondilit, aðrýya saðlýklý kontrollerle karþýlaþtýrýldýðýnda daha fazla duyarlýlýk göstermeyen tek hastalýktý. Osteoporoz hastalarý ayrýca VAS’da ortalama klinik aðrý 6.09 ± 3.23 ve doðrulanmýþ kýrýklarýn varlýðýna bakýlmaksýzýn genel hassasiyet göstermiþtir. Genel olarak, kadýn cinsiyet, ileri yaþ, depresyon ve NSAID kullanýmý düþük PPT ile koreleydi.
TARTIÞMA ve SONUÇ: Aðrý duyarlýlýðýnýn düzeyi, kas-iskelet bozukluklarýnýn mekanizmasý ve tedavi seçenekleri hakkýnda ipucu saðlayabilir.

INTRODUCTION: Pain is the most significant symptom in musculoskeletal disorders. General hypersensitivity to pain is often associated with conditions of chronic pain. In this study we compared pain degrees of different musculoskeletal disease groups by pain pressure threshold and visual analog scale.
METHODS: Patients diagnosed with ankylosing spondylitis (n=34), fibromyalgia (n=30), myofascial pain syndrome (n=33), osteoporosis (n=34), generalized osteoarthritis (n=34) and rheumatoid arthritis (n=34) and healthy subjects (n=30) were included in the study. Beck depression inventory was used for psychological evaluation. Visual analog scale (VAS) was used to quantify clinical pain. PPT measurements made from the areas that generally not showing involvement of disease: at middle deltoid, middle ulna, hypothenar eminence, thumb, mid-tibia, and quadriceps femoris.
RESULTS: VAS score for clinical pain ranged from 4.76±3.15 in ankylosing spondylitis to 7.44±2.42 in fibromyalgia. Fibromyalgia consistently had the lowest PPT across all sites of measurements indicating increased pain sensitivity. Myofascial pain syndrome and ankylosing spondylitis were the only diseasesthat did notshow greatersensitivity to pain compared to healthy controls. Osteoporosis patients also reported an average clinical pain of 6.09±3.23 on VAS, and showed general tenderness regardless of presence of verified fractures. Overall, female gender, advanced age, depression and NSAID use correlated with lower PPT
DISCUSSION AND CONCLUSION: The level of pain sensitivity may provide a clue regarding the mechanism and treatment options of musculoskeletal disorders.

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GÝRÝÞ ve AMAÇ: Mikroalbüminüri diyabetik nefropatinin klinik olarak tespit edilebilen ilk evresidir ve kardiyovasküler hastalýklar için bir risk faktörüdür. Artmýþ nabýz basýncý da kardiyovasküler bir risk faktörü olarak kabul edilmektedir. Bu çalýþmamýzda mikroalbüminüri düzeyine ulaþmamýþ üriner albümin atýlýmý olan tip 2 diyabetik hastalarda üriner albümin atýlýmý ile nabýz basýncý arasýndaki korelasyonu araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2015-Mayýs 2016 tarihleri arasýnda poliklinik kontrollerine gelmiþ tüm tip 2 diyabet hastalarý retrospektif olarak incelendi. Üriner albümin atýlýmý 30 mg/24 saat’in altýnda olan hastalar çalýþmaya alýndý. Tekrarlayan kayýtlarý önlemek amacýyla her hastanýn ilk geliþ kayýtlarý incelendi. Hastalar nabýz basýncýna göre ≤46 mmHg olanlar, 46-56 mmHg arasýnda olanlar ve ≥56 mmHg olanlar olmak üzere 3 gruba ayrýldý. Gruplar üriner albümin atýlýmý açýsýndan karþýlaþtýrýldý.
BULGULAR: Çalýþmaya %70,1’i kadýn (n: 103), %29,9’u erkek (n: 44) toplam 147 hasta dahil edildi. Nabýz basýncý gruplarý arasýnda açlýk plazma glukozu, HbA1c, total kolesterol, LDL kolesterol, HDL kolesterol, trigliserid, üre ve kreatinin deðerleri açýsýndan fark yoktu (sýrasýyla
p: 0,06, p: 0,1, p: 0,8, p: 0,7, p: 0,1, p: 0,6, p: 0,2 ve p: 0,09). Ortalama üriner albümin atýlýmý nabýz basýncý ≤46 mmHg olan grupta 6,92±4,2 mg/24 saat, 46-56 mmHg arasýndaki grupta 11,15±7,7 mg/24 saat ve nabýz basýncý en yüksek olan grupta ise 15,31±5,8 mg/24saat idi. Gruplarýn üriner albümin atýlýmý deðerleri ile nabýz basýnçlarý arasýnda istatistiksel olarak anlamlý pozitif bir korelasyon mevcuttu (p<0,0001, r: 0,458).
TARTIÞMA ve SONUÇ: Çalýþmamýz þunu ortaya koymuþtur ki; nabýz basýncý arttýkça mikroalbüminürisi olmayan diyabetli hastalarda üriner albümin atýlýmý artmaktadýr. Bu bulgu mikroalbüminüri geliþimi açýsýndan bir risk faktörü olabilir. Nabýz basýncýnýn diyabetik nefropati geliþimi üzerine etkilerini araþtýran ileri çalýþmalara ihtiyaç vardýr

INTRODUCTION: Microalbuminuria is the first clinically detectable stage of diabetic nephropathy and a risk factor for cardiovascular diseases. Also increased pulse pressure is regarded as a cardiovascular risk factor. In this study we aimed to investigate the correlation between urinary albumin excretion and pulse pressure in type 2 diabetic patients whom urinary albumin excretion did not reach to microalbuminuria level.
METHODS: All type 2 diabetic patients were retrospectively analyzed who come for outpatient control between January 2015 and May 2016. Patients have a urinary albumin excretion lessthan 30 mg/24h were included to study.First registrations of all patients were studied in order to prevent repeated recordings. Patients were divided into three groups according to pulse pressure as; ≤46 mmHg, between 46-56 mmHg and ≥56 mmHg. Groups were compared in terms of urinary albumin excretion.
RESULTS: Totally 147 patients were included the study; %70,1 (n: 103) were women and %29,9 (n: 44) were men. There were no differences between pulse pressure groups regarding to fasting plasma glucose, HbA1c, totally cholesterol, LDL-cholesterol, HDL-cholesterol, triglyserides, urea and creatinin levels(respectively p: 0,06, p: 0,1, p: 0,8, p: 0,7, p: 0,1, p: 0,6, p: 0,2 ve p: 0,09). The mean urinary albumin excretion was 6.92 ± 4.2 mg / 24 hours in the group ≤46 mm Hg, 11.15 ± 7.7 mg / 24 h in the group between 46-56 mmHg and 15 31 ± 5.8 mg / 24h in the group with the highest pulse pressure. There was a statistically significant positive correlation between urinary albumin excretion rates and pulse pressure groups (P <0.0001, r: 0,458).
DISCUSSION AND CONCLUSION: Our study shows that urinary albumin excretion increases with the increase in pulse pressure in diabetic patients without microalbuminuria. This finding may be a risk factor for microalbuminuria development. Further studies are needed to investigate the effects of pulse pressure on diabetic nephropathy development.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada üçüncü basamak bir saðlýk kuruluþunun acil servisine epistaksis nedenli baþvuran hastalar etyolojik, klinik ve demografik özellikler açýsýndan deðerlendirilmiþtir. Çalýþmamýzýn amacý bu tip hastalarda rutin istenen laboratuvar tetkiklerinin epistaksis etyolojisini aydýnlatmadaki yerini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmaya 2015 Ocak-2015 Haziran tarihleri arasýnda epistaksis tanýsý konularak acil serviste deðerlendirilmiþ, 18 yaþ ve üstü hastalar dahil edildi ve hasta dosyalarý retrospektif olarak incelendi. Travma nedenli epistaksis olan olgular çalýþmaya dahil edilmedi. Hastalarýn yaþý, cinsiyeti, eþlik eden ve kanamaya yatkýnlýk oluþturabilecek hastalýklarý, kanamayla iliþkili ilaç kullanýmlarý, vital bulgularý ve kan tetkikleri deðerlendirildi.
BULGULAR: Çalýþmadaki 100 olgunun 48’i kadýn, 52’si erkek olup, yaþ ortalamalarý 58,22±16,76 olarak hesaplandý. Ortalama sistolik kan basýncý 147±31,39, ortalama diyastolik kan basýncý 88,38±20,12 þeklindeydi. Olgularda hipertansiyon (%59), diyabetes mellitus (%16), kronik böbrek yetmezliði (%3), malignite (%6), Glanzman hastalýðý (%1) öyküsü olduðu saptandý. Kronik hipertansiyon tanýsý olan ve acile geliþ anýnda hipertansif olarak saptanan 33 olgunun 4’ünde uluslararasý düzeltme oraný (INR) yüksekliði olduðu ve bunlardan bir olgunun warfarin sodyum kullanmakta olduðu görüldü. Bu durum istatistiksel olarak anlamlý saptandý (p=0.022). Kanama ile iliþkili ilaç kullaným oranlarý warfarin sodyum (%11), asetil salisilik asit (%26) ve klopidogrel (%6) þeklindeydi. Neoplastik hastalýk öyküsü olanlarda düþük hemoglobin ve yüksek INR deðerleri saptandý (p<0.005).
TARTIÞMA ve SONUÇ: Hipertansiyon, yaþa baðlý olarak sýklýðý artan ve epistaksis etyolojisinde önemli yer tutan bir durumdur. Tek baþýna hipertansiyon, epistaksis etyolojisini açýklamakta çoðu olguda yeterli olabilmektedir. Kronik hipertansiyon tanýsý olan ve ayný zamanda acile geliþ anýnda hipertansif olarak saptanan hastalarda epistaksis etyolojisini belirlemek üzere ek laboratuvar tahlili almanýn gerekli olmayabileceðini düþünmekteyiz.

INTRODUCTION: Patients who applied to the emergency room of a tertiary hospital with epistaxis were evaluated in this study in terms of etiological, clinical and demographical characteristics. Our aim is to determine the value of routine laboratory tests in enlightening the etiology of
epistaxis.
METHODS: Between January 2015-June 2015, above 18 years old patients who were diagnosed with epistaxis in the emergency room were retrospectively reviewed from patient charts. Traumatic epistaxis cases were not included in the study. Patients were analzed in terms of age, sex, comorbidities and medications that may lead to bleeding, vital parameters and blood tests.
RESULTS: The study consisted of 100 patients (52 male, 48 female) and the average age was 58,22±16,76. Median systolic blood pressure was 147±31,39, while median diastolic pressure was 88,38±20,12. Hypertension (59%), diabetes mellitus (16%), malignancy (6%), chronic renal failure (3%) and Glanzman disease were the comorbidities of the patients. Thirty three of the cases with a diagnosis of chronic hypertension were also vitally hypertensive at the admission of the emergency room. International normalized ratio (INR) was elevated in
four of these patients and one of them was using warfarin sodium which was statistically significant (p=0.022). Medications that may lead to bleeding were warfarin sodium (11%), acetylsalicylic acid (%26) and clopidogrel (%6). Low hemoglobin level and elevated INR was seen in patients with a history of malignancy (p<0.005).
DISCUSSION AND CONCLUSION: Hypertension is an etiological factor in epistaxis with increased incidence related to age. Hypertension alone is generally sufficient to explain the etiology of epistaxis. We believe that additional laboratory tests may not be necessary to determine the etiology of epistaxis in patients which have a diagnosis of chronic hypertension and are vitally hypertensive at the same time.

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Clay Shoveler kýrýðý daha çok alt servikal vertebralar ve üst torakal vertebralar seviyesinde görülen spinöz proçes kýrýðýdýr. En yaygýn semptomu aðrýdýr. Tedavide 4 hafta boynun immobilizasyonu (boyunluk kullanma), aðrý kontrolü için analjezikler önerilmektedir. Biz bu olgu sunumunda travma sonrasý meydana gelen Clay Shoveler kýrýðý olgusunu görseli ile beraber sunmayý amaçladýk.

The Clay Shoveler fracture is the fracture of the spinous process which is seen in the lower cervical vertebrae and upper thoracic vertebrae. The most common symptom is pain. Treatment includes immobilization for 4 weeks (using a collar), analgesics for pain control. In this case report, we aimed to present a case of the Clay Shoveler fracture that occurred after trauma with images.

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59 yaþýnda bayan hastada arter dal týkanýklýðý sonrasýnda optik koherens tomografi (OKT) ve fundus fluorescein anjiografi (FFA) bulgularý deðerlendirildi.
OKT’de erken dönemde iç retinal katmanlarda kalýnlýk artýþý ve hiperreflektivite, fotoreseptör tabakasý ve retina pigment epitelinde ise reflektivitede azalma olduðunu görüldü. Foveolar çukurluk, foveadaki fotoreseptör tabakasý ve altýndaki retina pigment epitelinin normal olduðu görüldü. FFA’da arter akýmýnda yavaþlama ve dolum defektleri görüldü. Geç dönemde tekrarlanan incelemelerde iç retinal tabakalarda atrofi geliþimi ve nöroretinal rimde incelme görüldü. OKT bulgularý iskemi sonucu intrasellüler proteinlerin denaturasyonu ve yýkýmý sonucu geliþen iç retinal tabakalardaki intrasellüler ödem ve geç dönemde geliþen atrofi ile uyumluluk göstermektedir.

59-years-old female patient after retinal artery branch occlusion optic coherence tomography (OCT) and fundus fluorescein angiography (FFA) findings were evaluated. OCT examination showed increased thickness and hyperreflectivity in the inner retinal layers, and decreased reflexivities in the photoreceptor layer and retinal pigment epithelium. Foveolar depression, foveal photoreceptor layer and underlying retinal pigment epithelium were normal. In FFA, slowing of arterial flow and filling defects were observed. Repeated examinations in the late period revealed atrophy in the inner retinal layers and thinnig at the neuroretinal rim. OCT findings are consistent with intracellular edema in the inner retinal layers, resulting from denaturation and destruction of ischemic intracellular proteins, and late atrophy

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Metabolik asidoz, kanda bikarbonat konsantrasyonunda azalmaya neden olan, vücut tamponlarýnýn birincil tüketimi ile karakterize bir asit-baz bozukluðudur. Bu olguda delici kesici alet yaralanma sebebiyle acil servise baþvuran ve hemorajik sýrasýnda yaþamla baðdaþmayan derin metabolik asidoz (Ph=6.61) sonrasý saðkalýnýmýný ortaya koymaya amaçladýk.16 yaþýndaki erkek hasta delici kesici alet yaralanmasý sebebiyle acil servise baþvurdu. Hastanýn þuuru konfüze, hipotansif (40/20 mmHg) ve taþikardikti (145/dk). Hastanýn aktif kanamasý yoktu. Sað alt ekstremitede uyluk posteriorunda yaklaþýk 3 cm çapýnda açýk yarasý mevcuttu. Bilateral alt ekstremite nabýzlarý elle alýnamamaktaydý. Herhangi bir darp veya baska delici kesici alet yaralanmasý insizyonu olmayan hasta acilen entübe edilerek ameliyathaneye alýndý. Per-operatif hastanýn laboratuvar deðerleri: Hemotokrit %17, hemoglobin 6 mg/dL, lökosit 22800 mm3, pH: 6.61, PaCO2 44.5 mmHg, PaO2 352 mmHg, HgHCO3: 3,8 mmol/L, BE: -31 mmol/L, laktat: 20 mmol/l, SO2 %97,4 idi. Sað yüzeyel femoral arter ve sað ana femoral vendetama yakýn parsiyel kesi olduðu görüldü. Primer tamir tekniði ile arter, uç-uca onarým tekniði ile femoral ven tamiri yapýldý. Yapýlan acil operasyondan iki saat sonra hastanýn Ph deðeri 7.24, baz açýðý -10 mmol/L ve laktat 21 mmol/L olarak tespit edildi. Operasyondan 10 saat sonra hastanýn kan gazý deðerleri normale geldi ve hasta ekstübe edildi. Rehabilitasyon sonrasý hasta postop 7.gün taburcu edildi. Bu olgu acil müdahale tedavisi ile hemostaz saðlanan derin metabolik asidozda (Ph: 6.61, Laktat: 20) saðkalýmýn mümkün olabileceðini göstermektedir.

Metabolic acidosis is an acid-base disturbance, which is characterized by primary consumption of body buffers and causing decreased blood sodium-bicarbonate level. In this case report we discuss a 16 years-old male with profound metabolic acidosis (PH=6.61) due to hemorrhagic shock resulted by stab wounds.A 16-year-old male was admitted to the emergency department due to stab wounds. When he was seen in the red area, his blood pressure could not be measured with loss of consciousness and no active bleeding. On examination, he had a 3-cm incised wound in the mid posterior thigh. No other organ injuries and wound were observed. Bilateral lower extremity pulses were not detectable. Immediately after his admittance to the operation room, blood gas analysis which was done prior to surgery revealed profound metabolic acidosis (pH: 6.61, PaCO2: 44,5 mmHg, PaO2: 352 mm, HgHCO3: 3,8 mmol/L, SpO2: %97,4 BE: -31 mmol/L, lactate: 20 mmol/l), hematocrit %17, hemoglobine 6 mg/dL and leucocyte 22800 mm3. It was seen that the right superficial femoral artery and right common femoral vein were cut near completely. Femoral artery repaired primarily and femoral vein was repaired by end-to-end anastomosis technique. The patient received 32 NaHCO3 over the next 2 hours with good improvement in his haemodynamic profile. Two hours after the emergency operation, he had a pH 7,24, base excess rate was −10.0 mmol/l and lactate 21 mmol/l. Ten hours later, arterial blood gas values were measured as normal and he was extubated. After seven days recovery period without problem, the patient was eventually discharged from hospital. To our knowledge this is the first reported case of survival after a pH of 6.61 secondary to hemorrhagic shock in our country. Also it should be considered that immediate operative hemostasis and vascular repair may help to patients to survive even at profound metabolic acidosis.

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CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy/Serebral otozomal dominant arteriyopati ile subkortikal enfarktlar ve lökoensefalopati) Notch3 gen mutasyonundan kaynaklanan, bir serebral küçük damar hastalýðýdýr. Baþlýca klinik bulgularý geçici iskemik atak, inme, auralý migren, psikiyatrik semptomlar, erken baþlangýçlý demans ve epileptik nöbetler þeklindedir. CADASIL genç inmenin önemli nedenlerinden biri olarak kabul edilmektedir. Erken yaþlarda ortaya çýkan ve ailesel özellik gösteren serebrovasküler olaylarda ayýrýcý tanýda düþünülmelidir. Etkilenmiþ bireyler tespit edilerek diðer aile üyelerinin de genetik danýþmanlýk almasý saðlanmalýdýr. Bu vaka sunumunda Notch3 gen analiziyle CADASIL tanýsýný doðruladýðýmýz genç iskemik inme ataðý geçiren bir olguyu paylaþtýk.

CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a cerebral small vessel disease caused by mutations in the Notch3 gene. The major clinical manifestations of CADASIL are transient ischemic attack, stroke, migraine with aura, psychiatric symptoms, early onset demantia and epileptic seizures. CADASIL is one of the important causes of stroke in young. CADASIL should be considered in young patients with stroke with a positive family history, thus identification of affected patients would enable family members to seek genetic counselling. In this report, we present a young patient with ischemic stroke that we established the diagnosis of CADASIL by Notch3 gene analysis.

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Diyabetik amyotrofi (DA); sýklýkla Tip 2 diabetes mellitus hastalarýnda görülen, alt ekstremitelerde yanýcý tarzda aðrý ve proksimal kas güçsüzlüðüyle seyreden bir hastalýktýr. Diyabet hastalarýnýn daha yaþlý bir grubunu, sýklýkla 50 yaþ üzerindeki erkekleri etkilemektedir. Nadir görülmesi sebebiyle tanýnmasý zordur ve yanlýþ taný alabilir. Yanlýþ taný gereksiz tetkiklere ve tedavilere, hatta cerrahi giriþimlere neden olabileceðinden alt ekstremitede aðrý ve güçsüzlük þikayetiyle gelen diyabetik hastalarda DA mutlaka akýlda bulundurulmalýdýr. Taný klinik bulgular ve elektrofizyolojik çalýþmalarla konur. Manyetik Rezonans Görüntüleme (MRG) olasý patolojileri dýþlamak için kullanýlabilir. Tedavide sýký glisemik kontrol, aðrýya yönelik medikal tedavi ve fizik tedavi ve rehabilitasyon önemli yer tutar. Çoðunlukla spontan olarak geriler. Bu makalede diz patolojsiyle karýþan bir DA olgusu eþliðinde DA kliniði, tanýsý ve tedavi yöntemleri tartýþýldý.

Diabetic amyotrophy (DA); is a disease of the lower extremity most commonly found in type 2 diabetes mellitus patients, with burning pain and proximal muscle weakness. It affects an older group of diabetics, more frequently males, usually over age 50. Because it is a rare condition, It represents a serious diagnostic challenge and therefore may be misdiagnosed. DA should be kept in mind in diabetic patients with pain and weakness in the lower extremity as misdiagnosis may cause unnecessary examinations and treatments, and even surgery. Diagnosis is based on clinical findings and electrophysiological studies. Magnetic resonance imaging (MRI) may be used to exclude possible pathologies. Tight glycemic control,medical treatment for pain and physical therapy and rehabilitation have an important place in treatment of DA. Its natural course mostly is spontaneous recovery. Herein we report a patient with knee pain finally diagnosed as DA and discuss the clinical features, pathology and management of DA with the review of literature.

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Hipospadias, izole doðumsal anomaliler den olup insidansý 300 erkek çocukta 1 dir. Etiyolojisi tam olarak bilinmemekle birlikte; hormonal, genetik ve çevresel sebeblerden kaynaklandýðý düþünülmektedir. Cerrahi onarýmda çok sayýda teknik tanýmlanmýþ ve modifikasyonlarla birlikte bu sayý 300 civarýndadýr. Cerrahi saðaltým da ektopik mea düzeyine göre flep ya da greftleme yöntemi kullanýlýr, ileri olgularda iki evreli onarým yapýlýr. Ameliyat tekniklerinde ve cerrahideki teknolojik ilerlemeye raðmen hastalýðýn kendine özgü yapýsý nedeniyle bazý olgularda komplikasyonlara rastlanmaktadýr. Bu makalede hipospadias olgularýnýn cerrahisine yaklaþým ve baþarý þansýný artýran faktörler vurgulanmýþtýr.

Hypospadias is one of the most common isolated congenital anomalies in male children which reconstruction performed in pediatric surgery clinics. The incidence of the hypospadias is 1 in 300 male children. Although there is no determined certain etiological factor
for occurrence of the disease; hormonal, environmental and genetic multifactorial reasons are blamed for hypospadias occurrence. Numerous surgical techniques have been published to treat hypospadias including 300 different modifications of surgical repair. Despite numerous advances in operative techniques and suture materials complications can be seen during postoperative followup. To overcome these complication from clinics to clinics some technical differences and preferences related to the graft, flaps, types of stents, dressing, antibiotic use and issue of treatment in one or two steps. With this article, we try to underline and mention the current treatment modalities and factors improving hypospadias surgical outcomes.

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