Meme kanserli hastalarýn saðkalým hýzlarýndaki düzelme, meme kanseri için yapýlan tedavilerin sonucu olarak direkt veya uzun yaþam süreleri nedeniyle indirekt olarak geliþen östrojen eksiklik belirtilerinin daha fazla kadýn için sorun olmasýna sebep olmuþtur. Östrojen seviyesindeki düþme sonucu hipotalamik ýsý regüiasyon merkezi, vajen, deri, vasküler endotel, düz kas ve kemik gibi deðiþik doku ve organlar etkilenmektedir Saðlýklý kadýnlarda menopozal semptomlar için en etkili tedavi progesteronlu veya progesteronsuz östrojen replasman tedavileridir. Son dönemlerde, menopozda hormonaI içerikli ilaçlarýn kullanýmý ile ilgili; “The Women’s Health Initiative Study (WHI)” ve “The Million VVomen Study (MWS)"gibi klinik çalýþmalar yapýlmýþ ve meme kanserli hastalarda hormon replasman tedavisi tartýþmalý hale gelmiþtir. Bu grup hastalarda prospektif randomize çalýþmalarýn sonuçlan alýnana kadar hormon replasman tedavisi standart tedavi olarak önerilmemelidir. Fitoöstrojenler çeþitli derecede östroje-nik aktivite gösteren bitkisel kaynaklý bileþiklerdir. Fitoöstrojenlerin menopozal kadýnlarýn saðlýðý üzerindeki etkilerini deðerlendiren pek çok çalýþma vardýr. Antidopaminerjik bileþikler (metildopa ve veraliprid gibi) ve a-adrenerjik reseptör agonistleri (klonidin gibi), selektif serotonin re-uptake inhibitörleri (SSRI) sýcak basmasý ve premenstrüal semptomlarýn düzeltilmesi amacýyla kullanýlmýþtýr. Meme kanserli hastalarda menopozal semptomlar için etkili ve güvenli hormonaI olmayan tedavilere acilen ihtiyaç vardýr. Kanser hikayesi olan menopozal semptomlu hastalara hasta merkezli, multidisipliner yaklaþýmlar gereklidir.

Because of improved survival rates in breast cancer, more women are having to face the conseçuences of estrogen depri-vation, be it directly as a result of their treatment or indirectly simply through living longer. The resulting fail in estrodiol levels af-fect various tissues and organs, including the hypothalamic temparature-regulating centre, vagina, skin, vascular endothelium, smooth muscle, and bone. Estrogen replacement therapy (with and without added progestins) is the most effective treatment for menopausal symptoms in healthy vvomen. Recently, some studies related with hormonaI treatment at menopause were perfor-med; The IA/omen's Health Initiative Study (WHI), The Million Women Study (MWS) and the use of hormone replacement therapy in breast cancer survivors in controversial, and until the results from prospective randomized trials are available, cannot be recommended in this group as a Standard çare. Phytoestrogens are a large family of plant-derived molecules possessing various degrees of estrogen-like activity. There have been several studies performed with phytoestrogen in various aspects of the postmenopausal vvomen health. Antidopaminergic compounds (such as methyidopa and veralipride) and a-adrenergic-receptor agonists (such as clonidine), selective seratonin reuptake inhibitors (SSRI) were used for menopausal hot flashes and preme-nopausal symptoms. Safe and effective non-hormonal treatments for severe menopausal symptoms after breast cancer are ur-gently needed. The management of menopausal symptoms in patients with a history of cancer requires a patient-centred, but multidisciplinary approach.

Arka Plan: Bu çalýþmanýn amacý, aksiller disseksiyonda tüm aksillayý güvenli bir þekilde temsil edecek minimum lenf nodu sayýsýný beiiriemektir. Yöntem: Ekim 1999-Aðustos 2002 tarihleri arasýnda tedavi edilen 411 erken evre meme kanserli hastanýn kayýtlarý retrospektif olarak deðerlendirildi. Çýkarýlan toplam aksiller lenf nodu sayýsý, metastatik lenf nodu sayýsý, tümör boyutu, grad ve lenfovasküler invazyon varlýðý incelendi. Bulgular: Hastalarýn %60’ýnda aksiller lenf nodu metastazý saptandý. Çýkarýlan ortalama lenf nodu sayýsý 20.2 ± 0.4, metastatik lenf nodu sayýsý ise 3.6 ± 0.3 olarak bulundu. Aksillasýndan toplam 6-15 lenf nodu ile 16 ve üzeri lenf nodu disseke edilen hastalar arasýnda metastatik lenf nodu oraný bakýmýndan anlamlý fark olduðu tespit edildi (sýrasýyla %45 ve %78). En yüksek aksiller metastaz oraný, 16-20 lenf nodu çýkarýlan hastalarda saptandý (%68). Yirmi’den fazla lenf nodu çýkarýlan grupta aksiller metastaz oraný daha yüksek deðildi. Sonuçlar: Genel olarak aksi Ýlasý negatif meme kanserli hastalarý güvenle belirlemek için, aksiller disseksiyonla minimum 10 lenf nodu çýkarýlmasý gerektiði kabul edilmekle beraber, bu çalýþmanýn sonuçlarýna göre bu sayýnýn en az 16 olmasý gerektiði ileri sürülebilir.

Background: The aim of this study is to determine the minimum number of lymph nodes that confidently represents the complete axilla in an axillary dissection. Methods: The medical records of 411 patients vvith early breast cancer treated betvveen October 1999 andAugust 2002 were evaluated retrospectively. Total number of axillary lymph nodes removed, number of metastatic nodes, tumoursize, grade, and presence of lymphovascular invasion were revievved. Results: Axillary node metastases were detected in 60% of patients. The mean number of nodes collected was 20.2±0.4, vvith a mean of 3.6 ± 0.3 metastatic nodes. There was a significant difference in terms of the rate of metastatic nodes betvveen the patients vvith 6-15 nodes removed and those vvith 16 or more removed, 45% and 78%, respectively. The highest rate of metastatic nodes was determined in patients vvith 16-20 nodes removed (68%). The rate of axillary metastasis was not higher in group vvith more than 20 nodes removed. Conclusions: Although it is generaiiy considered that minimum 10 lymph nodes should be removed in an axillary dissectin to confidently determine the patients vvith breast cancer who had negative axiiiary node status, according to the results of this study, hovvever, it might be stated that the number of lymph nodes collected should be minimum 16.

Tiroid bezi nodüllerinin US kýlavuzluðundaki ince iðne aspirasyon biyopsisi (ÝÝAB) yönteminde, 21 G ve 22 G enjektör iðnelerinin sitolojik açýdan karþýlaþtýrýlmasý, çalýþmamýzýn amacýný oluþturmaktadýr. Eylül 2005-Ocak 2006 tarihleri arasýnda yeþil uçlu 21 G iðne ile yapýlan 102 adet ÝÝAB’nin (Grup 1), Þubat 2006-Mayýs 2006 tarihleri arasýnda siyah uçlu 22 G iðne ile yapýlan 136 ÝÝAB'nin (Grup 2) sitolojik sonuçlarýný istatistiksel olarak inceledik. Olgularýn malign (pozitifj/benign (negatif) oranlarý Grup 1 ile Grup 2 arasýnda farklý deðildi (p= 0.292). Yaþ, cinsiyet, biyopsiyi yapanlar, kullanýlan enjektörler, nodul boyutu ve özellikleri her iki grupta benzerdi (p> 0.05). Biyopsi sonuçlarý kan elemanlarý ve yetersiz materyal gelen olgular ile yalancý pozitif veya negatif olduðu takibinde anlaþýlan olgular baþarýsýz, doðru pozitif ve negatif çýkan olgular ise baþarýlý kabul edildi. Þüpheli malign sonucu gelenler dahil/hariç tutularak her iki durumda analiz yapýlmýþtýr, iðne gruplan arasýndaki baþarý karþýlaþtýrýlmýþým Olgularýn yaþ ortalamasý 47.5 ± 12.3 yaþ (Grup 1 ’de 46.8 ± 12.5, Grup 2’de 48.0 ± 12.2), erkek/kadm olgu %30.8 (Grup 1 ’de %37.8, Grup 2’de %25.9) idi. Deðerlendirmeye alýnan Grup 1 olgularýnýn %15.11 (13 olgu) baþarýsýz, %84.9’u (73 olgu) baþarýlý, Grup 2 olgularýnýn %8.3'ü (10 olgu) baþarýsýz, %91.7’si (110 olgu) baþarýlý bulunmuþtur. Grup 2 daha baþarýlý olmasýna karþýn, 2 grup arasýnda istatistiksel fark anlamlý bulunmamýþtýr (p= 0.127). Þüpheli malign olgular da dahil edildiðinde sonuç deðiþmemiþtir (p= 0.102). Toplam 238 olguda, genel doðruluk %87.4, pozitif prediktif deðer %100 ve negatif prediktif deðer %85.0 bulunmuþtur. Komplikasyon her iki grupta da görülmemiþtir. Tiroid bezi ÝÝAB’sinde 22 G siyah uçlu iðne ile 21 G yeþil uçlu iðne olgularýna göre yüzde baþarý oraný, istatistiksel fark önemli olmamasýna karþýn, daha fazla bulunmuþtur. 21 G veya 22 G iðne ile daha ince iðne karþýlaþtýrmasý, baþarý oranýný istatistiksel olarak anlamlý derecede artýrabilir.

To compare cytological betvveen 21 G and 22 G injector needles in the US-guided fine-needle aspiration biopsy (FNAB) met-hod of thyroid gland nodules forms the basis of our study. We statistically evaluated cytological results of 102 FNAB performed vvith 21 G (green) needles betvveen 2005 September-2006 January (Group 1) and 136 FNAB vvith 22 G (black) needles betvveen 2006 February-2006 May (Group 2). The rates of maügnant (positive)/berýign (negative) were not different between Group 1 and Group 2 (p= 0.292). Age, gender, performers of FNAB, injectors used, size and features of nodules were similarat eithergroup (p> 0.05). The patients whose biopsy results were blood elements and non-diagnostic and who were found false positive or faise negative at follow-up were accepted unsuccess-ful, whereas the patients who were true positive or true negative were successful. Analysis was performed in both conditions where the patients diagnosed as suspected maiignant were included/excluded. Success was compared betvveen both needle groups. The mean age of the patients and male/women ratio were 47.5 ± 12.3 years (46.8 ± 12.5 in Group 1, 48.0 ± 12.2 in Group 2) and 30.8% (37.8% in Group 1, 25.9% in Group 2) respectiveiy. 15.1% (13 cases) of Group 1 was unsuccessful and 84.9% (73 cases) successful; whereas 8.3%> (10 cases) of Group 2 was unsuccessful and 91.7% (110 cases) successful. Although Group 2 was more successful; the statistical difference was not significant betvveen 2 groups (p= 0.127). The result was the same in including of suspected maiignant cases (p=0.102). Ýn total 238 cases, 87.4% in accuracy, 100% in positive predictive value, and 85.0% in negative predictive value were found. No complication was observed in either group. Success rate percent, despite not significant statistical difference, in the cases of thyroid FNAB vvith 22 G needles (black) was higher than that vvith 21 G needles (green). To compare 21 G or 22 G needles vvith the thinner needles can make significant increase in the success rate statistically.

Çalýþmamýzda, kliniðimizde son 12 yýlda (1992-2004) yapmýþ olduðumuz adrenal bez tezyonu olan 33 olguda, yalnýzca US eþliðindeki ince iðne aspirasyon biyopsisinin etkinliðini araþtýrmayý planladýk. Takip sonucu olan 22 olgunun, 4’ü kadýn, 18’i erkek (kadýn/erkek oraný= %22.2) ve yaþ ortalamasý 54.0 ± 13.0 yaþ (27-75 yaþ) idi. Yirmi iki olguda (kayýp 11 olgu dýþýnda) lezyonlarýn %63.6’sý (14 olgu) sað adrenal bez, %36.4’ü (8 olgu) sol adrenal bez yerleþimliydi. Lezyonlarýn boyutlarý 2.5-6 cm arasýnda deðiþiyordu. Olgulardan kesin taný elde edilen 22 olguda baþarý (doðruluk) deðerlendirmesi yapýldý. Yetersiz materyal sonucu alýnan 5 (%23.0) olgu, yanlýþ negatif kabul edildi. Bir olguda lipom tanýsý kondu, ancak ikinci doku tanýsý düþük ‘grade’li liposarkom idi. Þüpheli malign tanýsý, patolojik veya klinik olarak malign çýktýðýnda, baþarýlý olarak kabul edildi. Malign olarak deðerlendirilen dokuz olgu ve þüpheli malign tanýsý alan altý olgudan, daha sonra patolojik taný veya klinik bulgularla benign olduðu anlaþýlan yanlýþ pozitif hiçbir olgu olmadý. Özgüllük %100 bulunmuþtur. Yedi metastaz ve altý þüpheli malign olgunun tümü, deðiþik organlardan kaynaklanan metastaz olarak bulunmuþtur. Toplam altý olgu yanlýþ negatif olarak deðerlendirilmiþtir. Benign tanýsý alan iki olgudan biri yanlýþlýkla lipom, diðeri doðru olarak adenom tanýsýný almýþtýr. Duyarlýlýk %71.4 ve doðruluk %73.0 idi. Cinsiyet ve sað-sol lokalizasyona göre, baþarý farklý bulunmamýþtýr (p> 0.05). Adrenal bezde, > 2.5 cm kitlesi olan hastalarda taný koyabilmek amacýyla, perkütan US kýlavuzluðunda yapýlan ince iðne aspirasyon biyopsisi güvenilir ve etkin bir yöntemdir. Sonuç alýnamazsa, bilgisayarlý tomografi veya sol adrenal bezde gerekirse endoskopik US kýlavuzluðunda tekrarlanmalýdýr.

Ýt was planned to investigate the efficiency of US-guided fine-needle aspiration biopsy betvveen 1992 and 2004 in 33 patients who had lesions in adrenal glands in our department. Of 22 patients who were follovved-up, 4 were vvomen and 18 were men (women/men rate= 22.2%); mean age was 54.0 ± 13.0 years, ranging betvveen 27 and 75 years. Ýn 63.6% (14 patients) and 36.4% (8 patients) were located in the right and left adrenal glands respectively. The diameters of lesions varied betvveen 2.5 cm and six cm. Evaluation of success (accuracy) was realized in 22 patients having definitive diagnosis. Ali 5 patients (23.0%) diagnosed, inadequate material, was accepted false negative. The diagnosis of lipoma was established, but second tissue diagnosis was vvell-differentiated liposarcoma. The diagnosis of suspected malign ývas found successful if outcome was maiignant pathologically or clinically. Among nine patients evaluated as maiignant and six patients suspected maiignant there tvas no patient who was found benign vvith pathologic or clinical diagnosis, false positivety. The specificity was 100%. Ali the patients of seven patients vvith metastasis and six patients suspected maiignant had metastases originated from various organs. Totally six patients were false negative. Of two patients who were diagnosed benign one was lipoma falsely, the other adenoma accurateiy. The sensitivity and accuracy were 71.4% and 73.0% respectively. There was detected no difference in the success due to gender and right-left localizations (p> 0.05). Percutaneous US-guided fine-needle aspiration biopsy is a saf e and effective method aiming to diagnose in the patients vvith adrenal gland masses greater than 2.5 cm. Ýt should be repeated vvith CT-guided or vvith endoscopic US-guided, if needed in left adrenal gland, if it is not concluded.

Kinolonlar, mükemmel biyoyararlanýmý olmasý, toksisitelerinin azlýðý ve çoðu Enterobacteriaceae üyesine ve büyük oranda Pseudomonas spp. ve Staphylococcus spp. suçlarýna etkisi nedeniyle tedavide sýkça kullanýlmaktadýr. Bu çalýþmada Ankara Onkoloji Hastanesinde Ocak 2005-Eylül 2006 tarihleri arasýnda ortopedi kliniðinde yatarak ve ayaktan tedavi gören ve infeksiyon hastalýklarý bölümünden konsültasyonu istenen hastalardan alýnan yara kültürlerinde üreme oranlarý ve üreyen mikroorganizmalarýn kinolon duyarlýlýðý retrospektif olarak deðerlendirilmiþtir. Kinolon duyarlýlýðý 132 mikroorganizmada (%79.04) test edilmiþtir. Test edilen tüm mikroorganizmalarýn 67 (%50.76)’si kinolon duyarlýyken 65 (%49.24)’i dirençliydi. Kinolon duyarlýlýðý test edilen 81 gram-negatif mikroorganizmanýn 37 (%45.68)'si, 51 gram-pozitif mikroorganizmanýn da 28 (%54.90)’i kinolon dirençli bulunmuþtur. Profilaksiden ampirik tedaviye kadar tüm alanlarda kinolon kullanýmýnýn daha dikkatli yapýlmasý direnç oranlarýnýn daha da artmamasý açýsýndan önemsenmelidir.

Because of their good bioavailability, minimal toxicity, effect on Enterobacteriaceae (especially on Pseudomonas spp.) and staphylococci quinolones are frequently used in treatment of orthopedic infections. Ýn this study quinolon susceptibility were evaluated in cultures obtained from orthopedic patients in January 2005-September 2006 period. ûuinolon susceptibility were tested in 132 isolated microorganisms, 67 ofthem (50.76%) were susceptibie and 65 isolates (49.24%) were found to be resistant to quinolons. ûuinolon resistance among gram-negatives was 45.68 percent and in gram-positives ývas 54.90 percent according to these data approximately half of isolated microorganisms in our study (gram-negative or gram-positive) were resistant against quinolon. Quinolon should be carefully used as empirical prophylactic agent for prevention of increasing resistance.

Hepatit delta virüsü (HDV) hepatit B virüsü (HBV) varlýðýnda infeksiyon oluþturabilen detektif bir RNA virüsüdür. Dünyada 10 milyon kiþinin HDV ile infekte olduðu tahmin edilmektedir. Doðu ve Güneydoðu Anadolu bölgelerinde yapýlan epidemiyolojik çalýþmalarda HBV ile infekte olan kiþilerin yaklaþýk %20'sinde delta süper infeksiyonu olduðu göz önünde bulundurulursa delta hepatitin ülkemiz için önemli bir saðlýk sorunu olduðu kabul edilebilir. Bu çalýþmada polikliniðimizce takip edilen hepatit B infeksiyonlu kiþilerde anti-HDV sýklýðý araþtýrýlmýþtýr. HDV antikoru ELISA (Abbott Axsym) yöntemiyle çalýþýlmýþtýr. Çalýþmaya alýnan 86 hastanýn 84 (%97.67)’ünde anti-HDV negatif, 2 (%2.33) hastada ise pozitif bulunmuþtur. Çalýþmamýzýn sonuçlarýna göre bölgemiz HDV infeksiyonu açýsýndan düþük endemisiteli olarak görülmektedir. Ancak, kronik hepatitlerden delta hepatitinde siroz ve terminal karaciðer yetmezliðine gidiþ daha hýzlý olduðundan, HBV ile infekte bireylerde delta hepatitinin varlýðý, araþtýrýlmasý gereken önemli bir konudur.

Hepatitis D virüs (HDV) is a defective RNA virüs that produce infection onty in the presence of hepatitis B virüs (HBV). Ýt is estimated that about 10 million people are infected vvith HDV worldwide. Epidemiologic investigations show that about 20% of the HBV carriers in east and southeast Turkey have HDV süper infection, therefore HDV infection can be considered one of the important health problems in our country. in this retrospective study we measured prevalence of anti-HD V antibody in our HBsAg positive patients. Anti-HDV antibody were detected by enzyme-iinked immunosorbent assay (ELISA-Abbot Axsym). From 86 patients that were included in the study 84 patients (97.67%) were negative for anti-HDV antibody. According to this result prevalence of HDV infection in our patient population is low, however because HDV infection in patients who are chronicaly infected vvith HBV can progress more rapidly tovvard cirrhosis and terminal hepatic failure we prefer and suggest screening for anti-HDV antibody in HBV infected patients.

Timomalarýn %15 kadarýnda çeþitli kanserler (akciðer, kolon, yumuþak doku, dijestiv sistem gibi) ikincil maligniteler olarak bildirilmiþtir. Mediastinal kitle ön tanýsýyla dýþ merkezde tetkik edilen 44 yaþýndaki erkek hastanýn sol torakotomi + kitle eksizyonu sonrasý patoloji raporu; mikst tip timoma, kapsül invazyonu pozitif olarak rapor edilmiþti. Postoperatif radyoterapi amacýyla kliniðimize refere edilen hasta Evre 2 olarak deðerlendirildi ve mediasten + primer kitle iojuna toplam 56 Gy radyoterapi uygulandý. Takipte radyoterapi sonrasý dördüncü ayda çekilen toraks tomografisinde nüks kitle saptanmayan hastanýn izlemleri 6 yýl boyunca hastalýksýz devam etti. Ancak radyoterapiden altý yýl sonra nefes darlýðý ve hemoptizi yakýnmalarýyla dýþ merkezde sað akciðer üst lobdan yapýlan bronkoskopik biyopsi sonucu; küçük hücreli dýþý akciðer karsinomu gelen hastanýn toraks tomografisinde; sað hilus üst arka komþuluðunda içi hava dolu, sað ana bronþ ile iliþkili kaviter lezyon saptandý. Ardýndan sisplatin + gemsitabin kemoterapisi planlanan hastaya bu aþamada radyoterapi düþünülmedi. Hasta kemoterapi baþlanamadan abondan hemoptizi nedeniyle bir ay içerisinde kaybedildi.

Various cancers (lung, colon, soft tissue, digestive system ete.) have been reported as second malignaney in about 15 percent of patients with thymoma. A 44 year old man who has mediastinal mass was performed left toracotomy and mass excision and diagnosed as mixt type thymoma and capsule invasion. After the patient was referred to our ctinic for postoperative radiotherapy and was evaluated as stage 2. Total dose of 56 Gy was planned to mediasten and primary mass area. Ýn follow-up thorax computerized tomography taken fourth months after radiotherapy was normal and routine Controls were vvithout iitness during six years. Unfortunately six years after radiotherapy fiberoptic broncoscopy was applied from upper lobe of right lung because of dyspnea and hemoptysis and nonsmall celi lung cancer was estabilished. At the same time thorax computerized tomography showed right hilar mass and caviter lesion associated vvith this. Therefore, chemotherapy was planned vvith Cisplatin and Gemcitabin. But the patient ývas lost because of severe hemoptysis before chemotherapy in one month.

Sakral kordomalar nispeten nadir görülen, lokal invaziv, malign tümörlerdir. Yüksek baþarýsýzlýk oraný ve kötü fonksiyonel geri dönüþle karakterizedirler. Kliniðimizde 2000-2006 yýllarý arasýnda takip edilen altý sakral kordoma olgusu sunulmuþtur. Primer malign bir kemik tümörü olan sakrokoksigeal kordomalarýn radyoterapi ve kemoterapiye yetersiz yanýtý nedeniyle optimal tedavi olarak komplet eksizyon gereklidir. Kordomalarýn komplet çýkarýlmasý için uygun cerrahi sýnýr, tutulan dokulara ve tümörün lokalýzasyonuna göre deðiþmektedir. Tümörün derin dokulara invazyonu sonucu peivik instabilite ve üriner-fekal inkontinans gibi komplikasyonlardan korunmak amacýyla lokal rekürrens ile sonuçlanan inkomplet eksizyon yapýlmaktaysa da, biz tedavide komplet rezeksiyon ve lokal rekürrens halinde ise agresif müdahaleyi savunuyoruz.

Sacral chordomas are relatively rare, locally invasive, maiignant neoplasms. Chordomas is characterized by a high failure rate and a poor fonctional outcome. Six patients were treated for sacral chordoma between 2000-2006 in our clinic. Due to inadequate response to chemo and radiotheraphy, sacrococcygeal chordoma which is a primary malign bone tumour should be excised completely as an optimal therapeutic modality. Complete surgical exploration depends on site of affected tissues and tumour localisation. To prevent these postoperative complications such as pelvic instability, urinary-feacal incontinence, incomplet excision may be a treatment option vvith high local reccurence rate. We advocate an attempt at complete resection and aggressive treatment of local reccurence.

Mesane tümörünün sýk tekrarlamasýnýn bir nedeni de, TUR sonrasý rezidü tümör oranýnýn yüksek olmasý olabilir. Bu nedenle bazý otörler tüm yüzeyel mesane tümörlü hastalara ikinci TUR önermektedir. Fakat ikinci TUR’un yüzeyel mesane kanserindeki yeri hala tartýþmalýdýr. Bu çalýþmada yüzeyel mesane tümörlü hastalarda ikinci TUR’un yeri araþtýrýldý. Ocak 2004-Ocak 2005 tarihleri arasýnda mesane tümörü nedeni ile hastanemiz üroloji kliniðine baþvuran, daha önce bir veya birkaç kez öpere edilmiþ ve ikinci mesane tümörü rezeksiyonunu kabul eden 20 hasta çalýþmaya dahil edildi. Çalýþmaya dahil edilen tüm hastalara ilk rezeksiyonlarýndan iki-altý hafta sonra ikinci bir rezeksiyon uygulandý. Ýkinci tümör rezeksiyonunun histopatolojik sonuçlarý son rezeksiyon sonuçlarý ile rezidü tümör varlýðý, tümör evre ve grade deðiþimine, tedavi ve takipte deðiþime yol açýp açmadýðý açýsýndan karþýlaþtýrýldý. Çalýþmaya dahil edilen 20 hastanýn 3 (%15)’ü kadýn, 17 (%85)'si erkekti. Kadýn hastalarýn ortalama yaþý 61.7 (55-68), erkek hastalarýn 59.6 (29-71) idi. Hastalara yapýlan ikinci rezeksiyon sonucunda 7 (%35) hastada rezidü tümör saptanmýþtýr. Bunlarýn 5 (%25)'i Ta, 2 (%10)’si T1 idi. Sonuç olarak yüzeyel mesane tümörlerindeki sýk rekürrens oranýnýn bir nedeni de yetersiz cerrahi olabilir, ikinci TUR'un, gözden kaçmýþ tümör yayýlýmýnýn erken saptanmasýna ve tedavisine olanak saðlayarak, sistektomi ihtiyacýný azaltacaðý ve saðkalým üzerine olumlu etkileri olacaðý kanaatindeyiz.

Transurethral tumor resection (TUR) is the first treatment step in bladder cancer. Ýt is a diagnostic, prognostic and also the-rapeutic procedure. Ali further treatment decisions, if any, are based on the results of the TUR. However, the histologic diagnosis may be compromised by fulguration of the surgical specimen or by incomplete resection of the tumor and this increases the risk of early recurrence and progression. Therefore some investigators suggest second TUR routinely in ali cases of superficial bladder cancer. However, the role of second TUR is stili controversial. The objective of this study was to evaluate the value of second TUR in patients vvith superficial bladder cancer. From January 2004 to January 2005 a total of 20 patients vvith superficial bladder cancer (stage Ta and Tl) undervvent second TUR in our clinic. Ali second TUR were video assisted and 26 F 30° optic Kari Storz™ resectoscopes were used. Firstly the visible tumor was resected, also resection of tumor margin and tumor base to the dee-per muscle layer were performed. Subsequent operations were performed vvithin 2 to 6 weeks. The histopathologic reports of the first and second TUR specimens of ati patients included in our study were revievved. The rate of residual tumor tissue after the initial resection was determined and correlated vvith the tumor characteristics and histologic findings during the first operation. No operative com-plication was visualized. Of the 20 patients 3 (15%) were female, 17 (85%) male. The mean age of femaie and male patients were 61.7 and 59.6, respectively. 55% of patients were in stage Ta and 45% in stage T1. Divided by grade, 6 (30%) patients had grade 1, 14 (70%) had grade 2 tumor. Nine patients had unifocal, 11 had multifocal tumor. Second TUR 2-6 vveeks later showed persisting carcinoma in 7 of 20 patients. Of these 7 patients 5 had Ta, 2 had T1 tumor. No upstaging was observed in any patients. Persisting tumor found at second TUR was independent of patient’s age and sex, but most of patients vvith residual tumor (86%) had multifocal disease. Retrospective studies have shown that second TUR some weeks later stili revealed tumor in 30% to 70% of patients and 80% ývere found on the initial localisation. Also surgeon’s experience was found to have no effect on the rate of tumor detected at the second TUR. Significant proportion of superficial bladder cancer recurrences might be due to high rate of tumor left behind. Second TUR may be useful as it provides a better evaluation of clinical stage and seeks out residual tumor. Also it may provide better long-term recurrence free survival and may decrease the need for radical cystectomy. Ýn the light of our data and literatüre, second TUR is a saf e procedure vvith low morbidity and virtually no complication, so should beco-me a routine procedure in patients vvith superficial bladder cancer. To evaluate the true impact of second TUR, larger prospecti-ve randomized trials should be conducted.

Tiroglossal kanal kistinde malignite geliþimi son derece nadir bir durum olup çoðunlukla ince iðne aspirasyon biyopsisi materyali ya da total eksizyon spesimeninin histopatolojik incelemesi esnasýnda tesadüfen saptanýr. Tiroglossal kanal kistinin total eksizyonu ile histopatolojik olarak taný konmuþ bir papiller karsinom olgusu sunuyoruz. On bir yaþýnda erkek hasta boyun orta hatta iki adet þiþlik yakýnmasýyla baþvurdu. Ýki yýl önce dýþ merkezde tiroglossal kanal kisti total eksize edilerek papiller karsinoma tanýsý almýþ olan hastanýn fizik muayenede boyun her iki tarafta lenfadenopatiler tespit edilerek total tiroidektomi ve bilateral modifiye radikal boyun diseksiyonu uygulandý. Hastada halen tespit edilebilmiþ lokal nüks ve metastatik bulgu yoktur. Tiroglossal kanal kistinde geliþen papiller karsinomlarýn nadir görülmesi sebebiyle olgunun tedavi planlamasý yapýlýrken total tiroidektomi ve klinik olarak boyun bölgesinde ele gelen lenf bezi varlýðýnda boyun diseksiyonunun da eklenmesinin uygun tedavi seçeneði olacaðý görüþündeyiz.

As the maiignant lesion from thyroglossal duct cyst is extremely rare; the diagnosis of malignaney was made incidentally on hystologic study of the excised surgical specimen or examination of fine needle aspiration material. We deseribed a case of tyroglossal duct cyst in which the histopathological examination of tyroglossal cyst surgical specimen established presence of papillary carcinoma. A 11 year old male presented with 2 neck swelligs. Two years earlier tyrogloss al cyst excision was done and histopathological examination showed presence of papillary carcinoma. On physical examination lymph nodes on both side of the neck determined and total thyroidectomy bilateral modified neck disseetion performed. The patient has no evidence of local recurrence or methastazis. Due to the unusuality of papillary carcinoma of thyroglossal cyst tve believe that total thyroidectomy and bilateral modified neck disseetion is the appropriate surgical approach when there is lymph nodes on physical examination.

Valproik asit (VPA), sýkça kullanýlan, oldukça teratojen olduðu bilinen bir antiepileptik ilaçtýr. Özellikle gebeliðin ilk 8 haftasýnda kullanýmýyla teratojenik etkisinin arttýðý bilinmektedir. Fetusta oluþan anomaliler arasýnda birçok sistemik tutulum ve kra-niofasial anomaliler bildirilmiþ olmakla beraber daha önce literatürde bildirilen kraniofasial anomaliler arasýnda araknoid kiste rastlanmamaktadýr. Gebeliðinin ilk 8 haftasýnda VPA kullanmýþ olan epileptik gebede izlediðimiz fetal araknoid kistin bu antiepi-leptiðin kullanýmýna baðlý olabileceðini düþünerek, VPA’nýn teratojenik spektrumunun bilinenden daha geniþ olabileceðini tartýþmak amacýyla vakayý sunuyoruz.

Valproic acid (VPA) is a commonly used antiepileptic drug, that is well known to be a potent teratogen. Especially, its use in the 8 weeks of pregnancy increases this teratogenic potential. Among these anomalies caused by VPA are many forms of syste-mic involvement and craniofacial anomalies, however there was no case of arachnoid cyst. Here, we present a case of fetal arachnoid cyst in an epileptic pregnant vvomen who used VPA which is the most probable reason for this teratogenic effect, to draw attention to teratogenic spectrum of VPA.

Gonad dýþý germ hücre tümörleri tüm germ hücre tümörlerinin %1-2’sini oluþturur. Viseral lokalizasyonlar çok nadirdir. Uterin korpus ve servikste oluþan teratomlar literatürde çok az sayýdadýr. Multipl uterin miyomlarý nedeniyle Ankara Onkoloji Hastanesi Kadýn Hastalýklarý Kliniðine baþvuran hastaya total abdominal histerektomi ve bilateral salpingo-ooferektomi yapýldý Hastanýn postoperatif patolojik incelemesinde endoservikat yerleþimli matür teratom saptandý. Bu olgu sunumunda, nadir görülen bir olgu olmasý nedeniyle servikal matür teratomu literatürü gözden geçirerek sunuyoruz.

Gonad dýþý germ hücre tümörleri tüm germ hücre tümörlerinin %1-2’sini oluþturur. Viseral lokalizasyonlar çok nadirdir. Uterin korpus ve servikste oluþan teratomlar literatürde çok az sayýdadýr. Multipl uterin miyomlarý nedeniyle Ankara Onkoloji Hastanesi Kadýn Hastalýklarý Kliniðine baþvuran hastaya total abdominal histerektomi ve bilateral salpingo-ooferektomi yapýldý Hastanýn postoperatif patolojik incelemesinde endoservikat yerleþimli matür teratom saptandý. Bu olgu sunumunda, nadir görülen bir olgu olmasý nedeniyle servikal matür teratomu literatürü gözden geçirerek sunuyoruz.