GÝRÝÞ ve AMAÇ: En az üçüncü derece pelvik organ prolapsusu olan ve Gizli Stres Ýnkontinans tanýsý konulan hastalarda prolapsus cerrahisi sonrasýnda ortaya çýkabilecek stres inkontinanstan korunmak için yapýlacak eþ zamanlý profilaktik antiinkontinans cerrahisinin etkinliðini deðerlendirmek.
YÖNTEM ve GEREÇLER: Ocak 2005-Ocak 2007 tarihleri arasýnda 3.derece ve üzerindeki pelvik organ prolapsusu nedeniyle hastanemize baþvuran ve yapýlan incelemeler sonucunda Gizli Stres Ýnkontinans tanýsý konulan 140 hasta çalýþmamýza dahil edildi. Hastalar iki gruba ayrýldý. Grup 1: Prolapsus cerrahisine ek olarak profilaktik antiinkontinans cerrahisi yapýlan hastalar (n=105) ve Grup 2: Sadece prolapsus cerrahisi yapýlan, antiinkontinans cerrahisi yapýlmayan hastalar (n=35).Hastalarýn hiçbirinde preoperatif inkontinans þikayeti yoktu.Preoperatif
muayenede anamnez,fizik muayene ve ürodinamik incelemeler yapýldý.Prolapsusu redükte edildikten sonra inkontinans varlýðý ürodinamik incelemeylede gösterildi.Postoperatif kontrollerinde stres inkontinans, de novo sýkýþma hissi, iþeme zorluðu ve
rekürren prolapsus açýsýndan deðerlendirildi.
BULGULAR: Ocak 2005-Ocak 2007 tarihleri arasýnda 3.derece ve üzerindeki pelvik organ prolapsusu nedeniyle hastanemize baþvuran ve yapýlan incelemeler sonucunda Gizli Stres Ýnkontinans tanýsý konulan 140 hasta çalýþmamýza dahil edildi. Hastalar iki gruba ayrýldý. Grup 1: Prolapsus cerrahisine ek olarak profilaktik antiinkontinans cerrahisi yapýlan hastalar (n=105) ve Grup 2: Sadece prolapsus cerrahisi yapýlan, antiinkontinans cerrahisi yapýlmayan hastalar (n=35).Hastalarýn hiçbirinde preoperatif inkontinans þikayeti yoktu.Preoperatif
muayenede anamnez,fizik muayene ve ürodinamik incelemeler yapýldý.Prolapsusu redükte edildikten sonra inkontinans varlýðý ürodinamik incelemeylede gösterildi.Postoperatif kontrollerinde stres inkontinans, de novo sýkýþma hissi, iþeme zorluðu ve rekürren prolapsus açýsýndan deðerlendirildi.
TARTIÞMA ve SONUÇ: Ýleri derecede pelvik organ prolapsusu olan hastalar operasyon sonrasýnda ortaya çýkabilecek stres inkontinansý açýsýndan risklidirler. Bu nedenle hastalara prolapsus cerrahisine ek olarak yapýlacak profilaktik antiinkontinans cerrahisi hastalarý önemli bir problemden kurtaracaktýr.

INTRODUCTION: Clinically continent women with severe genitourinary prolapse and occult stress incontinence are considered to be at high risk of developing symptomatic stress incontinence once the prolapse is repaired. We studied the efficacy and safety of prophylactic anti-incontinence surgery in preventing postoperative stres incontinence in these women.
METHODS: One hundred forty consecutive women with stage 3 or higher genitourinary prolapse and occult stres incontinence were enrolled
between January 2005-January 2007. This was a retrospective study that compared women underwent prolapse surgery with prophylactic antiincontinence procedure (Group 1, n=105) and only prolapse surgery (Group 2, n=35). Preoperatively,none of
the women complained of stress incontinence. Preoperative evaluation included history, physical examination and urodynamic assesment. However, all had urodynamically-confirmed occult stres incontinence, revealed by repositioning of the prolapse. The main outcome measures were postoperative stres incontinence,voiding dysfunction, de novo urgency and recurrence of prolapse.
RESULTS: IPatient characteristics and preoperative urodynamic evaluation were similar in two groups. The mean duration of follow-up was 26.5 months and all patients underwent a repeat urodynamic evaluation at 3 months postoperatively.The rate of postoperative voiding disfunction, de novo urgency and recurrent prolapsus 15.2, 9.5, 2.9% in Group 1 and 5.7, 8.6, 5.7% in Group 2, respectively.There was no statistically difference among Group 1 and Group 2 (p>0,05). Nine (%8.6) patients in Group 1 and ten (%28.6) in Group 2 developed postoperative stress incontinence (p<0,05).
DISCUSSION AND CONCLUSION: Prophylactic anti-incontinence procedure(TVT or Burch colposuspension) is effective in preventing postoperative urinary stress incontinence in clinically continent patients who undergo surgery for severe genitourinary prolapse

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GÝRÝÞ ve AMAÇ: Pelvik organ prolapsusu/üriner inkontinans ile iliþkili þikayetlerin kadýnlarýn cinsel fonksiyonuna etkisini araþtýrmak.
YÖNTEM ve GEREÇLER: Bu çalýþmaya 18 yaþ üstü 259 kadýn alýnmýþ, verilerin toplanmasýnda anket formu ve “Pelvik Organ Prolapsusu/ Ýdrar Ýnkontinansý Cinsel Fonksiyon Sorgulamasý” (PISQ-12) ölçeði kullanýlmýþtýr.
BULGULAR: Üriner inkontinans ile iliþkili þikayetlerle (%26.6) gebelikte idrar kaçýrma, ailede idrar kaçýrma, hemoroid, kabýzlýk ve üriner sistem enfeksiyonu arasýnda anlamlý iliþki bulunmuþtur (p<0,05). Sistosel ve uterus prolapsusu ile iliþkili þikayetlerin oraný sýrasýyla %8.1 ve %3.5’tir. PISQ-12 ölçeði ortalama toplam puaný 14,36±6,64’tür. Sistosel ile iliþkili þikayetlerle eðitim düzeyi, doðum sayýsý, 24 saatten uzun süren doðum süresi, hemoroid, kabýzlýk, düþük, kürtaj ve jinekolojik ameliyat geçirme arasýnda anlamlý iliþki saptanmýþtýr (p<0,05). Uterus prolapsusu ile iliþkili þikayetlerle doðum sayýsý, eðitim düzeyi ve kabýzlýk arasýnda anlamlý iliþki bulunmuþtur (p<0,05).
TARTIÞMA ve SONUÇ: Bu çalýþmada, üriner inkontinans, sistosel ve uterus prolapsusu ile iliþkili þikayetlerle anlamlý iliþkisi olan özelliklerin kadýnlarda cinsel fonksiyonlarý etkilediði görülmüþtür.

INTRODUCTION: To determine the effect of pelvic organ prolapse/urinary incontinence associated complaints on the sexual function of women.
METHODS: 259 women completed a questionnaire and the “Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire” (PISQ-12)
scale.
RESULTS: The percentage of urinary incontinence associated complaints was 26.6% and they were significantly related with urinary incontinence
during the pregnancy, family history of incontinence, hemorrhoids, constipation, and urinary tract infection (p<0,05). The percentages of complaints associated with cystocele and uterine prolapse were 8,1 and 3,5 % respectively. The mean total score of PISQ-12 was 14,36 ± 6,64. Educational level, the number of births, duration of longer than 24 hours of birth, hemorrhoids, constipation, miscarriage, abortion and gynecological surgery were significantly related with cystocele associated complaints (p <0,05). Whereas the number of birth, the educational level, and constipation were found significantly related to uterine prolapse associated complaints (p <0,05).
DISCUSSION AND CONCLUSION: Urinary incontinence associated complaints significantly affect sexual function particularly in women between cystocele and uterine prolapse associated complaints.

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Konjenital klor diyaresi sýklýðý 1/10000 ve 1/40000 arasýnda deðiþen ve otozomal resesif yolla kalýtýlan bir hastalýktýr. Yenidoðan döneminde yüksek konsantrasyonda klor içeren bol miktarda sulu diyare, dehidratasyon, hipokloremi, hiponatremi, hipokalemi ve metabolik alkaloz ile ortaya çýkar. Ultrasonografik incelemede baðýrsak anslarýnda yaygýn dilatasyon ve aðýr polihidramniyos görülmesiyle prenatal tanýsý mümkündür, ancak ayný bulgularýn konjenital baðýrsak obstrüksiyonunda da görülüyor olmasý yanlýþ tanýya ve gereksiz operasyonlara yol açabilmektedir. Medikal yolla tedavisi mümkün olan bu hastalýðýn ayýrýcý tanýsý hem prenatal danýþmanlýkta hem de postnatal yönetimde çok önemli bir yer tutmaktadýr. Bu olgu sunumunda bir konjenital klor diyaresi olgusunun prenatal ultrason bulgularýný sunmakta ve bu hastalýðýn ayýrýcý tanýsýný tartýþmaktayýz.

Congenital chloride diarrhea is an autosomal recessive disease with an incidence ranging from 1/10000 to 1/40000. In the neonatal period, it presents with profuse watery diarrhea with high chloride concentration, dehydration, hypochloremia, hyponatremia, hypokalemia and metabolic alkalosis. Its prenatal diagnosis is possible by ultrasonographic examination which reveals generalized intestinal dilatation and polyhydramnios, however, these findings also indicates congenital intestinal obstruction resulting in misdiagnosis and unnecessary operations. The differential diagnosis of this medically treatable disease is essential for both prenatal counseling and postnatal management. In this case report, we present ultrasonographic findings of a case of congenital chloride diarrhea and discuss the differential diagnosis of this disease.

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GÝRÝÞ ve AMAÇ: Dengesiz beslenme ve azalmýþ fiziksel aktivite bütün ülkelerde obezite sýklýðýný arttýrmaktadýr. Obezitenin ileride daha büyük bir halk
saðlýðý problem olacaðý tahmin edilmektedir. Bu çalýþmanýn amacý, yaþamýn erken döneminde insulin direncini tespit edip, obezitenin muhtemel komplikasyonlarýný önlemektir.
YÖNTEM ve GEREÇLER: Mart 2011 – Ekim 2011 tarihleri arasýnda Haydarpaþa Numune Eðitim Araþtýrma Hastanesi Çocuk Polikliniðine baþvuran çocuklar randomize olarak seçilmiþ ve antropometrik ölçümleri yapýlarak, obez ve obez olmayanlar olarak sýnýflandýrýlmýþtýr. Çocuklardan insulin, HDL, LDL, trigliserid ve kolesterol deðerleri ölçülmesi için açlýk kan örneði alýnmýþtýr. Hesaplanan HOMA – IR deðerinin 2,5 ve üzeri deðerler insulin direnci olarak kabul edilmiþtir.
BULGULAR: Çalýþmaya katýlan 107 çocuðun %47’si erkek, %53’ü kýz idi. %61,7’si obez, %38,3’ü obez deðildi. Hipertansiyon sýklýðýnýn %19,1 (n=21) olarak tespit ettik. Bununla birlikte, özellikle kolesterol ve trigliserid deðerleri ile HOMA – IR yüksekliði arasýnda pozitif korelasyon tespit edilmiþtir. WHO kriterlerine göre 107 katýlýmcýnýn 24 tanesinde metabolik sendrom tespit edildi. Homa – Ir yüksekliði ile metabolic sendrom arasýndaki iliþki deðerlendirildiðinde, metabolic sendrom tanýsý alan çocuklarýn %70,8’inde Homa –ýr deðeri 2,5 üzeri tespit edilmiþtir.
TARTIÞMA ve SONUÇ: Dünya genelinde obezite önemli bir halk saðlýðý sorunudur. Eriþkinlerde olduðu gibi, çocukluk çaðýnda görülen obezite, hipertansiyon, trigliserid yüksekliði, HDL düþüklüðü ve bozulmuþ glukoz toleransý gibi kardiyovasküler risk faktörlerinin sýklýðýný arttýrmaktadýr. Bu nedenden dolayý, geliþmekte olan ülkelerde dahi önemli bir halk saðlýðý problemidir. Bu problemlemin en önemli çözümü obezitenin önlenmesi olup buna yönelik önemli stratejiler geliþtirilmelidir.

INTRODUCTION: As a result of unbalanced nutrition and lack of physical activity, the prevalence of obesity is increasing in all countries. In the future, it is expected to be greater public health problem. The purpose of these studies is to demonstrate the insulin resistance in earlier period of life to avoid possible complications of obesity.
METHODS: We selected randomly children who admitted to Haydarpaþa Numune Training and Research Hospital Department of Pediatrics between March 2011 and October 2011. The anthropometrical measures were assessed and classified as obese and non-obese children. Fasting blood sample was obtained to measure insulin, HDL, LDL, triglyceride and cholesterol serum level. HOMA-IR indexes was calculated and HOMA –IR value above 2,5 was accepted as insulin resistance.
RESULTS: In the study population, we examined 107 children and 47% of the children were male and 53% female. 61, 7% of children were obese and 38, 3% were non-obese. Hypertension were detected in 19,6 % (n=21) of children. There was a positive correlation between HOMA – IR level and total cholesterol and triglycerides levels (r=0.1). According to WHO criteria, we detected metabolic syndrome in 24 of 107 subjects When we looked at the relation between insulin resistance and metabolic syndrome, 70,8% of children with metabolic syndrome had Homa –ýr value above 2,5.
DISCUSSION AND CONCLUSION: Obesity is a significant public health problem in worldwide. As in adulthood, childhood onset obesity contributes to an increased prevalence of cardiovascular risk factors. Therefore obesity is an alarming problem of public health even for developing countries. The prevention of the obesity is the most important solution so particular strategies should be developed by the states to prevent obesity.

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Miyokardiyal nonkompaction endokard ve myokardýn normal embriyogenezisin duraklamasý sonucu oluþan genetik primer kardiyomyopatidir. Otuzbeþ haftalýk erkek olgunun intrauterin AV blok ve bradikardi tanýsý vardý. 1. dakikada APGAR skoru 4’tü. Doðum odasýnda bradikardisi nedeni ile resusite edildi. Geliþ EKG’sinde mobitz tip 2 av blok saptandý. Çekilen EKO’da nonkompaction kardiyomyopati saptandý. Ýzleminde 02 ihtiyacý gerileyen, inotrop desteði olmayan, aritmisi aralýklý devam eden hasta kardiyoloji polikliniðine baðlanarak taburcu edildi. Biz bu olgu sunumunda hidrosp fetalis ve mobitz tip 2 atrioventriküler blok ile prezente olan biventriküler nonkompaction tanýsý alan hastayý sunmayý amaçladýk.

Myocardial nonkompaction is a genetic primary cardiomyopathy whých develops as a result of the arrest of normal embroyogenesis of the endocardium and myocardium. A thirty-five-week old male newborn has the intrauterine diagnosis of AV block and bradycardia. The APGAR score was 4 points at 1 minute after birth. He was resuscitated at the delivery room because of bradycardia. The ECG on admission showed mobitz type 2 AV block. An echocardiography showed biventricular noncompaction cardiomyopathy. At the follow-up the patient without O2 need and inotropic support with ongoing intermittent arrhythmia, connected to the cardiology outpatient clinic. In this case report we aimed to present the patient with a dignosis of bi-ventricular noncompaction cardiomyopathy presenting with mobitz type 2 atrioventricular block and hidrosp fetalis.

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GÝRÝÞ ve AMAÇ: Nekrotizan enterokolit (NEK), yenidoðan yoðun bakým ünitelerinde mortalite ile morbiditenin önde gelen sebeplerindendir. Çalýþmamýzda
NEK tanýsýyla kliniðimizde opere edilmiþ olgularýn, seçilen cerrahi yönteme göre morbidite ve mortalitelerini karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2006-Ocak 2011 yýllarý arasýnda, Bell Evre IIb ve üzeri NEK tanýsý konulan ve cerrahi müdahale yapýlan 34’ü erkek, 39’u kýz olmak üzere toplam 73 yenidoðanda ileriye dönük olarak yapýlan bu çalýþmada olgular; trombosit düzeyi düþük, dolaþýmý bozulmuþ ve idrar çýkýþý azalmýþ olmasý dolayýsýyla lokal anestezi ile drenaj sonrasý geç opere edilmesi planlanan olgular (A Grubu, n=37), genel anestezi ile doðrudan laparotomi yapýlan olgular (B Grubu, n=36) olarak iki gruba ayýrýldý. Olgularýn uygulanan takip ve tedavi þekline göre morbidite ve mortalite oranlarý karþýlaþtýrýldý
BULGULAR: A grubundaki olgularýn, ortalama aðýrlýklarý 1597 gr (616gr-3400 gr), ortalama gestasyonel yaþlarý 29,7 hafta (24-40 hf ), ve saðkalým
oraný %38 (n=14) olarak saptandý. Olgulardan 7’si drenajdan sonra opere edilemeden kaybedildi, bir olgu opere edilmeden þifa ile taburcu edildi. B grubundaki olgular sývý ve elektrolit replasmanlarý sonrasý doðrudan opere edildiler. Bu grupta olgularýn ortalama aðýrlýklarý 1448 gr (390gr-3500gr), ortalama gestasyonel yaþlarý 30.5 hafta (23-40 hafta), ve saðkalým oraný %69 (n=25) olarak saptandý.
TARTIÞMA ve SONUÇ: Çalýþmamýzda erken drenaj sonrasý cerrahi tedavi ve doðrudan cerrahi yapýlan olgularýn ortalama gestasyonel yaþlarý ve doðum aðýrlýklarý benzer olmasýna raðmen, drenaj sonrasý cerrahi yapýlan olgularýn mortalite oranlarýnýn daha yüksek olduðu saptandý. NEK olgularýnýn cerrahi endikasyon konulduktan sonra gecikmeden opere edilmesi gerektiði; ancak genel durumu bozuk olgularda cerrahi operasyona hazýrlýk ve zaman kazanmak açýsýndan lokal drenaj yapýlmasýnýn,saðkalým oranlarý üzerinde olumlu etkisi olabileceði düþünülmektedir

INTRODUCTION: Necrotizing enterocolitis (NEC) is one of the major causes of morbidity and mortality in premature and/or newborn intensive care units. The aim of this study was to compare the mortality rates of operated NEC cases according to the surgical method at our institution.
METHODS: 73 cases (34 male, 39 female) operated at our institution between January 2006 and January 2011, were divided into two main groups. Group A (n=37); penrose-drain placement with local-anesthesia, abdominal irrigation, late abdominal exploration, Group B (n=36); early abdominal exploration. Results were reviewed prospectively. Mortality rates were determined according to the surgical approach.
RESULTS: In group A, cases which showing clinical improvement were operated. Of the 37 cases, 7 cases died before abdominal exploration, 1 case survived without operation. Mean birth weight was 1597 gr (616gr-3400gr), mean gestational age was 29,7 weeks (24-40 weeks), and survival rate was 38% (n=14) in group A. In group B, all cases were operated in early period after having fluid and electrolyte resuscitation. Mean birth weight was 1448 g (390g-3500g), mean gestational age was 30.5 weeks (23-40 weeks), and survival rate was 69% (n=25) in group B.
DISCUSSION AND CONCLUSION: In our study, mean birth weights and mean gestational ages were similar in both group A and B. However, mortality rates were high in group A. In Grade 2b and more NEC cases, early surgical intervention when the diagnosis has been established is advisable. However, in cases with severe NEC, abdominal drainage to and delayed surgery may improve survival rates.

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GÝRÝÞ ve AMAÇ:
YÖNTEM ve GEREÇLER:
BULGULAR:
TARTIÞMA ve SONUÇ:

INTRODUCTION: Sacrococcygeal teratoma is a rare condition (1: 35.000-40.000 for the newborn). We report single-center experiences about it focusing on functional sequelae.
METHODS: From December 1997 to November 2007, 2 boys and 14 girls were treated in our department for Sacrococcygeal teratoma. Their hospital records were analysed retrospectively. Only 12 of these cases were evaluated prospectively, the others were not assessed because they were not available for follow-up. They were evaluated by a physical exam, an uroflowmetry- EMG and cystometry. A questionnaire was administered about bowel and voiding habits.
RESULTS: 9 out of 12 were operated at an average age of 8.4 days and were diagnosed in the neonatal period, their histopathology proving benign. Tumor manifestation occurred in 2 months, 11 months and 19 months of age in the remaining 3 children. Histopathology was mature in 8, immature in 3, malignant in 1 case. Surgery comprised tumor excision with coccygectomy. The child with the malignant tumor received chemotherapy after colostomy. During follow-up AFP levels were normal for all patients. None of children had reccurrences. Overall survival rate was 100%. 5 children had voiding dysfunction. 3 children was voiding in urgency and also squatting down. 3 children had been reported for enuresis nocturna and 1 for enuresis diurna. Functional bladder capacity was low in 2 cases. One patient with a high functional bladder capacity had strained and interrupted voiding. Abnormal EMG potentials were observed in 4 patients. Detrussor instability was seen in 3 children. None of children had anal stenosis and fecal soiling, 4 had constipation. Satisfaction levels of parents about operation cavity and scar of their children were found 5 out of 12 null, 4 medium and 3 mildly high.
DISCUSSION AND CONCLUSION: Follow-up after surgery for SCT should include a careful examination of voiding and anorectal dysfunctions because of neuorourological and/or anorectal dysfunction. Detailed information about cosmetic reconstruction after teen age should be made available to the parents.

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