GÝRÝÞ ve AMAÇ: Diffüz büyük B-hücreli lenfoma (DBBHL) ve Burkitt lenfoma (BL), klinik, morfolojik, immünfenotipik ve sitogenetik özellikleri açýsýndan heterojen özellik gösteren matür agresif B hücreli lenfomalardýr ve oldukça deðiþken klinik seyir gösterirler. Bu çalýþmada DBBHL ve BL’da görülen immünhistokimyasal ve sitogenetik özellikler ve bunlarýn prognoz ile iliþkileri araþtýrýlmýþ ve DBBHL ile BL ayrýmýnda kullanýlabilecek özellikler tanýmlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya Gazi Üniversitesi Týp Fakültesi Patoloji Ana bilim dalýnda 2000-2007 yýllarý arasýnda taný alan 45 DBBHL ve 11 BL olmak üzere toplam 56 olgu dahil edildi. Olgulara immünhistokimyasal olarak bcl-2, bcl-6, CD10, MUM-1 ve Ki-67 antikorlarý uygulandý ve fluoresan in situ hibridizasyon yöntemi ile c-myc amplifikasyonu, PTEN delesyonu ve t(14;18) translokasyonu deðerlendirildi.
BULGULAR: DBBHL olgularýnda bcl-2, bcl-6 ve CD 10 ekspresyonu sýrasýyla %55.6, %35.6 ve %25.8 oranýnda olup, BL olgularýnýn ise tümü bcl-2 negatif olup, bcl-6 ve CD 10 pozitif saptandý. Ki-67 proliferasyon indeksi ise DBBHL’da ortalama %63.2 iken, BL’da ortalama %97.2’dir (p=0.001). BL olgularýnda c-myc amplifikasyonu %80 oranýnda görülmüþ olup, DBBHL’da %43.7 oranýndadýr (p<0.05). t (14;18) ve PTEN delesyonu, DBBHL’da sýrasýyla %7.7 ve %26.7 iken, BL’da %20 ve % 9.1 oranýnda görülmüþtür (p>0.05).
TARTIÞMA ve SONUÇ: DBBHL ile BL ayrýmýnda immünhistokimyasal olarak CD10, Bcl-6, Bcl-2 ve Ki-67 panelinin uygulanmasý yararlý bir yöntemdir. Ki-67 proliferasyon indeksinin %95’in üzerinde olmasý da BL tanýsý için oldukça faydalýdýr. C-myc amplifikasyonu özellikle BL olgularýnda yüksek oranda saptanmakla birlikte, DBBHL olgularýnda da düþük oranda da olsa görülebilir. DBBHL ve BL ayýrýmýnda t(14,18) ve PTEN delesyonu açýsýndan anlamlý fark saptanmamýþtýr.

INTRODUCTION: Diffuse large B cell lymphoma (DLBCL) and Burkitt lymphoma (BL) are mature agressive B cell lymphomas that have heterogeneous clinical, morphological, immunofenotypical and cytogenetic features, and have widely different clinical course. In this study, the immunohistochemical and cytogenetic features seen in DLBCL and BL and the association between the prognosis are studied. Also the characteristics that can be used to differentiate DLBCL and BL is defined.
METHODS: Totally 56 cases (45 DLBCL and 11 BL), which were diagnosed in Gazi University, Medical School, Department of Pathology between 2000 and 2007 were included to study. Bcl-2, bcl-6, CD10, MUM-1 and Ki-67 antibodies were performed immunohistochemically and c-myc amplification, PTEN deletion and t(14;18) translocation was evaluated by fluorescent in situ hybridization.
RESULTS: The expression of bcl-2, bcl-6 and CD 10 were 55.6%, 35.6% and 25.8% respectively in DLBCL cases. In the cases of BL, all the cases were bcl-2 negative, bcl-6 and CD 10 positive. While the proliferation index of Ki-67 were 63.2% in DLBCL, it was 97.2% in BL (p=0.001). The ratio of c-myc amplification was 80% in BL and 43.7% in DLBCL (p<0.05). The ratio of t(14;18) translocation and PTEN deletion was 7.7% and 26.7% in DLBCL, while it was 20% and 9.1% in BL (p>0.05).
DISCUSSION AND CONCLUSION: The usage of immunohistochemical panel, including CD 10, bcl-6, bcl-2 and Ki-67 to differentiate between DLBCL and BL is absolutely beneficial. Also Ki-67 proliferation index higher than 95% is helpful for the diagnosis of BL. Altough c-myc amplification is highly detected in BL cases, it can be seen in DLBCL slightly. No statistically significant association was detected in t(14;18) and PTEN deletion between the distinction of DLBCL and BL.

GÝRÝÞ ve AMAÇ: Bu çalýþmada, omuz cerrahisi uygulanmýþ vakalarda ultrasonografi yardýmýyla gerçekleþtirilen interskalen brakial pleksus bloðunda, 2 farklý düþük volümde lokal anestezik kullanýmýnýn postoperatif analjezi üzerine etkilerinin, intravenöz tramadol analjezisiyle karþýlaþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Hastanemiz Etik Kurul onayý (2013-4/52) alýnarak, ASA I-III, 18-80 yaþ arasý omuz cerrahisi uygulanacak 69 hasta çalýþmaya alýndý ve rastgele 3 gruba ayrýldý: Grup I; 3ml % 0.5 bupivakain, 2 ml prilokain toplam 5 ml, Grup II: 3 ml % 0.5 bupivakain, 2 ml prilokain ile 5 ml salin toplam 10 ml., Grup III 2 mg/kg tramadol intravenöz aldý. Ýnterskalen sinir bloðu, genel anestezi altýnda ultrasonografi ve periferik sinir stimülatörü yardýmýyla uygulandý. Blok baþlama ve derlenme zamanlarý, gruplarýn aðrý skorlarý, ilk analjezik gereksinim zamanlarý ve tüketilen total analjezik miktarlarý gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Sensoryal ve motor blok baþlama zamaný, yüksek volüm kullanýlan grupta (Grup II) daha kýsaydý (sensoryal; 5.54/8.54 dakika, motor; 8.30/11.00 dakika). Sensoryal ve motor blok sonlanma süreleri, yüksek volüm kullanýlan grupta anlamlý olarak uzundu. (Grup I/ Grup II: 399.50/288.00 ve 424.00/330.50 dakika). Ýlk analjezik gereksinim zamaný intravenöz analjezi grubunda diðer gruplara göre anlamlý olarak daha kýsaydý. (Grup I; 6.86±0.40, Grup II; 7.06±0.52, Grup III;3.25±0.40 saat, p<0,05). Total analjezik tüketimi de Grup III’de anlamlý yüksekti. Tüm deðerlendirme zamanlarýnda aðrý skoru ortalamalarý, blok yapýlan gruplarda, intravenöz tedavi grubuna göre anlamlý olarak düþüktü.
TARTIÞMA ve SONUÇ: Düþük volümlü lokal anestezikle uygulanan interskalen sinir bloðu, yüksek volümle uygulanan blok ile benzer þekilde, intravenöz analjezi grubuna göre aðrý skorlarý, ek analjezik gereksinim zamaný ve total analjezik tüketimi bakýmýndan üstün bulunmuþtur. Düþük volümle ultrasonografi eþliðinde yapýlan interskalen sinir bloðu ile yeterli blok baþarýsýnýn elde edilebileceðini ve tüketilen analjezik miktarýnýn azalabileceðini düþünüyoruz.

INTRODUCTION: The aim of this study was to compare the postoperative analgesic effects of 2 different low volumes of local anesthetics used in interscalene nerve block with intravenous tramadol analgesia in patients underwent shoulder surgery.
METHODS: After approval of Hospital Ethics Committee (2013-4/52), 69 patients who were ASA I-III, 18-80 years old and scheduled for shoulder surgery were included in the study and randomly divided into 3 groups: Group I received 3 ml 0.5% bupivacaine, 2 ml prilocaine, total is 5 ml, Group II: 3ml 0.5% bupivacaine, 2ml prilocaine and 5ml saline total is 10ml and Group III 2 mg/kg tramadol intravenously. The interscalene nerve block was applied under general anesthesia using USG and peripheral nerve stimulator. Onset of block and recovery times, pain scores of the groups, first analgesic requirement times and total amount of analgesic consumed were compared between the groups.
RESULTS: The time for sensory and motor block onset were shorter in the high-volume group (Group II) (Sensory; 5.54 / 8.54, motor; 8.30 / 11.00 min). Sensory and motor block termination times were significantly longer in Group II (GroupI / GroupII: 399.50/288.00, 424.00/330.50 minutes). The first analgesic requirement times were significantly shorter in the intravenous tramadol group (Group I; 6.86±0.40, Grup II; 7.06±0.52, GrupIII;3.25±0.40 hour, p<0,05). Total analgesic consumption was also significantly higher in Group III. The mean pain scores were significantly lower in the block groups than the intravenous treatment group at all assessment times.
DISCUSSION AND CONCLUSION: Interscalene nerve block applied with low volume local anesthetics was found to be superior to intravenous analgesia group, similar to high volume, in terms of pain scores, additional analgesic requirement time, and total analgesic consumption. We think that adequate block success can be achieved in the interscalene nerve block performed with ultrasonography using low volume and the amount of analgesic consumption can be reduced.

GÝRÝÞ ve AMAÇ: Mide kanseri olan hastalarda ameliyat öncesi evrelendirme cerrahi tedavi için gereklidir. Ancak ameliyat öncesi lenf nodu (LN) deðerlendirilmesinde tek baþýna yeterli olabilecek bir test bulunmamaktadýr. Bu çalýþmanýn amacý mide kanseri olan hastalarda, ameliyat öncesi LN tutulumunun deðerlendirilmesinde pozitron emisyon tomografisi (PET/BT) ile bilgisayarlý tomografinin (BT) tanýsal deðerlerinin karþýlaþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Geriye dönük olarak gastrektomi ve D2 LN diseksiyonu ameliyatý olan seksen yedi hastanýn deðerlendirlmesidir. Görüntüleme yöntemleri ve patoloji raporlarý hasta dosyalarýnda toplandý.
BULGULAR: PET/BT ile BT arasýnda mide kanseri olan hastalarda LN tutulumun kestirim gücü arasýnda anlamlý bir fark bulunmadý (p>0.05). PET/BT’nin LN nodunu öngerme duyarlýlýðý, özgüllüðü, pozitif kestirim deðeri (PKD) ve negatif kestirim deðeri (NKD) ile doðruluk deðeri %55.56, %54.55, %55.26, %75 ve %33.3 olarak hesaplanýrken BT için % 57.69, %59.42, %70.27, and %46.88 olarak bulundu. Ancak, hem PET/BT ve BT birlikte kullanýldýðýnda ameliyat öncesi mide kanseri olan hastalardaki LN metastazý belirlemede özgüllük PKD % 80 ve % 88.9 olarak bulundu. Sonuçlarýmýza göre hastaya veya tümöre ait herhangi bir özelliðin PET/BT veya BT’nin LN metastazý öngörme gücü üzerinde etkisi görülmedi.
TARTIÞMA ve SONUÇ: PET/BT ve BT’nin birlikte kullanýlmasý özgüllüðü ve PKD’ni arttýrmaktadýr. Bu artýþ, mide kanseri olan hastalarýnda ameliyat öncesi LN metastazý belirmede doðruluk deðerini her iki testin ayrý ayrý kullanýlmasýnda daha yüksektir.

INTRODUCTION: Preoperative evaluation is necessary for the surgical treatment of gastric cancer (GC). Nonetheless, there is no single best diagnostic modality to predict lymph node metastases prior to surgery. The aim of this study was to analyze of the diagnostic utility of positron emission tomography-computed tomography (PET-CT) and CT for the preoperative evaluation of lymph node (LN) metastases in GC.
METHODS: Eighty seven patients with a history of GC, who underwent gastrectomy and D2 LN dissection were investigated. Imaging test results and pathology reports were collected from the patients’ charts.
RESULTS: There was no statistical differences between PET/CT and CT scans in regard to predicting LN metastases in GC patients (p>0.05). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT scans in predicting LN metastases were 55.56%, 54.55%, 55.26%, 75%, and 33.3%, respectively, versus 60.47%, 57.69%, 59.42%, 70.27%, and 46.88% for CT scans, respectively. However, combined PET/CT and CT showed better outcomes and specificity with a PPV of 80% and 88.9%, respectively. No patients or tumor factors were found to increase the accuracy of LN metastasis prediction using either PET/CT or CT scans.
DISCUSSION AND CONCLUSION: The combination of CT and PET/CT scans increases the specificity and PPV. This increases the prediction accuracy of LN metastasis in GC patients compared to the use of each type of imaging modality alone.

GÝRÝÞ ve AMAÇ: Malign kemik tümörleri cerrahisi sonrasý oluþan defektlerin giderilmesinde farklý rekonstrüksiyon yöntemleri kullanýlabilir. Bu çalýþmada primer malign kemik tümörleri cerrahisi sonrasý kemik defektlerinin biyolojik rekonstrüksiyon yöntemi ile tedavisini ve fonksiyonel sonuçlarýmýzý deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: 2003-2017 yýllarý arasý primer malign kemik tümörü nedeniyle biyolojik rekonstrüksiyon uygulanan 24 hasta çalýþmaya alýndý. Hastalarýn 11’i Ewing sarkom, 8’i osteosarkom, 2‘si malign dev hücreli tümör, 2’si kondrosarkom ve 1’i fibrosarkom tanýlý idi. 18 olguda otogreftleme,1 olguda adjuvan sývý nitrojen sonrasý otogreftleme ve 5 olguda distraksiyon osteogenezisi ile kemik transportu yöntemi kullanýldý.
BULGULAR: Hastalarýn 14’ü erkek,10’u kadýn olup ortalama yaþ 18.6(5-42), takip süresi 41.4 ay (10-78 ay) ve rezeksiyon sonrasý ortalama kemik defekti 10.7cm idi (4-22). Ortalama MSTS skorlarý kemik transportuyla rekonstrükte edilenlerde 77.3 ve otogreft uygulananlarda 74.5 olarak bulundu. Ortalama DASH skoru 2.29(2.0-2.65), Knee Society ortalama diz skorlarý 72.4(60-89) ve fonksiyon skorlarý 76.2 (65-91)idi. Avasküler fibuler greft uygulanan hastalardan 3’ünde kaynamama (%17.6),1’inde greft fraktürü görüldü. Hiçbir hastada nörovasküler komplikasyon görülmedi.3 hastada pin dibi enfeksiyonu görüldü.
TARTIÞMA ve SONUÇ: Ekstremite koruyucu cerrahi uygulanýrken primer tümörün takip ve tedavisini etkileyecek rekonstrüksiyonlardan kaçýnýlmalýdýr.Yaþlý,yüksek gradeli tümörü olan, tedavi kooperasyonu olmayan hastalarda modüler endoprotezlerle rekonstrüksiyon ilk tedavi seçeneðidir.Ancak kemik geliþimi tamamlanmamýþ,yaþam beklentisi uzun ve kooperasyonu tam hastalarda biyolojik rekonstrüksiyon;kaynamama,greft komplikasyonlarý ve uzun tedavi süreçleri gibi zorluklara raðmen canlý kemik dokusuyla rejenarasyon saðlamasý bakýmýndan ön plana çýkmaktadýr.Yakýn gelecekte kaynamayý ve greft hipertrofisini arttýrýcý,komplikasyonlarý azaltýcý adjuvan faktörlerin kullanýma girmesi ile biyolojik rekonstrüksiyon yöntemlerinin kullanýmýnýn artacaðýný düþünmekteyiz.

INTRODUCTION: There may be several reconstruction methods in order to eliminate the defects developed after the surgery of malignant bone tumors. In this study, we aimed to evaluate our functional results in the treatment of bone defects by biological reconstruction method after primary malign bone tumor surgery.
METHODS: Between 2003-2017 years,24 patients with primary malignant bone tumors undergone biological reconstruction were included into study.11 of the patients had Ewing’s sarcoma,8 of them had osteosarcoma,2 of them had malignant giant cell tumor,2 of them had chondrosarcoma and 1 of them had fibrosarcoma. Autografting were applied in 18 cases, autografting after liquid nitrogen in 1 case and bone transport after distraction osteogenesis were applied in 5 cases.
RESULTS: 14 of the patients were male,10 of them were female. The mean age was 18.6(5-42), follow-up period was 41.4 months (10-78) and bony defect was 10.7 cm (4-22). Mean MSTS scores was 77.3 reconstructed with bone transport and 74.5 undergone autografting. DASH score was 2.29(2.0-2.65), knee Society scores were 72.4(60-89) and the functional scores were 76.2 (65-91). There were nonunion in 3 cases undergone avascular fibulare grafting (%17.6) and 1 graft fracture. No neurovascular complication in any of the patients.Pin-tract infection was observed in 3 patients.
DISCUSSION AND CONCLUSION: One must avoid reconstructions that may affect the follow-up and treatment of the primary tumor when applying extremity-sparing surgery.Reconstruction with endoprosthesis must be the first-line option in the patients who are old,has high-grade tumor and has not treatment cooperation.On the other hand, for the patients with long survey with cooperation and ongoing bone development, biological reconstruction comes into prominence in terms of its regeneration providing nature with live bone tissue despite the shortcomings like nonunion, graft fracture and long treatment periods.In near future, we expect an increase in the use of biological reconstruction methods as some adjuvant factors that are facilitating union,graft hypertrophy and decreasing complications put into use.

GÝRÝÞ ve AMAÇ: Matür kistik teratom olgularýnýn tümör karakteristikleri, tümör belirteçleri, preoperatif, intraoperatif özellikleri ve cerrahi tedavileri açýsýndan retrospektif olarak deðerlendirilmesi
YÖNTEM ve GEREÇLER: SBÜ Dr.AY. Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi Kadýn hastalýklarý kliniðinde opere edilen ve histopatolojik olarak ovaryan matür kistik teratom tanýsý alan toplam 96 olgu retrospektif olarak analiz edildi.
BULGULAR: Olgularýn yaþ ortalamasý 33,84±13,16, bilateralite oraný %9,4, torsiyon görülme oraný %10,4 idi, ortalama tümör boyutu 7,67±3,81cm (2-21 cm) idi. CA 125 olgularýn %10,6'sýnda, Ca 19-9 ise %27'sinde yüksek bulundu. Tümör belirteçlerinin yüksek olduðu olgularda torsiyon, bilateralite ve tümör boyutlarýnda anlamlý yükseklik gözlenmedi.
TARTIÞMA ve SONUÇ: Tümör belirteçlerinin tümör özelliklerinden bilateralite, torsiyon ve tümör boyutu üzerine etkisi gözlenmedi.

INTRODUCTION: The aim of the study is to evaluate tumor characteristics, tumor markers, preoperative, intraoperative approach in ovarian mature cystic teratomas. retrospectively.
METHODS: A total 96 cases operated in Gynecology Deparment of SBU Dr.AY Ankara Oncology Education and Research Hospital and diagnosed as ovarian mature cystic teratomas were evaluated, retrospectively.
RESULTS: The mean age was 33,84±13,16, bilaterality range was %9,4, torsion rate was %10,4 and the mean tumor diameter was 7,67±3,81cm (2-21 cm). Ca125 levels were high above the cut-off value 10,6% of cases and Ca 19-9 levels were high above the cut-off value in 27%. There were no high rates of torsion, bilateralty and tumor size in cases with high levels of tumor markers.
DISCUSSION AND CONCLUSION: There were no correlation between high levels of tumor markers and torsion, bilaterality and tumor size.

GÝRÝÞ ve AMAÇ: Sunulan çalýþmada, vücut yüzeyi tarama sistemi kullanýlarak akciðer ve meme kanseri hastalarýnýn pozisyonlanmasý gerçekleþtirildi. CBCT çekim sonuçlarý 12 hasta için 200 fraksiyon süresince karþýlaþtýrýldý ve tedavi esnasýnda intra-fraction hasta hareketleri incelendi.
YÖNTEM ve GEREÇLER: 3.0 mm kesit aralýklý CT görüntüleri kullanýlarak akciðer hastalarýnýn radyoterapi tedavi planlamasý VMAT, meme kanseri hastalarýnýn ise IMRT yöntemi ile gerçekleþtirildi. Referans görüntüler ile 200 fraksiyon süresince tedavi odasýnda hastalarýn pozisyonlanmasý C-RAD vücut yüzeyi tarama sistemi ile gerçekleþtirilerek masa kaydýrmalarý yapýldý, ardýndan hastalarýn CBCT çekimleri gerçekleþtirildi. Vücut yüzeyi takip sistemi ve CBCT sonucunda elde edilen korelasyon belirlendi. Tedavi esnasýnda hastalarýn vücut yüzeyi takip edilerek intra-fraction hareketleri her hasta için elde edildi.
BULGULAR: CBCT çekimi sonucunda elde edilen masa kaydýrma deðerleri 87 fraksiyonda 7 akciðer kanseri hastasý için lateral yönde 0,22±0,08 cm, longitidunial yönde 0,28±0,08 cm ve vertikal yönde 0,30±0,10 cm olarak elde edildi. 5 Meme kanseri hastasý için 113 fraksiyonda karþýlaþtýrma sonucunda lateral yönde 0,22±0,06 cm, longitidunial yönde 0,25±0,03 cm ve vertikal yönde 0,21±0,08 cm olarak elde edildi. Tedavi süresince 7 akciðer kanseri hastasýnda meydana gelen intra-fraction hareketi 0-1dk. aralýðýnda 0,7±0,4mm, 1-2dk. aralýðýnda 1,5±0,5mm, 2-3dk. aralýðýnda 2,4±0,7mm, 3-4dk. aralýðýnda 3,1±0,6mm, 4-5dk. aralýðýnda 3,7±0,9mm ve 5-6dk. aralýðýnda 4,1±1,4mm olarak belirlendi.5 meme kanseri hastasýnda meydana gelen intra-fraction hareketi ise 0-1dk. aralýðýnda 0,6±0,1mm, 1-2dk. aralýðýnda 1,6±0,2 mm, 2-3dk. aralýðýnda 2,6±0,5mm, 3-4dk. aralýðýnda 3,2±0,4mm, 4-5dk. aralýðýnda 3,8±0,7mm, 5-6dk. aralýðýnda 4,2±0,4mm ve 6-7dk. aralýðýnda 4,4±0,7mm olarak elde edildi.
TARTIÞMA ve SONUÇ: Akciðer ve meme kanseri hastalarýnýn vücut yüzeyi tarama sistemi ile pozisyonlanmasý ve CBCT çekimi sonucu sonuçlarýnýn 200 fraksiyon süresince karþýlaþtýrýlmasý ile ortalama 0,3cm’in altýnda farklýlýk elde edildi. Hastalarýn pozisyonlanmasý için iyonlaþtýrýcý radyasyonun kullanýmýnýn azaltýlmasýnda vücut yüzeyi taramasý sisteminin kullanýmýnýn akciðer ve meme kanseri radyoterapisinde uygun olduðu tespit edildi.

INTRODUCTION: In this study, we adjusted lung and breast cancer patient’s positioning by using body surface scanning system. We compared CBCT scan's results deviation for 12 patients during 200 fractions and we investigated intra-fraction motion of patients.
METHODS: Lung cancer patient's radiotherapy treatment planning were performed with VMAT, breast cancer's patients with IMRT method while using 3,0 mm thickness CT slices. Couch shifts were performed while using C-RAD body surface scanning system during 200 fractions in the treatment room, then patient's CBCT scans were performed. We obtained body surface guided scanning system and CBCT scan correlation. Intra-fraction motion was obtained during treatment for each patient while using body surface guided.
RESULTS: Couch shift parameters were obtained in lateral direction 0,22±0,07cm, longitudinal direction 0,28±0,08cm and vertical direction 0,30±0,10cm during 87 fractions for 7 lung cancer patients. Correlation results were obtained in lateral direction 0,22±0,06 cm, longitidunial direction 0,25±0,03 cm and vertical direction 0,21±0,08 cm during 113 fractions for 5 breast cancer patients. We determined intra-fraction motion 0,7±0,4mm in 0-1min. interval, 1,5±0,5mm in 1-2min. interval, 2,4±0,7mm in 2-3min. interval, 3,1±0,6mm in 3-4min. interval, 3,8±0,7mm in 4-5min. interval and 4,1±1,4mm in 5-6min. interval for 7 lung cancer patients.We obtained intra-fraction motion 0,6±0,1mm in 0-1min. interval, 1,6±0,2mm in 1-2min. interval, 2,6±0,5mm in 2-3min. interval, 3,2±0,4mm in 3-4min. interval, 3,8±0,7mm in 4-5min. interval, 4,2±0,4mm in 5-6min. and 4,4±0,7mm in 6-7min. interval for 7 lung cancer patients.
DISCUSSION AND CONCLUSION: Correlation between body surface guided system posioning and CBCT positioning were obtained an average less than 0.3cm for lung and breast cancer patients during 200 fractions. Reducing the ionisation radiation for patient positioning with body surface guided system were obtained feasible for lung and breast cancer radiotherapy.

GÝRÝÞ ve AMAÇ: HPV DNA kullanýlarak yapýlan ulusal servikal kanser tarama programý ýþýðýnda ASCUS ve LSIL sitoloji sonucuna sahip HPV DNA pozitif kadýnlarýn kolposkopi sonrasý histopatoloji sonuçlarýnýn incelenmesi.
YÖNTEM ve GEREÇLER: Bu çalýþma Zekai Tahir Burak Kadýn Saðlýðý Eðitim ve Araþtýrma Hastanesi Jinekolojik Onkoloji Kliniðinde Temmuz 2016 ile Ocak 2018 arasýnda arasýnda gerçekleþtirildi. Hastalarýn kayýtlarý retrospektif olarak tarandý. Çalýþmaya servikal kanser tarama testinde ASCUS ve ya LSIL sitolojisine sahip olan ve HPV DNA pozitif olan 30 – 65 yaþ arasý 178 olgu dahil edildi.
BULGULAR: Hastalarýn ortalama yaþý 41 idi. 178 hastanýn yüz on birinin sitolojisi ASCUS altmýþ yedisinin sitolojisi LSIL idi. ASCUS ve LSIL gruplarý arasýnda yaþ, histopatoloji, HPV DNA tipi ve cerrahi sýnýr pozitifliði açýsýndan istatistiksel olarak anlamlý bir farklýlýk bulunmamaktaydý (sýrasýyla p=0.49, p=0.25, p=0.15 ve p=0.17).
TARTIÞMA ve SONUÇ: HPV DNA pozitif ASCUS ve LSIL olgularý arasýnda HSIL ve üzeri servikal patoloji bulunma oraný farklýlýk göstermemektedir.

INTRODUCTION: Aim: To analyze colposcopic histopathology results of HPV DNA positive women with ASCUS and LSIL cytology in the era of national HPV based cervical cancer screening program
METHODS: This study was conducted in Zekai Tahir Burak Women's Health Research and Training Hospital Gynecological Oncology Clinic between July 2016 and January 2018. The patient records were retrospectively reviewed. 178 patients aged between 30 and 65 years with ASCUS or LSIL cytology and HPV DNA positive were included in this study.
RESULTS: The mean age of the patients were 41 years. 178 hastanýn yüz on birinin sitolojisi ASCUS altmýþ yedisinin sitolojisi LSIL idi. Out of 178 woman in total, primarily referring 111 were positive for ASCUS cytology, 67 were positive for LSIL cytology. There was no statistically significant difference in regard to age, histopathology, HPV DNA type and surgical cone margin positivity between two groups (p=0.49, p=0.25, p=0.15, ve p=0.17, respectively).
DISCUSSION AND CONCLUSION: The incidence of HSIL and over cervical pathology is not different between HPV DNA positive ASCUS and LSIL cases.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý jinekolojik lezyonlarda benign malign ayrýmýnda Difüzyon Aðýrlýklý MR incelemenin doðruluðunu araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmaya pelvik kitle ön tanýsýyla alt batýn MRG tetkiki istenen toplam 125 olgu dâhil edildi.MR görüntülemeri 1,5 Tesla görüntüleme sisteminde yapýldý. Bu hastalardan DAG ile sýrasýyla b100, b600, b1000 gradient deðerlerinde difüzyon aðýrlýklý EPI görüntüler alýndý. Pelvik kitle saptanan olgularda lezyonlardan ADC deðerleri ölçüldü,125 jinekolojik lþezyonda ortalama kitle ADC deðerleri karþýlaþtýrýldý.
BULGULAR: Malign lezyon saptanan 35 olgunun lezyona ait ADC deðerleri (b100, b600, b1000) (2.18x10–3; 1.47x10–3; 1.22x10–3), benign lezyon saptanan 90 olgunun lezyona ait ADC deðerlerinden (b100, b600, b1000) (2.60x10–3; 2.05x10–3; 1.79x10–3 mm2/sn) düþük olup aradaki fark istatistiksel olarak anlamlý bulunmuþtur (p<0,05). Ayrýca benign-malign ayrýmýný yapmamýzý saðlayabilecek bir kestirim noktasý araþtýrýldý ve 1.6x10–3 mm2/s nin b100 deðeri için %40 duyarlýlýk ve %88 özgüllük ile; 1.4x10–3 mm2/s ADC deðerinin b600 gradientinde % 57duyarlýlýk %77 özgüllük ile; ve 0.9x10–3 mm2/s deðerinin b1000 gradientinde %57 duyarlýlýk ve %91 özgüllük gösterdiði görüldü. Bu analizler sonucu b1000 ADC deðerinin jinekolojik lezyonlarýn benign-malign ayrýmýnda en yüksek doðruluða sahip olduðu görüldü.
TARTIÞMA ve SONUÇ: ADC deðer ölçümleriyle birlikte difüzyon MRG bir fonksiyonel görüntüleme yöntemi olarak kitlelerin malign-benign ayýrýmýnda önemli katkýlar saðlayabilmektedir.

INTRODUCTION: The aim of the present study was to investigate the accuracy of diffusion weighted magnetic resonance imaging (DWI) in differentiation of malignant from benign gynecologic lesions.
METHODS: A total of 125 patients who underwent pelvic MRI with an initial diagnosis of gynecologic mass included in the study. The MRI examinations were performed on a 1.5 Tesla MR imaging system. The DWI protocol included water excitation with three b values (100, 600 and 1000s/mm2) and apparent diffusion coefficient (ADC) maps were created. Mean ADC values were calculated in 125 gynecologic lesions.
RESULTS: We observed significantly lower ADC values in malignant lesions compared with benign ones in all b values (p= 0.047 for b100, p<0.001 for b600, p<0.001 for b1000). We also evaluated the cut-off points of ADC value for differentiation of malignant from benign lesions and observed 1.6x10–3 mm2/s for b100 with a sensitivity of 40% and a specificity of 88%; 1.4x10–3 mm2/s for b600 with a sensitivity of 57% and a specificity of 77%, and 0.9x10–3 mm2/s for b1000 with a sensitivity of 57% and a specificity of 91%. According to these analyses, ADC value at b1000 was found to have the highest accuracy for differentiation of malignant from benign gynecologic lesions.
DISCUSSION AND CONCLUSION: ADC measurements can be used for differentiation of malignant from benign gynecologic lesions.

GÝRÝÞ ve AMAÇ: Üst gastrointestinal sistem kanamalarý halen %10’a yakýn ölüm oranýyla önemli bir acil servis baþvuru nedeni olmaya devam etmektedir. Bu çalýþmamýzda üst gastrointestinal sistem kanamasýyla acil servise baþvuran hastalarýn epidemiyolojik özelliklerini, ölüm oranýný, yatýþ sürelerini belirlemeyi; ölüm ve yatýþ süresi üzerine etkili olabilecek faktörleri araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Aralýk 2007 – Mart 2010 tarihleri arasýnda Ankara Numune Eðitim ve Araþtýrma Hastanesi Acil Dahiliye Servisi’nde üst gastrointestinal sistem kanamasý tanýsý ile yatarak tedavi edilen hastalar çalýþmaya dahil edildi. Hastalarýn demografik özellikleri, hastaneye baþvuru þikâyeti, yatýþ süresi, ek hastalýklarý, ilaç kullanýmý, endoskopi bulgularý, hastaneye baþvuru anýndaki yaþamsal bulgularý ve hemoglobin deðeri, kan ürünü transfüzyon ihtiyacý, hastanede yatýþ süresi ve ölüm durumlarý retrospektif olarak incelendi. Ölü ve yaþayan hastalar bu parametreleri içerecek þekilde karþýlaþtýrýldý.
BULGULAR: Çalýþmaya dahil edilen 185 hastanýn ortalama yaþý 63.2 (21-96) olarak bulundu. Hastalarýn 134’ünün (%72.4) en az bir tane ek hastalýðý varken; %37.3’ü (n: 69) steroid olmayan anti-inflamatuar ilaç, %34.1’i (n: 63) aspirin kullanmaktaydý. Endoskopik tanýlarýna bakýldýðýnda en sýk 69 (%37.3) hastada duodenal ülser ve 45 (%24.3) hastada mide ülseri saptanmýþtý. Endoskopik olarak aktif kanamasý saptanan 33 (%17.8) hastanýn 25’ine (%13.5) endoskopik olarak müdahale edilmiþ, 8 (%4.3) hasta ise yalnýzca medikal tedavi ile izlenmiþti. Kanama nedeniyle cerrahi yapýlan hasta yoktu. Tüm hasta grubunda hastanede yatýþ süresi ortalama 5.5 (1-21) gün iken; bu süre özofagiyal varisi olanlarda 8 (6-10) gün, duodenal ülseri olanlarda 5.4 (1-8) gün ve mide ülseri olanlarda ise 5.5 (2-7) gün olarak bulundu (p: 0.56). Hastalarýn 14’ü (%7.5) ölmüþtü. Yaþayan ve ölü olan hastalar karþýlaþtýrýldýðýnda; ölmüþ olan hastalarýn ortalama yaþýnýn daha yüksek olduðu (p: 0.02) ve daha yüksek oranda komorbiditesi olduðu (p: 0.01) görüldü.
TARTIÞMA ve SONUÇ: Akut üst gastrointestinal sistem kanamalarý halen önemli bir acil servis baþvuru sebebi olmaya devam etmektedir. Özellikle ileri yaþtaki ve ek hastalýðý olan hastalarda, ölüm oranýnýn arttýðý görülmektedir.

INTRODUCTION: The mortality rate in upper gastrointestinal system bleeding is still close to 10% and remains an important cause of emergency service admission. In this study, we aimed to evaluate the epidemiologic features, duration of hospitalization, mortality rate and factors that might affect mortality and length of stay in patients with upper gastrointestinal system bleeding.
METHODS: Between December 2007 and March 2010, the patients who were hospitalized with the diagnosis of upper gastrointestinal system bleeding in Ankara Numune Training and Research Hospital were included in the study. The demographic characteristics of the patients, the cause of admission to the hospital, duration of hospitalization, comorbidities, drug use, endoscopy findings, vital signs and hemoglobin values, blood transfusion and mortality were retrospectively analyzed. Deceased and living patients were compared to include these parameters.
RESULTS: The mean age of 185 patients included in the study was 63.2 (21-96). The rate of patients with at least one comorbidity was 72.4% (n: 134) and 69 (37.3%) patients were using non-steroidal anti-inflammatory drugs and 34.1% (n: 63) aspirin. The cause of bleeding was found as duodenal ulcer in 69 patients (37.3%) and gastric ulcer in 45 (24.3%) patients. 33 (17.8%) patients had active bleeding and sclerotherapy or band ligation was performed in 25 (13.5%) of these patients. The mean duration of hospitalization was 5.5 (1-21) days for all cohort, 8 (6-10) days for esophageal varices, 5 days for bleeding, 5.4 (1-8) days for duodenal ulcer and 5.5 (2-7) days for gastric ulcer (p: 0.56). The mortality rate was 7.5% (n: 14). Patients who were dead had higher mean age (p: 0.02) and more comorbidities (p: 0.01).
DISCUSSION AND CONCLUSION: Acute upper gastrointestinal system bleeding continue to be an important cause of emergency department admission. It is seen that the mortality rate increases especially in patients with advanced age and comorbid diseases.

GÝRÝÞ ve AMAÇ: Erken evre dýþýndaki mide kanserinin en etkili küratif tedavisi radikal gastrektomi ile birlikte D2 diseksiyon uygulanmasýdýr. Bu konuda bir diðer teknik alternatif ise laparoskopi yardýmlý gastrektomidir. Her ne kadar minimal ivaziv iþlem olarak laparoskopik cerrahinin avantajlarý iyi bilinse de, bu iþlem radikal onkolojik prensiplere ulaþabilmesi ve sonuçlarýn ortaya konmasý açýsýndan deðerlendirilmelidir.
YÖNTEM ve GEREÇLER: Evre IIA ve üzeri mide kanserli hastalarda laparoskopi yardýmlý (19 hasta) ve açýk cerrahinin (23 hasta) erken sonuçlarý deðerlendirilmiþtir.
BULGULAR: Laparoskopi yardýmlý grupta, hem kanama hem de postoperatif dönmede analjezik ihtiyacý belirgin olarak daha az iken (sýrasýyla, 166.9±66.5mL’ye karþýlýk 264.3±91.3 mL, 6.4±1.5’ye karþýlýk 9.04±1.7 kez), ameliyat süresi daha uzun olarak bulundu (183± 31.1 dakikaya karþýlýk 155± 29.5 dakika). Cerrahi sýnýrlar ve çýkarýlan lenf nodu sayýsý açýsýndan fark yoktu. Açýk cerrahi grubunda akciðer komplikasyonlarý daha sýktý.
TARTIÞMA ve SONUÇ: Laparoskopi yardýmlý radikal gastrektomi ile birlikte D2 diseksiyon erken evre dýþý mide kanserlerinde de etkin ve güvenilir bir cerrahi uygulamadýr. Erken postoperatif iyileþme döneminde bazý üstünlükleri olduðu düþünülmüþtür.

INTRODUCTION: The most effective curative treatment for gastric cancer other than early stage is radical gastrectomy with D2 lymph node dissection. Laparoscopy assisted gastrectomy is one of the technique alternatives on this issue. Although the advantages of laparoscopic surgery as a minimal invasive procedure is well known, it should be evaluated for the reach of radical oncological principles and the results should be revealed.
METHODS: The early results of patients with clinical stage IIA and over gastric carcinoma that had been operated with laparoscopy assisted (19 patients) and open surgery (23 patients) were evaluated.
RESULTS: In laparoscopy assisted group, both the bleeding and the need for analgesics in postoperative period were significantly less (166.9±66.5ml vs 264.3±91.3ml, 6.4±1.5 vs 9.04±1.7, times respectively) but the time needed to complete surgery was longer (183± 31.1 min vs 155± 29.5 min). There was no difference in the numbers of lymph nodes removed and surgical resection margins. The pulmonary complications were more frequent in open surgery group.
DISCUSSION AND CONCLUSION: Laparoscopy assisted radical gastrectomy with D2 lymph node dissection is an effective and safe surgical technique for gastric cancers other than early stage. It is thought to have some superiorities in early postoperative healing.

GÝRÝÞ ve AMAÇ: Stereotaktik beyin biyopsisi yapýlan 87 hastada klinik-radyolojik özellikler, patolojik korelasyon ve cerrahi sonuçlarýn paylaþýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Ocak 2013 ile Haziran 2018 tarihleri arasýnda çeþitli intraserebral lezyonlara yönelik stereotaktik biyopsi yapýlan 87 hastanýn radyolojik görüntüleri, yatan hasta kayýtlarý, patoloji sonuçlarý geriye dönük olarak incelendi. Stereotaktik biyopsi iþleminin taný koyduruculuk oraný, histopatolojik sonuçlarýn radyolojik ön tanýlarla ve intraoperatif patoloji konsültasyonu bulgularý ile uyumu incelendi; iþleme baðlý komplikasyonlar deðerlendirildi ve tanýmlayýcý istatistiki veriler paylaþýldý. Komplikasyon ile iliþkili risk faktörleri çýkarýmsal istatistiki araçlar kullanýlarak gözden geçirildi.
BULGULAR: Stereotaktik beyin biyopsisi ile olgularýn %92’sinde bir tanýya ulaþýlmýþtýr. Radyolojik görüntülemeye dayalý ön tanýlarýn %71,3’ü, intraoperatif konsültasyonlarýn da %63,3’ü nihai histopatolojik tanýlar ile uyumluydu. En sýklýkla taný konulan lezyon, santral sinir sistemi lenfomasýydý. Ýþleme baðlý mortalite oraný %0, toplam komplikasyon oraný ise %9,2 olarak bulundu. Ýþleme baðlý en sýk karþýlaþýlan komplikasyon biyopsi lojunda kanamaydý. Komplikasyon ile iliþkili olabilecek risk faktörlerinden sadece derin yerleþimli lezyon biyopsisi marjinal olarak kanama ile iliþkili bulundu (p=0.066).
TARTIÞMA ve SONUÇ: Stereotaktik beyin biyopsisi intrakranial patolojilerin tanýsýnda güncelliðini koruyan yüksek taný koyduruculuða ve görece düþük mortalite ve morbidite oranlarýnda sahip önemli bir araçtýr.

INTRODUCTION: The aim of this study is to present clinical-radiological characteristics, pathological correlation and surgical results of 87 patients in whom stereotactic brain biopsy was performed.
METHODS: Radiological workup, patient charts and pathological diagnoses of 87 patients who had stereotactic brain biopsy for various intracerebral lesions between January 2013 and June 2018 were retrospectively reviewed. Diagnotic yield, concordance between histopathological diagnoses, radiological presumptive diagnoses and frozen section results were identified. Procedural complicaiton rates were determined and descriptive statistical data was presented. Risk factors that may be associated with the procedure were evaluated with inferential statistical tools.
RESULTS: Diagnostic yield of procedures was 92%. Overall 71.3% of presumptive radiologic diagnoses and 63.3% of intraoperative consultation results were in accordance with final histopathologic diagnosis. Most commonly encountered diagnosis was central nervous system lymphoma. Procedure related mortality rate was 0%, whereas procedure related complication rate was 9.2%. Most common complication was bleeding at biopsy site. Only the deep seated biopsy site was marginally significant risk factor for bleeding among other possible risk factors.(p=0.066).
DISCUSSION AND CONCLUSION: Stereotactic brain biopsy is still a reliable tool with high diagnostic yield and relative low mortality and morbidity rates.

GÝRÝÞ ve AMAÇ: Klinik evre I renal hücreli karsinom(RHK) olgularýnda, günümüzde öncelikli olarak önerilen cerrahi teknik parsiyel nefrektomidir (PN). Ancak tümöre ait olumsuz patolojik özellikler varlýðýnda, daha kötü bir prognoz gözlenebilmektedir. Çalýþmadaki amacýmýz, patolojik tanýsý yüksek Fuhrman dereceli(derece 3-4) pT1 evre RHK gelen olgularda, cerrahi teknik olarak parsiyel veya radikal nefrektomi (RN) uygulanmýþ olmasýnýn, postoperatif dönemde lokal nüks, uzak metastaz geliþimi ve kansere özgü saðkalýma etkisinin deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Ocak 2009-Temmuz 2016 tarihleri arasýnda, PN veRN yapýlan hastalar içerisinden, patolojik tanýsý yüksek Fuhrman dereceli pT1 evre RHK gelen, verilerine tam olarak ulaþýlabilen 66 hasta çalýþmaya dahil edildi. Hastalarýn demografik verileri, histolojik tümör tipi, tümörün Fuhrman derecesi, nefrektomi sonrasý saðkalým, lokal nüks ve metastaz verileri kaydedilerek, hastalar RN (Grup I) ve PN(Grup II) uygulananlar þeklinde iki gruba ayrýldý.
BULGULAR: Hastalarýn ortalama yaþý 57.67±10.23 olup,ortanca 57(6-102) aylýk takip süresi boyunca 6(%9.1) hastada lokal nüks, 8(%12.1) hastada uzak metastaz, 8(%12.1) hastada kansere baðlý ölüm gerçekleþmiþtir.PN grubunda daha yüksek lokal nüks oraný (%11.1, p=0.532),uzak metastaz oraný (%18.9, p=0.630) ve kansere özgü saðkalým süresi (94.16 ay, p=0.560) saptanýrken; öngörülen nükssüz saðkalým süresi (89.46 ay, p=0.433) ve metastazsýz saðkalým süresi (84.94 ay, p=0.617) daha düþük bulundu. Ancak gruplar arasýnda anlamlý bir fark izlenmedi. Çok deðiþkenli analizde, hipertansiyon lokal nüksü; Fuhrman derece 4, kadýn cinsiyet, VKI>27 olmasý uzak metastazý; tahmini glomerüler filtrasyon hýzý<90 olmasý ise kansere özgü saðkalýmý etkileyen baðýmsýz prediktif faktörler olarak saptandý.
TARTIÞMA ve SONUÇ: Yüksek Fuhrman dereceli pT1 evre RHK olgularýnda cerrahi yöntem olarak PN veya RN uygulanmýþ olmasýnýn, izlemde onkolojik sonuçlarý anlamlý olarak deðiþtirmediðini saptadýk. Bu nedenle tümör boyutu ve lokalizasyonu uygun olan olgularda, nefron koruyucu teknik olan PN’yi kullanmak daha uygun gözükmektedir.

INTRODUCTION: In clinical stage I renal cell carcinoma (RCC), partial nephrectomy (PN) is actual recommended surgical technique. However, poor pathological tumor features have more negative prognosis. We aimed to evaluate the effects of performing partial or radical nephrectomy(RN) on local recurrence, distant metastasis and cancer-specific survival in stage pT1 RCC with high Fuhrman grade.
METHODS: Data of patients who underwent PN or RN due to pathological stage pT1 RCC with high Fuhrman grade, between January 2009 and July 2016 were retrospectively evaluated. 66 of them whose datas were fully accessible, were included to study. Demographic datas, histological tumor types, Fuhrman grading, local recurrence, distant metastasis and survival rates after nephrectomy were recorded. The patients were divided into two groups as RN (Group I) and PN (Group II).
RESULTS: Mean age of patients was 57.67±10.23. Among them, 6(9.1%) patients had local recurrence, 8(12.1%) had distant metastasis and 8(12.1%) had cancer related death. Group II had higher local recurrence rate (11.1%, p=0.532), distant metastasis rate (18.9%, p=0.630), cancer-specific survival (94.16 months, p=0.560); lower predicted recurrence-free survival (89.46 months, p=0.433) and metastasis-free survival (84.94 months, p=0.617). But there were no significantly difference. In multivariate analysis, hypertension for local recurrence; Fuhrman grade 4, female gender, BMI>27 for distant metastasis, and estimated glomerular filtration rate<90 for cancer-specific survival were independent predictive factors.
DISCUSSION AND CONCLUSION: We found that PN or RN did not significantly alter the oncologic outcomes in follow-up of patients with high Fuhrman grade, stage pT1 RCC. For this reason, it is more appropriate to use nephron sparing technique.

GÝRÝÞ ve AMAÇ: Lokal ileri küçük hücre dýþý akciðer karsinomu tanýsý almýþ olan hastalarda tedavi sonrasý tümör boyutu yanýtýný deðerlendirmede ortalama trombosit hacmi, eritrosit daðýlým geniþliði ve nötrofil/lenfosit oranýnýn prediktif bir deðer olup olamayacaðýný araþtýrdýk.
YÖNTEM ve GEREÇLER: Lokal ileri (Evre III) küçük hücre dýþý akciðer karsinomu tanýsý olan ve kemoradyoterapi tedavisi almýþ 39 hastanýn verileri retrospektif olarak incelendi. Hastalarýn tedavi öncesi ve sonrasýnda bakýlan, nötrofil, lenfosit, ortalama eritrosit hacmi, eritrosit daðýlým geniþliði verileri deðerlendirildi. Ayrýca hastalarýn tedavi öncesi ve sonrasý pozitron emisyon tomografi (PET-BT) raporlarýnda belirtilen primer tümör boyutlarý ve bu lezyonlarýn suv-max deðerleri kaydedildi.
BULGULAR: Hastalarýn ortalama yaþý 61 olup (daðýlým 43-78) 38 hasta erkek, 1 hasta kadýndý. Tedaviye parsiyel yanýt veren hasta sayýsý 22, stabil yanýtý olan 17 idi. Yirmi bir hasta skuamöz hücreli karsinom (%53.8), 18 hasta (%46.2) ise adenokarsinom tanýsý almýþtý. Cut-off deðerleri nötrofil/lenfosit oraný için 2,99, eritrosit daðýlým geniþliði için 14,65, ortalama trombosit hacmi için 9,5 olarak saptandý. Her üç parameter için bakýlan cut-off deðerler istatiksel olarak anlamlý deðildi.
TARTIÞMA ve SONUÇ: Lokal ileri küçük hücre dýþý akciðer karsinomu nedeni ile kemoradyoterapi tedavisi alan hastalarda tedaviye tümör boyutu yanýtýný deðerlendirmede bakýlan parametreler içerisinde prediktif bir deðer elde edilemedi.

INTRODUCTION: We investigated whether the mean platelet volume, erythrocyte distribution width and neutrophil / lymphocyte ratio can be a predictive values for the evaluation of tumor size response after treatment in patients with local advanced non-small cell lung carcinoma.
METHODS: The data of 39 patients with local advanced (stage III) non-small cell lung carcinoma who had received chemoradiotherapy treatment were retrospectively reviewed., Neutrophil, lymphocyte, mean erythrocyte volume, erythrocyte distribution width datas which noted before and after treatment were evaluated. In addition, pre and post-treatment the primary tumor size and the suv-max values of these lesions were recorded which is noted in positron emission tomography (PET-CT) reports
RESULTS: The mean age of the patients was 61 (range 43-78), 38 patients were male and 1 were female. The number of patients with partial response to treatment was 22 and with stable response was 17. Twenty-one patients had squamous cell carcinoma (53.8%) and 18 (46.2%) had adenocarcinoma. Cut-off values were 2.99 for neutrophil / lymphocyte ratio, 14.65 for erythrocyte distribution width and 9.5 for mean platelet volume. The cut-off values for each of the three parameters were not statistically significant
DISCUSSION AND CONCLUSION: In patients who received chemoradiotherapy treatment for local advanced lung carcinoma, a predictive value could not be obtained within the parameters evaluated in response of treatment.

GÝRÝÞ ve AMAÇ: Ýnguinal herni onarýmý, genel cerrahide en sýk yapýlan ameliyatlardan birisidir. Çok sayýda yöntem tanýmlanmýþtýr. Laparoskopik fýtýk onarýmý 1990'lý yýllardan sonra yapýlmaya baþlanmýþ ve birçok merkez tarafýndan benimsenmiþtir. Çalýþmamýzýn amacý, ilçe devlet hastanesinde yaptýðýmýz laparoskopik transabdominal preperitoneal fýtýk onarýmý sonuçlarýmýzý literatür eþliðinde deðerlendirmektir.
YÖNTEM ve GEREÇLER: Kasým 2015- Aðustos 2017 tarihleri arasýnda laparoskopik transabdominal preperitoneal yöntem ile inguinal herni onarýmý yapýlan hastalarýn sonuçlarý retrospektif olarak incelendi.
BULGULAR: 30’u erkek, 3’ü kadýn olmak üzere 33 hasta çalýþmaya dahil edildi. Yaþ ortanca deðeri 46( 19 ile 75 arasý) idi. 18(%54,6) hastada sað, 4(%12,1) hastada sol ve 11(%33,3) hastada bilateral herni olmak üzere toplam 44 onarým yapýldý. Hastanede kalýþ süresi ortalama 1,09( ±0,29) gün ve 1 ile 2 arasýnda idi. Ameliyat sonrasý 2(%6,1) hastada psödonüks(seroma), 1(%3) hastada hematom, 2(%6,1) hastada orþit gözlendi. Hastalarýn takip süresi 6 ile 27 ay arasý olup ortalama 13,76( ±5,84) idi. 33 hastanýn takibinde 1(%3,1) hastada nüks tespit edildi.
TARTIÞMA ve SONUÇ: Laparoskopik fýtýk onarýmýnýn; küçük kesiler yapýlmasý, daha erken iyileþme, daha az aðrý ve günlük aktiviteye erken dönüþ saðlamasý gibi avantajlarý olduðu bilinmektedir. Ancak öðrenme süreci açýk yönteme göre daha uzundur. Uzmanlýk eðitiminde veya daha sonraki süreçte laparoskopik yöntemin eðitimini alan kiþilerde nüks oranýnda farklýlýk gözlenmediði bildirilmiþtir. Sonuç olarak laparoskopik yöntem eðitimini almýþ kiþiler tarafýndan ilçe hastanelerinde de bu yöntemin güvenle yapýlabileceði kanatindeyiz.

INTRODUCTION: Inguinal hernia repair is one of the most commonly performed operations in general surgery. A great number of methods has been described. Laparoscopic hernia repair was initiated to be performed after 1990s and adopted by many centers. The objective of this study is to evaluate our outcomes in laparoscopic transabdominal preperitoneal hernia repair which we performed in the county state hospital in the light of the literature.
METHODS: Outcomes of patients for whom inguinal hernia repair was performed via laparoscopic transabdominal preperitoneal method between the dates of November 2015 and August 2017 were evaluated retrospectively.
RESULTS: 33 patients were included in the study, 30 being male and 3 being female. Median age value was 46 (ranging between 19 and 75). A total of 44 repairs were performed, being right-sided inguinal hernia in 18 (54.6%) patients, left-sided in 4 (12,1%) patients and bilateral in 11 (33.3%) patients. Mean duration of hospital stay was 1,09 (±0,29) days and ranging between 1 and 2. Postoperatively, 2(6.1%) patients were observed to develop pseudorecurrence (seroma), 1 (3%) patient to develop hematoma and 2 (6.1%)patients to develop orchitis. Mean follow-up duration of the patients was varying between 6 to 27 months, with a mean of 13,76( ±5,84). During follow-up of 33 patients, 1 (3,1%) patient was determined to develop recurrence.
DISCUSSION AND CONCLUSION: Laparoscopic hernia repair has been known to have some advantages, including smaller incisions, more rapid recovery, less pain and earlier return to daily activities. However, process of learning takes longer compared to the open method. It was reported that no difference occurred in recurrence rates in individuals who received a training on the laparoscopic method during specialization training or during further educational processes. In conclusion, we considered that this method can also be safely performed in county hospitals by individuals who received training on the laparoscopic method.

GÝRÝÞ ve AMAÇ: Meme kanseri tedavisi gören kadýnlarýn ameliyat ve kemoterapi ile sýklýkla cinsel iþlev bozukluklarý yaþadýðýný gösteren kanýtlar artmaktadýr. Çalýþmamýzýn bir parçasý olarak, yaþam kalitesini (YK) ve cinsel doyum düzeylerini ve ayrýca kemoterapinin Türk meme kanseri hastalarýnýn ve partnerlerinin cinsel doyum üzerindeki etkilerini araþtýrmayý amaçladýk
YÖNTEM ve GEREÇLER: Otuz iki meme kanseri hastasýndan ve partnerlerinden elde edilen verileri topladýk. Üç form kullandýk: biri hastalarýn sosyodemografik özellikleri, EORTC-QoL-C30 ve Cinsel Tatmini Golombok-Rust Envanteri (GRISS) hakkýnda bilgi içeriyor
BULGULAR: Meme kanseri hastalarýnýn GRISS'e göre tedavi öncesi ve tedavi sonrasý cinsel memnuniyetlerinin karþýlaþtýrýldýðýnda, sýklýk, kaçýnma, dokunma ve anorgazmi için istatistiksel olarak anlamlý alt ölçekler osaptanmýþtýr (sýrasýyla p <0.0001, <0.0001, 0.007 ve 0.001). Buna karþýlýk, sadece sýklýk parametreleri partnerlerinde belirgin olarak yüksekti (p: 0.001). Ayrýca, duygusal iþlevsellik, sosyal iþlevsellik ve biliþsel iþlevsellik açýsýndan hastalarýmýzda istatistiksel olarak anlamlý farklýlýklar bulduk (sýrasýyla p = 0.023, 0.022 ve 0.035).
TARTIÞMA ve SONUÇ: Kemoterapinin genel yaþam kalitesi puanlarýný düþürmeden cinsel doyum oranlarýný düþürdüðünü bulduk. Hastalarýn yaþam kalitesini deðerlendirirken, cinsel doyumlarýnýn kötüleþebileceði ihtimaline dikkat edilmelidir. Tüm onkoloji uzmanlarý, uygun tavsiyeleri yapmanýn yaný sýra hastalarýyla açýk diyaloðu teþvik etmeleri için çok önemlidir; kemoterapinin zararlý etkilerini en aza indirgemek ve yaþam kalitesini iyileþtirmek için antikanser tedavisi öncesi, sýrasýnda ve sonrasýnda izlenmelidirler.

INTRODUCTION: There is growing evidence suggesting that women treated for breast cancer with surgery and chemotherapy commonly experience disturbances in sexual functioning. As part of the present study, we aimed to investigate quality of life (QoL) and sexual satisfaction levels, as well as the effects of chemotherapy upon the sexual satisfaction of Turkish breast cancer patients and their partners.
METHODS: We collected data were from thirty-two breast cancer patients and their partners. We used three forms: one is covering information about socio-demographic characteristics of the patients, EORTC-QoL-C30 and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS).
RESULTS: A comparison of the pre-treatment and post-treatment sexual satisfaction of breast cancer patients with respect to GRISS showed statistically significant subscores of frequency, avoidance, touch and anorgasmia (p: <0.0001, <0.0001, 0.007 and 0.001 respectively). In contrast, only the frequency parameter was significantly high in their partners (p: 0.001). Also, we found statistically significant differences in our patients in terms of emotional functioning, social functioning, and cognitive functioning (p: 0.023, 0.022 and 0.035, respectively).
DISCUSSION AND CONCLUSION: We found that chemotherapy reduced sexual satisfaction rates without lowering overall quality of life scores. While assessing patients’ quality of life, one should pay sufficient attention to the possibility that their sexual satisfaction may get worse. It is of crucial importance for all the oncology professionals to encourage open dialogue with their patients in addition to making appropriate referrals; and they should be monitored before, during, and after anticancer treatment to minimize the deleterious effects of chemotherapy and improve their quality of life.

GÝRÝÞ ve AMAÇ: Cyberknife tedavisi almýþ hipofiz adenomlu olgularda tedaviye yanýtýn MR ile deðerlendirilmesi
YÖNTEM ve GEREÇLER: Bu çalýþmada 2010 ile 2014 yýllarý arasýnda, hipofiz adenomu tanýsýyla Cyberknife tedavisi almýþ hastalar retrospektif olarak deðerlendirildi. Cyberknife tedavisinden en az 6 ay sonra takip MR’ý bulunan olgular çalýþmaya dahil edildi. 38 hastanýn (erkek/kadýn=1) tedavi öncesi ve sonrasý MR görüntüleri, tedaviye yanýtýn deðerlendirilmesi amacýyla retrospektif olarak incelendi. Tümör hacimlerindeki deðiþiklikler, lokal kontrol oraný, hacim deðiþikliðinin izlem süresi ile iliþkisi ve olasý çevre beyin parankim deðiþiklikleri araþtýrýldý.
BULGULAR: Çalýþmaya dahil 38 hastanýn ortalama takip süresi 25 ay (daðýlým, 6-51 ay) idi. Tedavi öncesi ve sonrasý ortalama tümör hacimleri arasýnda istatistiksel olarak anlamlý bir azalma vardý (sýrasýyla 4722 mm3 ve 3475 mm3). Otuzsekiz hastanýn 2 tanesinde radyolojik progresyon, 18 tanesinde stabil hastalýk, 18 tanesinde ise regresyon saptandý. Tümör lokal kontrol oraný %94.7 olarak hesaplandý. Ayrýca, stabil ve regresyon gruplarý arasýnda yapýlan analizde izlem süresinin uzamasýnýn daha anlamlý hacim düþüþüne neden olduðu görüldü. Hasta cinsiyeti, ek týbbi tedavi, hasta yaþý, önceki ameliyatlarýn sayýsý gibi durumlarýn tedavi sonucunu etkilemediði saptandý. Hiçbir vakada çevre dokularda patolojik sinyal ortaya çýkmadý.
TARTIÞMA ve SONUÇ: Cyberknife hipofiz adenomlu olgularda etkili bir tedavi yöntemidir. Bu sonuçlar Cyberknife radyoterapisinin çevre dokularda radyopatolojik deðiþiklik oluþturmaksýzýn oldukça tatmin edici lokal tümör kontrol oranlarý saðladýðýný desteklemektedir.

INTRODUCTION: Our aim is to determine treatment response to Cyberknife based on follow-up MRI in patients with pituitary adenoma.
METHODS: We retrospectively identified the patients with pituitary adenoma treated with Cyberknife between 2010 – 2014. Patients with postreatment eligible follow-up MRI scan after at least 6 months of Cyberknife treatment were included in this study. Pre- and posttreatment MRI scans of 38 patients (male/female=1) were retrospectively analysed to evaluate tumor response. Volumetric changes of the tumors, local control rate, volumetric changes over time and signal alterations on the surrounding brain parenchyma were assessed.
RESULTS: The mean follow-up time of 38 patients was 25 months (range, 6-51 months). Significant mean tumor volume reduction was found between pre- and posttreatment mean tumor volumes, which were 4722 mm3 and 3475 mm3, respectively. There were 2 cases with radiological progression, 18 cases with stable disease and 18 cases with regression. Thus, tumor local control rate was calculated as 94.7% in our study. There was also a significant follow-up time difference between stable and radiological regression groups which indicates that increased follow-up time may be related with better volume decrease. Patient gender, additional medical treatment, age, the number of previous surgeries did not affect treatment response. Lastly, there was no case with signal alteration on the surrounding brain parenchyma.
DISCUSSION AND CONCLUSION: Cyberknife is a known and effective treatment method in patients with pituitary adenoma. Our results also support that Cyberknife provides excellent local tumor control without any radiological obvious side effects on surrounding tissues.

GÝRÝÞ ve AMAÇ: Jinekolojik kanser tedavileri, hastalarýn psikoseksüel durumlarýný ve yaþam kalitelerini etkileyebilir. Bu çalýþmamýzýn amacý jinekolojik kanserli (JK) hastalarda cinsel doyum durumlarýný deðerlendirmektir. Ayrýca cinsel doyum durumlarý ile birlikte psikolojik durumlarý (anksiyete ve depresyon) ve yaþam kaliteleri deðerlendirildi.
YÖNTEM ve GEREÇLER: Kemoterapi alan ve izlemdeki JK'li hastalarýnýn verileri, yüz yüze anketler yapýlarak bilgiler toplanmýþtýr. Görüþmeler sýrasýnda dört form kullanýlmýþtýr. Ýlk form sosyo-demografik özelliklerden oluþmaktadýr. Diðer formlar, Golombok-Rust Cinsel Doyum Anketini (GRISS), European Organization for Research on Treatment of Cancer Questionnaires-C30 Yaþam Kalitesi Anketini (EORTC-QoL-C30), Durumluk-Sürekli Kaygý Envanteri (STAI), Beck Depresyon Envanteri (BDI) idi.
BULGULAR: Bu çalýþmaya, JK'li 62 hasta dahil edildi. Toplam GRISS skoru 37.54±11.71 olup, 33 hastada (%53) GRISS cut-off skoru > 35'e göre cinsel tatminsizlik görülmüþtür. Toplam GRISS skoru düþük olan hastalar (<35), total GRISS skoru (≥35) olan hastalarla karþýlaþtýrýldýðýnda depresyon skorlarý (p=0.010) ve STAI-II skorlarý (p=0.044) anlamlý olarak yüksekti ve EORTC-QLQ-C30 yaþam kalitesi alt ölçekleri (fiziksel iþlevler (p=0.004), biliþsel iþlevler (p=0.021), duygusal iþlevler (p=0.019) ve global yaþam kalitesi (p=0.022) anlamlý olarak daha düþüktü.
TARTIÞMA ve SONUÇ: Cinsel olarak doyumsuz olan hastalar kötü yaþam kalitesine sahiptirler ve genellikle endiþeli ve depresiftirler. Jinekolojik hastalarýn onkolojik tedavilerinin yaný sýra, cinsel rehabilitasyon ve psikolojik duygu durumlarýnýn rutin deðerlendirmelerde entegrasyonunun saðlanmasý gerekmektedir.

INTRODUCTION: Treatments in gynecologic cancer can affect a patient's psychosexual status and quality of life. The aim of this study was to evaluate the sexual satisfaction levels in patients with gynecological cancer (GC). We also evaluated the relationship between sexual status of these patients with the psychological status (anxiety and depression) and quality of life.
METHODS: The data for GC patients treated with chemotherapy or in surveillance were collected by using four forms completed during face-to-face interviews. The first form consists of socio-demographic features. Other forms were Golombok-Rust Inventory of Sexual Satisfaction (GRISS), European Organization for Research on Treatment of Cancer Questionnaires Quality of Life-C30 (EORTC-QLQ-C30), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI) scoring system.
RESULTS: In this study, 62 patients with GC were included. The mean total GRISS score was 37.54±11.71 and sexual dissatisfaction was seen in 33 patients (53%) according to GRISS cut-off score>35. Depression scores (p=0.010) and STAI-II scores (p=0.044) were significantly higher, and EORTC-QLQ-C30 function subcales (physical functioning (p= 0.004), cognitive functioning (p=0.021), emotional functioning (p=0.019)) and the global quality-of-life (p=0.022) were significantly lower in patients with high total GRISS scores (≥35) when compared with the patients with low total GRISS scores (<35).
DISCUSSION AND CONCLUSION: Patients with sexual dissatisfaction have poor quality of life, and they are generally anxious and depressive. Besides the oncological treatments of the GC patients, it is necessary to make integration of sexuality rehabilitation and physiological status into their routine assessment.

GÝRÝÞ ve AMAÇ: Safra kesesi kanserleri nadir fakat ölümcül kanserlerdendir. Literatürde genellikle safra yolu kanserleri ile birlikte sýnýflandýrýlmýþtýr. Bu yazýda safra kesesi kanserli hastalarýn klinik özelliklerini, adjuvan ve metastatik tedavi rejimleri ile sað kalýmlarýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2011-Ekim 2017 tarihleri arasýnda Saðlýk Bilimleri Üniversitesi, Dr. A. Y. Ankara Onkoloji Hastanesi Týbbi Onkoloji Kliniði'ne safra kesesi tanýsý ile baþvuran hastalar retrospektif olarak deðerlendirildi. Hastalarýn demografik özellikleri,cerrahi türleri, adjuvan ve metastatik tedavi rejimleri, tedavi yanýt durumlarý, genel saðkalým (OS) oraný ve hastalýksýz sað kalýmlarý (DFS) deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilen 58 hastanýn 34'ü (%58.6) lokalize veya lokal ileri evredeydi. Metastatik olmayan hastalarýn 13'ü (% 38.2) herhangi bir adjuvan tedavi almamýþtý. Kemoradyoterapi en çok tercih edilen adjuvan tedavi seçeneðiydi (rezeke edilen hastalarýn% 35.2'si). Adjuvan tedavi alan hastalarda median DFS ve OS, sýrasýyla 24.8 (% 95 CI: 1.5-48.1) ve 28 (% 95 Cl: 20.6-35.4) ay iken adjuvan tedavi almayan hastalarda median DFS ve OS'ye ulaþýlamadý.
TARTIÞMA ve SONUÇ: Rezeke edilen safra kesesi kanserlerinde adjuvan tedavinin etkinliðini göstermek ve en uygun tedavi modalitesinin seçimi için prospektif, randomize kontrollü çalýþmalara ihtiyaç vardýr.

INTRODUCTION: Gallbladder cancer (GBC) is an uncommon and highly fatal carcinoma. It is usually classified with biliary tract cancers in the literature. In this report we have planned to evaluate the clinical characteristics, adjuvant and metastatic treatment options and the survival of GBC patients.
METHODS: A retrospective analysis of GBC patients treated in University of Health Sciences, Dr. A. Y. Ankara Oncology Hospital, Department of Medical Oncology between January 2011 and October 2017 was performed. The files of 58 patients with GBC were screened retrospectively. Treatment regimens, response rates, overall survival (OS) rate and disease-free survival (DFS) of the patients were evaluated.
RESULTS: A total of 58 patients of whom 34 (58.6%) were presented as non-metastatic stage. Thirteen (38.2%) of non-metastatic patients did not receive any adjuvant treatment. Chemoradiotherapy was the most preferred adjuvant treatment option (35.2% of resected patients). Median DFS and OS were 24.8 (95% CI: 1.5- 48.1) and 28 (%95 Cl: 20.6-35.4) months respectively in patients who received adjuvant treatment however both were not reached in patients who did not receive any adjuvant treatment.
DISCUSSION AND CONCLUSION: In resected GBC, it is needed to prospective, randomized controlled trials for adjuvan treatment efficacy and choice of treatment modalities.

GÝRÝÞ ve AMAÇ: Radyoterapide tedavinin baþarýsý hedefe uygulanan dozun doðruluðu ile doðrudan iliþkilidir. Hedef volümün ve etrafýndaki saðlýklý doku ve organlarýn dozunu doðru hesaplamak kritik öneme sahiptir. Hesaplama algoritmalarýnýn dozimetrik hesaplamalardaki en önemli etkeni, etkileþime girilen maddenin fiziksel özellikleridir. Solunum kaynaklý hareket ile tümör ve saðlýklý akciðer dokusu etkilenmektedir ve bu nedenle tomografi görüntülerinde tümörün ve akciðerin þekli, pozisyonu, yoðunluðu deðiþebilmektedir. Bu solunum kaynaklý deðiþimler, tümör hacminin büyüklüðünü, tedavi bölgesinin Hounsfield Unit ve elektron yoðunluðu deðerlerini deðiþtirebilmektedir.
YÖNTEM ve GEREÇLER: Çalýþmamýzda 13 akciðer SBRT hastasý için NormalCT, BreathHoldCT ve AverageCT (4DCT) taramalarý yapýldý. Her bir teknikle taramasý yapýlan 13 hasta için; Gross tümör hacimleri (GTV) incelendi. Doz hesaplamasýnda önemli olan elektron yoðunluðu ve Hounsfield Unit deðerleri üç tarama için karþýlaþtýrýldý.
BULGULAR: BreathHoldCT’ye göre NormalCT de %19.3, AverageCT de %31.3 GTV daha büyük bulundu. NormalCT ve AverageCT ile GTV de yoðunluk azalýrken, etrafýnda saðlýklý akciðer dokusunda yoðunluk artmaktadýr. NormalCT ve AverageCT’de elektron yoðunluðu ve Hounsfield Unit deðerleri saðlýklý akciðer dokusu için benzer bulunurken, GTV için NormalCT de daha yüksek deðerler bulundu. GTV de elektron yoðunluðu ve Hounsfield Unit deðerleri bakýmýndan su eþdeðeri ortama benzer sonuçlar BreathHoldCT ile bulundu. AverageCT de ise en büyük farklar bulundu.
TARTIÞMA ve SONUÇ: Solunum hareketinden kaynaklý distorsiyon ve artifaklar BreathHoldCT ile minimize edilmektedir. BreathHoldCT ile daha solid ve sýnýrlarý daha belirgin görüntüler elde edilmektedir. BreathHoldCT ile elektron yoðunluðu ve Hounsfield Unit deðerleri solunum kaynaklý hareketten baðýmsýz olarak daha doðru hesaplanabilmektedir. BreathHoldCT’ye göre NormalCT ve AverageCT de akciðer yoðunluðu artmakta ve bu durum saðlýklý akciðerdeki doz daðýlýmýný etkilemektedir.

INTRODUCTION: The success of radiotherapy treatment is related with accuracy of dose delivery directly. The exact dose calculation of target volume and healthy organs surround are critically important. The most important effect of calculation algorithms on dosimetric calculations is the physical properties of the material being interacted. Tumor and healthy lung tissue are affected by respiratory motion. therefore, the shape, position, density of the tumor and lung could change in tomography images. The serespiratory variations could change the size of tumor volume, the Hounsfield Unit and electron density of the treatment region.
METHODS: In our study, normalCT, BreathHoldCT and AverageCT (4DCT) scans were performed for 13 lung SBRT patients. The tumor volumes (GTV) were investigated for 13 patients patients who were scanned with each technique. The electron density and Hounsfield Unit values which are important for dose calculation were compared for three scanning techniques.
RESULTS: We determined Tumor volume (GTV) 19.3% larger at NormalCT and 31.3% larger at AverageCT than BreathHoldCT. Density of GTV decreased in NormalCT and AverageCT, while healty lung tissiues’s density were increasing. Electron density and Hounsfield Unit values at NormalCT and AverageCT were similar with healthy lung tissue. We obtained higher values For GTV, in NormalCT. In terms of electron density and Hounsfield Unit values at GTV were equivalent the water results with BreathHoldCT. The biggest difference was found in AverageCT.
DISCUSSION AND CONCLUSION: Distortion and artifacts were caused by respiratory movement which were minimized by BreathHoldCT. More solid and clear boundary images could obtain with BreathHoldCT. Electron density and Hounsfield Unit values could be calculated more accurately, independent of respiratory motion With BreathHoldCT. Lung density is increasing in NormalCT and AverageCT, which affects the dose distribution in healthy lung.

GÝRÝÞ ve AMAÇ: Akut böbrek hasarý (ABH) intravenöz kolistin kullanan kritik hastalarda sýklýkla görülebilen bir durumdur. Oluþan nefrotoksisite doz baðýmlýdýr ve genellikle geri dönüþümlüdür, kalýcý böbrek hasarý nadiren görülür. N-Asetil Sistein (NAC) kullanýmýnýn böbrek hasarýndan koruyucu etkisi uzun yýllardýr araþtýrýlan bir konu olmuþtur. Biz bu çalýþmada yoðun bakým ünitemizde intravenöz kolistin kullanmýþ olan hastalarýmýzda beraberinde mukolitik amaçlý NAC kullananlarda akut böbrek hasarýný incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ankara Onkoloji Hastanesi Anestezi Yoðun Bakým Ünitesi’nde Haziran-Aralýk 2017 tarihleri arasýnda antimikrobiyal tedavi olarak intravenöz yoldan beþ gün ve üzeri kolistin kullanan 18 yaþ üzeri otuz beþ hasta çalýþmaya alýndý. Hastalar mukolitik dozda NAC kullanýp kullanmamalarýna göre retrospektif olarak incelendi ve iki gruba ayrýldý. NAC kullanan yirmi üç hasta kullanmayan on iki hasta tespit edildi. Mukolitik dozda kullanýlan NAC’ýn akut böbrek hasarý ile iliþkisi incelendi. Elde edilen veriler SPSS 24.0 programýnda frekans, çapraz tablolar ve Mann Whitney-U analizleri ile deðerlendirildi.
BULGULAR: Kolistin kullanan hastalarýn yirmi altýsýnda KDIGO kriterlerine göre ABH geliþti (%74,3). NAC kullanan ve kullanmayan grup arasýnda ABH oluþma oraný, mortalite oraný, mekanik ventilatör gün sayýsý, yoðun bakým yatýþ süresi arasýnda fark bulunamadý. Yatýþ sýrasýndaki eGFR düzeyi ile kolistin kullanýmý sonrasý ABH geliþimi arasýnda iliþki bulunamadý.
TARTIÞMA ve SONUÇ: Bu retrospektif çalýþmada mukolitik amaçlý NAC kullanýmýnýn kolistin nefropatisini engellemede baþarýsýz olduðu bulundu. Hayvan çalýþmalarýnda ve in vitro çalýþmalarda yüksek doz NAC’ýn kolistinin böbrek hasarý etkisinden koruyuculuðu gösterilmiþ olmasýna raðmen, yoðun bakýmda yatmakta olan hastalarda mukolitik dozda kullanýlan NAC’ýn kolistine baðlý oluþan ABH’dan koruyucu etkisi görülmedi.

INTRODUCTION: Acute kidney injury (AKI) is a common condition in critically ill patients using intravenous colistin. Nephrotoxicity is dose-dependent and usually reversible. The protective effect of the use of N-Acetyl Cysteine (NAC) on kidney injury has been the subject of research for many years. In this study, we aimed to investigate the AKI in our patients who have used intravenous colistin in our intensive care unit with N-Acetyl Cysteine for mucolytic use.
METHODS: In the Intensive Care Unit of Ankara Oncology Hospital between June-December 2017, thirty-five patients over 18 years of age who were using colistin via intravenous route for five days and above as antimicrobial therapy were included in the study. Patients were retrospectively examined and divided into two groups according to whether they were using NAC in the mucolytic dose. Twelve patients who did not use NAC and twenty-three patients who used NAC were detected. The relationship of NAC with AKI was investigated. The data were analysed by frequency, cross-tables and Mann Whitney-U analysis in SPSS 24.0 program.
RESULTS: In twenty-six of the patients who were using colistin, AKI developed according to the criteria of KDIGO (74.3%). There was no significant difference between AKI rate, mortality rate, number of days of mechanical ventilation and ICU length of stay among the NAC group and non-NAC group. There was no relationship between eGFR level during hospitalization and development of AKI after use of colistin.
DISCUSSION AND CONCLUSION: It was found that mucolytic use of NAC was unsuccessful in inhibiting the nephropathy of the colistin. Although high doses of NAC have been shown to be protective against kidney damage in animal studies and in vitro studies, no protective effect of NAC due to colistin was observed in patients who were in intensive care.

GÝRÝÞ ve AMAÇ: 1980’lerden günümüze kullanýlan ekipmanlarýn teknolojisindeki geliþmelerle perkütan nefrolitotomiyle (PNL) taþsýzlýk oranlarýnda artýþ, operasyon süresinde kýsalma, hastanede kalýþ süresinde azalma ile daha güvenilir ve etkin hale gelmiþtir. Ancak peroperatif ve postoperatif komplikasyon oranlarý zaman içerisinde azalmýþ ancak kaybolmamýþtýr. PNL, minimal invaziv bir yöntem olarak açýk taþ cerrahisinin yerini almýþtýr. Bu çalýþmamýzda olgularda geliþen komplikasyonlar modifiye Clavien sistemine göre ve PNL için uyarlanmýþ modifiye Clavien sistemine göre inceleyip farklýlýklarý saptamayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya Kasým 2004 ile Ocak 2013 tarihleri arasýnda kliniðimizde PNL operasyonu uygulanmýþ 928 hastadaki 980 renal üniteye uygulanan 1011 PNL operasyonu dahil edildi. Her ünite için preoperatif, operatif, postoperatif veriler retrospektif olarak deðerlendirildi. Hastalarda geliþen komplikasyonlar modifiye Clavien sistemine göre ve PNL için uyarlanmýþ modifiye Clavien sistemine göre sýnýflandýrýldý.
BULGULAR: Tüm vakalarda komplikasyon oraný %18.29 olarak bulundu. Clavien derecelendirilmesine göre derece 1’de 23 komplikasyon (%2.27), derece 2’de 143 komplikasyon (%14.14), derece 3A’da 11 komplikasyon (%1.08), derece 3B’de 6 komplikasyon (%0.59), derece 4A’da 4 komplikasyon (%0.39), derece 4B’de 15 komplikasyon (%1.48) görülürken, derece 5’e uygun komplikasyon görülmemiþtir. PNL için modifiye Clavien derecelendirilmesine göre derece 1’de 23 komplikasyon (%2.27), derece 2’de 144 komplikasyon (%14.24), derece 3A’da 22 komplikasyon (%2.17), derece 3B’de 9 komplikasyon (%0.89), derece 4A’da 4 komplikasyon (% 0.39) görülürken, derece 4B ve 5’e uygun komplikasyon görülmemiþtir.
TARTIÞMA ve SONUÇ: PNL’ye uyarlanmýþ modifiye Clavien sistemine göre sýnýflandýrmalarda düþük dereceli komplikasyonlarda fark saptanmazken; yüksek dereceli komplikasyonlarda düþüþ gözlenmiþtir. Bu nedenle PNL’ye uyarlanmýþ modifiye Clavien sistemine göre sýnýflandýrmanýn daha objektif olduðunu düþünmekteyiz.

INTRODUCTION: Percutaneous nephrolithotomy (PNL) in technology today with the development of the equipment used from 1980, the stone-free rate increase, reduction in operation time, with a reduction in length of hospital stay has become more reliable and efficient. However, the perioperative and postoperative complication rates decreased over time but did not disappear. PNL has substituted of open stone surgery as a minimally invasive method. In this study, we aimed to determine the differences in the complications developed according to the modified Clavien system and the modified Clavien system adapted for PNL.
METHODS: The study included 1011 PNL operations performed in 980 renal units in 928 patients who underwent PNL operation between November 2004 and January 2013 in our clinic. Preoperative, operative and postoperative data were evaluated retrospectively for each unit. Complications developed in patients were classified according to the modified Clavien system and the modified Clavien system adapted for PNL.
RESULTS: The complication rate was %18.29 in all cases. According to Clavien's classified, there were 23 (%2.27) complications in grade 1, 143 (%14.14) complications in grade 2, 11 (%1.08) complications in grade 3A, 6 (%0.59) complications in grade 3B, 4 (%0.39) complications in grade 4A, 15 (%1.48) complications in grade 4B were seen, but no complication according to grade 5 was observed. According to the modified Clavien classified for PNL, 23 (%2.27) complications in grade 1, 144 (%14.24) complications in grade 2, 22 (%2.17) complications in grade 3A, 9 (%0.89) complications in grade 3B, There were 4 (%0.39) complications in grade 4A, but no complications according to grade 4B and 5.
DISCUSSION AND CONCLUSION: Classification according to modified Clavien system adapted to PNL did not show any difference in low-grade complications; there was a decline in high-grade complications. Therefore, we think that classifying according to modified Clavien system adapted to PNL is more objective.

GÝRÝÞ ve AMAÇ: Nadir görülen ve iyi prognoza sahip olan evre I düþük grade-endometrial stromal sarkom (LG-ESS) hastalarýnýn incelenmesi ve nüks oluþumuna etki eden prognostik faktörlerin deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Tepecik eðitim ve araþtýrma hastanesi ve Zonguldak Bülent Ecevit üniversitesi týp fakültesinde, evre I LG-ESS tanýsý alan ve takiplere gelen 24 hasta retrospektif olarak incelendi. Çalýþmaya 1998-2016 yýllarý arasýnda, ameliyat ve takiplerini bu iki merkezde olan hastalar dahil edildi. Çalýþmaya alýnmama kriterleri; endometrial stromal nodül veya farklýlaþmamýþ stromal sarkom histolojik tipler, evre II,III ve IV ESS, eþlik eden baþka malignitelerin olmasý ve takiplere gelmeyen hastalar.
BULGULAR: Yaþ, adjuvan radyoterapi (RT), myometrial invazyon (MI), tümör boyutu ve mitoz sayýsýnýn lojistik regresyon analizine göre evre I LG-ESS hastalarýnda takipte nüks oluþma riski üzerine etkileri incelendi ve on büyük büyütme alanýnda ≥5 mitoz olmasý nüks riskini saptamada anlamlý iliþkili olduðu görüldü. Prognostik faktörlerin Hastalýksýz (DFS) ve toplam saðkalým (OS) sonuçlarý üzerine etkileri araþtýrýldý ancak istatistiksel olarak anlamlý etki eden faktör olmadýðý saptandý. Evre I, LG-ESS hastalarýnýn, 5 yýllýk OS %100, 10 yýllýk OS %86.2 ve 5 yýllýk DFS %91.7 ve 10 yýllýk DFS %85.1 olarak hesaplandý.
TARTIÞMA ve SONUÇ: LG-ESS hastalarý mükemmel prognoza sahiptir ve adjuvan RT tedavisi prognoz üzerine etki etmemektedir. Saðkalým süreleri uzun olan bu hastalarda adjuvan RT iþlemi nüks tedavisine saklanmalýdýr.

INTRODUCTION: To investigate patients with stage I, low-grade endometrial stromal sarcoma (LG-ESS) which is rare and has good prognosis and to evaluate prognostic factors affecting recurrence.
METHODS: Twenty-four patients with stage I LG-ESS diagnosis and followed-up in Tepecik Education and Research hospital and medical faculty of Zonguldak Bülent Ecevit University were investigated as retrospective. Patients who had undergone surgery and had follow-up at these two centers between 1998 and 2016 were included in the study. Exclusion criteria were endometrial stromal nodule or undifferentiated stromal sarcoma histologic types, stage II, III and IV ESS, accompanying malignancies and non-follow-up patients.
RESULTS: The effects of age, adjuvant radiotherapy (RT), myometrial invasion (MI), tumor size and number of mitotic figures on the recurrence risk of patients with stage I LG-ESS in follow-up were analyzed according to logistic regression analysis and it was found that there was a significant correlation between the risk of recurrence and presence of ≥5 mitosis in 10 microscopic high power fields. The effects of prognostic factors on disease free (DFS) and overall survival (OS) outcomes were investigated, but there was no statistically significant factor. 5-year OS and 10-year OS for Stage I, LG-ESS patients were calculated as 100% and 86.2%, respectively; 5-year DFS and 10-year DFS for those patients were 91.7% and 85.1%, respectively.
DISCUSSION AND CONCLUSION: LG-ESS patients have excellent prognosis and adjuvant RT therapy has no effect on prognosis. These patients have long survival time, adjuvant RT treatment should be considered in recurrence treatment.

GÝRÝÞ ve AMAÇ: Bu çalýþmada meme kanseri tanýsý almýþ ve onkoplastik cerrahi teknikleri ile tedavi edilmiþ hastalarda geliþen erken dönem yara komplikasyonlarý ve bu komplikasyonlara etki eden faktörler araþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Superior ve inferior pedikül onkoplastik cerrahi tekniklerinden biri uygulanarak opere edilmiþ 77 hastaya ait veriler retrospektif olarak incelendi. Hastalara ait veriler ile yara komplikasyonlarýnýn geliþip geliþmediði kayýt altýna alýndý.
BULGULAR: Yapýlan istatistiksel deðerlendirmeler sonucunda ileri yaþ, hipertansiyon ve doku aðýrlýðýnýn yara komplikasyon riskini arttýrdýðý tespit edilmiþtir. Çýkarýlan doku aðýrlýðý ve hipertansiyon baðýmsýz risk faktörü olarak saptanmýþtýr. Meme kanseri nedeni ile ameliyat edilen hastalardan oluþan serimizde minör komplikasyonlar %23.4 oranýnda görülmüþtür.
TARTIÞMA ve SONUÇ: Çalýþmamýzdaki minor komplikasyon oraný literatürde belirtilmiþ komplikasyon oranlarý ile uyumludur. Hasta yaþý, yara iyileþmesini etkileyen komorbid hastalýklar ve çýkarýlan doku hacmi arttýkça komplikasyon oranlarýnýn arttýðý bilinmektedir. Ýleri yaþ ve komorbid hastalýklarýn varlýðý komplikasyonlarý arttýran bir faktör olmakla birlikte ameliyat için kontrendikasyon teþkil etmez.Çalýþmamýz sonucunda elde ettiðimiz veriler de onkoplastik meme cerrahisinin, meme kanseri olan hastalarda klasik meme koruyucu cerrahi tekniklerinden daha geniþ eksizyon imkaný saðladýðý ve komplikasyon oranlarýný arttýrmadan güvenle kullanýlabileceðini göstermektedir.

INTRODUCTION: In this study, early wound complications and factors affecting these complications were investigated in patients diagnosed with breast cancer and treated with oncoplastic surgery techniques.
METHODS: The data of 77 patients who underwent surgery with superior or inferior pedicle oncoplastic breast surgery techniques were retrospectively analyzed. The patients' data and the information about wound complications were recorded.
RESULTS: As a result of statistical evaluations, it was determined that age, hypertension and removed tissue weight increased the risk of wound complications. The removed tissue weight and hypertension were found to be independent risk factors. In our series, our minor complication rate is 23.4%.
DISCUSSION AND CONCLUSION: Minor complication rate of our series is similar with the literature. It is known that the complication rates increases with patient age, comorbid diseases and the amount of removed tissue volume. Age and the presence of comorbid diseases are some of the factors that increase complications, but not a contraindication for the surgery. The data obtained from our study showed that; since oncoplastic breast surgery provides wider excision than classical breast-conserving surgical techniques, it can be used safely without increasing complication rates in the patients.

GÝRÝÞ ve AMAÇ: Kanser hastalarýnda damar yolu eriþimi hayati önem taþýyan bir konudur. Özellikle santral venöz basýnç monitorizasyonu, intravenöz kemoterapi, çoklu antimikrobiyal tedavi, laboratuvar inceleme için kan örneði alma, uzun süreli beslenme, kan ve kan ürünü transfüzyonu gibi iþlemlere kolaylýk saðlamasý sebebiyle sýklýkla ihtiyaç duyulur. Ancak bu grup hastalarda santral venöz kateterizasyon giriþimi ciddi komplikasyon riski içerir. Kateter iliþkili enfeksiyonlar ve kanama problemleri bu grup hastalarda önemli bir sorun oluþturmaktadýr. Santral venöz kateter uygulama bölgesine karar vermek ve yönetmek hematolojik malignensili hastalar için önem arz etmektedir. Biz de bu çalýþmada son bir yýl içinde anestezi yoðun bakým ünitesinde takip ettiðimiz hematolojik malignensili hastalardaki santral venöz kateter giriþimlerimizi uygulama bölgesi tercihimiz ve ortaya çýkan komplikasyon oranlarý açýsýndan retrospektif olarak incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bir yýl içerisinde yoðun bakýmda santral ven kateteri yerleþtirilmiþ hematolojik malignensi olan 40 hasta retrospektif olarak deðerlendirildi. Hastalar giriþim yeri, kanama, kateter enfeksiyonu ve kateterin kalýþ günü açýsýndan incelendi. Veriler bir kiþisel bilgisayarda SPSS 24.0 versiyon ile frekans, çapraz tablolar, mann whitney-u analizleri ile deðerlendirildi.
BULGULAR: Takýlan kateterlerin 16 tanesinin internal juguler ven/subklaviyen ven (%40), 24 tanesinin ise femoral ven (%60) olarak tercih edildiði tespit edildi. Takýlan kateterlerin üç tanesindeki üreme kateter iliþkili enfeksiyon olarak kabul edildi, bu kateterlerin yerleþim yeri femoral dýþý giriþimdi. Femoral dýþý giriþim yapýlan bir hastada kanama komplikasyonu görüldü. Femoral kateterlerin ortalama kalýþ süresi 5,8 gün internal juguler ven/subklaviyen venden yerleþtirilen kateterlerin ortalama kalýþ süresi 9,3 gün olarak tespit edildi.
TARTIÞMA ve SONUÇ: Hematolojik maligniteli ve yoðun bakým endikasyonu olmuþ hastalarda, gerekli asepsi kurallarýna uyulduðunda femoral kateterizasyonun enfeksiyon açýsýndan da güvenle tercih edilebileceðini, hemostaz açýsýndan uygun koþullar oluþtuðunda subklaviyen veya internal juguler vene geçilmesini tavsiye ediyoruz.

INTRODUCTION: Intravenous access in cancer patients is a matter of vital importance. In particular, central venous pressure monitoring, intravenous chemotherapy, multiple antimicrobial treatment, laboratory review of blood sample, long-term nutrition, blood and blood product transfusion as a convenience for such operations are often needed. However, in this group of patients, the central venous catheterization attempt involves a serious complication risk. Catheter-related infections and bleeding problems are a major problem in this group of patients. The decision and management of the central venous catheter is important for patients with haematological malignancies. In this study, we aimed to investigate the use of Central venous catheter interventions in hematologic malignancies patients who have followed anaesthesia intensive care unit in the last year and retrospectively in terms of the complication rate of our choice in the region.
METHODS: In one year, 40 patients with haematological malignancies with a central venous catheter were retrospectively evaluated. The patients were examined in terms of location, bleeding, catheter infection and the day of the catheterization. The data were analysed with SPSS 24.0 version on a personal computer.
RESULTS: 16 of the implanted catheters were preferred as internal jugular vein/subclavian vein (40%) and 24 as femoral vein (60%). Three of the implanted catheters were associated with catheter infection, the placement of these catheters was a non-femoral attempt. A patient with a non-femoral procedure had bleeding complication. The mean duration of the femoral catheters was 5.8 days and the mean duration of the catheters placed from the internal jugular vein/subclavian vein was 9.3 days.
DISCUSSION AND CONCLUSION: In patients with hematologic malignancy and intensive care indications, we recommend that femoral catheterization be safely chosen in terms of infection if the required asepsis rules are followed, and subclavian or internal juguler vene should be recommended when appropriate conditions are established for haemostasis.

GÝRÝÞ ve AMAÇ: Meme kanseri, halen kadýnlarda dünyada en sýk görülen kanser tipi olup; yine geliþmiþ ve geliþmekte olan ülkelerde kadýnlarda kansere baðlý ölüm nedenleri içerisinde ilk sýrada yer almaktadýr. Cerrahi ve cerrahi dýþý tedaviler yanýnda, kanserli hastalarda yaþam kalitesinin arttýrýlmasý oldukça önemlidir. Çalýþmamýzda kemik metastazý olan meme kanserli hastalarda fiziksel aktivite düzeyi ve yaþam kalitesinin deðerlendirilmesi amaçlanmaktadýr.
YÖNTEM ve GEREÇLER: Kemik metastazý olan ve olmayan meme kanseri ile takip edilen 100 hastada Uluslararasý Fiziksel Aktivite Anketi ve kýsa form-36 yaþam kalitesi ölçeði yardýmý ile kemik metastazý olan ve olmayan hastalarýn fiziksel aktivite düzeylerinin ve yaþam kalitelerinin belirlenmesini amaçlayan kesitsel bir çalýþmadýr.
BULGULAR: Kemik metastazý olmayan hastalarýn kemik metastazý olan hastalara göre fiziksel olarak daha aktif olduðu istatistiksel olarak saptanmýþtýr Kýsa Form-36'nýn alt ölçeklerine göre karþýlaþtýrýlmasýnda kemik metastazý olmayan hastalarýn fiziksel fonksiyon, fiziksel rol güçlüðü, aðrý, genel saðlýk, vitalite (enerji), sosyal fonksiyon, emosyonel güçlük, mental saðlýk puan ortalamalarýnýn kemik metastazý olan hastalara göre istatistiksel olarak anlamlý derecede yüksek olduðu saptanmýþtýr (p<0.001).
TARTIÞMA ve SONUÇ: Kanser tedavisi almalarýna raðmen kemik metastazý olmayan grupta, kemik metastazý olanlara göre fiziksel aktivite ve yaþam kalitesi oranýnýn her kategoride anlamlý olarak yüksek olduðu görülmüþ ve patolojik kýrýklarý olmasa da kemik metastazý sonrasý hastalarýn fiziksel aktivite düzeylerinin ve yaþam kalitesinin düþtüðü anlaþýlmýþtýr.

INTRODUCTION: Breast cancer is still the most common type of neoplasm in the world. It is also the first reaon of cancer-related death on women in developed and developing countries. In addition to surgical and non-surgical treatment, it is important to improve the quality of life in cancer patients. The aim of this study is to evaluate the physical activity level and quality of life on breast cancer patients with bone metastasis.
METHODS: A cross-sectional studywas done that aimed determining the physical activity levels and quality of life of patients with and without bone metastasis. International Physical Activity Questionnaire (short) and short form-36 quality of life questionnaire were used for 100 breast cancer patients.
RESULTS: It was found that patients without bone metastasis were physically more active than patients with bone metastases. In comparison of subscales of Short Form-36; physical functioning, role functioning, pain, general health, vitality (energy), social function, The mean scores of emotional health and mental health scores were found to be significantly higher in the without bone metastases group (p <0.001).
DISCUSSION AND CONCLUSION: In this study, it has been shown that though th cancer treatment, the ratio of physical activity and quality of life was significantly higher in the group without bone metastasis compared to those with bone metastasis and it was found that the physical activity levels and quality of life of the patients after bone metastasis were found to be decreased.

GÝRÝÞ ve AMAÇ: Kas iskelet sistemi benign ve malign tümörleri, önemli nörovasküler yapýlarla iliþkili olabilmektedir ve uygulanan bazý cerrahi prosedürlere damar cerrahý da eþlik etmektedir. Bu çalýþmada, nörovasküler yapýlarla iliþkili olabilen tümörlerin demografik incelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: 2010-2014 yýllarý arasý, ortopedi ve travmatoloji kliniðinde, kas iskelet sistemi tümörü nedenli ile ameliyat edilen ve ameliyata damar cerrahýn eþlik ettiði 56 hasta çalýþmaya dahil edildi. Hastalar yaþ, cinsiyet, benign/malign olmasý, kemik-yumuþak doku yerleþimi, histopatolojik taný ve tümör lokalizasyonu açýsýndan incelendi.
BULGULAR: Ortalama yaþý 36±xx std (2-76 yaþ arasý) olan 30 erkek ve 28 kadýn hastanýn 15 sýnda benign, 43 sinde malign tümör mevcuttu. En sýk görülen tümör malign mezenkimal tümör idi ve 14 vakada görüldü. En sýk görülen benign tümör, 6 vakada görülen osteokondromdu. En sýk tutulan lokalizasyon, 13 vakanýn görüldüðü uyluk idi.
TARTIÞMA ve SONUÇ: Nörovasküler yapýlara yakýnlýk gösteren ve damar cerrahýnýn operasyona eþlik ettiði tümörler, geniþ bir yaþ aralýðýnda görülebilmektedir. Sýklýkla malign tümörlerdir. En sýk uyluk ve diz lokalizasyona yerleþirler.

INTRODUCTION: Benign and malignant tumors of the musculoskeletal system may be related to important neurovascular structures. Therefore some surgical procedures are applied with cardiovascular surgery. In this study, demographic examination of the tumors which may be related to neurovascular structures is aimed.
METHODS: Between 2010 and 2014, 56 patients who were operated with cardiovascular surgeon due to musculoskeletal tumors in orthopedics and traumatology clinic were included in the study. Patients were examined for age, sex, benign / malignant features, bone-soft tissue location, histopathological diagnosis and tumor localization.
RESULTS: Among 30 male and 28 female patients with a mean age of 36 ± 17 std (2-76 years), 15 patients had benign and 43 patients had malignant tumors. The most common tumor was a malignant mesenchymal tumor and it was seen in 14 cases. The most common benign tumor was osteochondroma and it was found in 6 cases. The most common localization was the femur and it was seen in 13 cases in total.
DISCUSSION AND CONCLUSION: Tumors that are closely related to the neurovascular structure and therefore are operated with cardiovascular surgeon can be seen in a wide range of age. These are often malignant tumors. The most common localitazions are thigh and knee.

GÝRÝÞ ve AMAÇ: Nora’nýn lezyonu olarak da bilinen bizarre parosteal osteokondromatöz proliferasyon, kemikten egzofitik büyüme ile kendini gösteren, benign bir lezyondur. Bu çalýþmada, 2010-2018 yýllarý arasýnda tedavi edilen Nora lezyonuna sahip dört hastanýn deðerlendirilmesi ve kýsa bir literatür taramasý yapýlarak güncel bilgilerin incelenmesi amaçlandý.
YÖNTEM ve GEREÇLER: Ortalama yaþlarý 32+24 std (26-37 yaþ arasý) olan iki erkek ve iki kadýn toplam 4 hasta çalýþmaya dahil edildi. Hastalarýn tanýya kadar geçen süre ve semptomlarý, klinik bulgularý, kitle boyutu, MRI bulgularý, cerrahi tedavileri, tedavi sonuçlarý ve komplikasyonlar incelendi.
BULGULAR: Tüm hastalara marginal eksizyon yapýldý. En sýk kitle lokalizasyonu ön kolun uzun kemikleri idi. Bir vakada post-operatif 24. ayda rekürrens görüldü, nüks rezeksiyonu yapýldý. Diðer üç hastada takiplerinde nüks ya da komplikasyon görülmedi.
TARTIÞMA ve SONUÇ: Bizarre parosteal osteokondromatöz proliferasyon, vücudun birçok farklý lokalizasyonunda yerleþebilen, benign karaktere sahip ancak sýk rekürrens ile karþýmýza çýkabilen, nadir bir kemik lezyonudur. Ýyi bir preoperatif planlama ile yapýlan dikkatli bir marginal eksizyon, nüksün önlenmesinde en önemli anahtardýr.

INTRODUCTION and OBJECTIVE: Also known as Nora lesion, bizarre parosteal osteochondromatous proliferation (BPOP) is a benign exophytic lesion originated from the bone. In this study, we aimed to evaluate four patients with Nora lesion who were evaluated between 2010 and 2018, and to review current information through a brief literature screening.
MATERIAL and METHODS: A total of four patients with a mean age of 32 ± 24 years (26-37 years) including 2 female and 2 male patients were included in the study. Patients’ time to diagnosis and symptoms, clinical findings, mass size, MRI findings, surgical treatments, treatment outcomes and complications were investigated.
RESULTS: Marginal excision was made to all the patients. The most common mass localization was the long bones of the forearm. Recurrence was developed in one patient at postoperative 24th month, and underwent relapse resection. The remaining three patients did not develop relapse or complications at follow-up.
DÝSCUSSION and CONCLUSION: Bizarre parosteal osteochondromatous proliferation is a rare bone lesion, which may be localized in many different part of the body, has a benign character, but may be encountered with frequent recurrence. A careful marginal excision to performed with a good preoperative planning is the most crucial key in prevention of relapses.

Bu olgu sunumunda evre I düþük grade seröz over kanseri rekürrensi olan bir kadýnýn ayrýntýlarýný bildirdik. 72 yaþýnda bir kadýn izole paraaortik lenf nodu rekürrensiyle baþvurdu. Hastaya 2015 yýlýnda primer sitoredüktif cerrahi uygulanmýþtý. Bu cerrahi esnasýnda pelvik ve paraaortik lenfadenektomi uygulanmamýþtý. Aralýk 2017 esnasýnda uygulanan PET CT görüntülemede belirgin olarak aortokaval alanda paraaortik 2.7x1.8 cm lenfadenopati gösterildi. Bu olgu sunumunda düþük grade seröz over kanseri yönetiminde sistemik pelvik ve paraaortik lenfadenektominin önemini gösterdik.

In this case report, we reported the details of a woman with stage I low-grade serous ovarian carcinoma recurrence. A 72-year-old woman presented with isolated para-aortic lymph node recurrence. In 2015, she underwent primary cytoreductive surgery. A pelvic/para-aortic lymphadenectomy was not performed during this primary surgery. PET CT Examination on December 2017 clearly demonstrated para-aortic 2.7x1.8 cm lymphadenopathy in the aortocaval region (SUV max: 24.09). This case report shows that importance of systematic pelvic and para-aortic lymphadenectomy in the management of low-grade serous ovarian cancer.