AMAÇ: Bu çalýþmada farklý sistem malignitelerine sekonder olarak geliþen akciðer tümörlerin klinik özellikleri ve primer tümörle olan iliþkilerinin araþtýrýlmasý amaçlandý.
YÖNTEMLER: 2002-2010 yýllarý arasýnda takipleri sýrasýnda ikinci primer kanser tanýsý alan otuz hasta çalýþmaya dahil edildi. Hastalar, akciðer kanseri geliþme sürelerine göre senkron (n: 7 hasta, %16,7)ve metakron (N.23 Hasta, %83,3) grup olarak iki grupta deðerlendirildi.
BULGULAR: Hastalarýn %50sinde ilk 2.5 yýl içinde ikinci primer kanser saptandý. Hastalarýn çoðunluðunun (%43.3) akrabalarýnda ekstra pulmoner kanser öyküsü vardý. Akciðer kanseri tanýsý konulan hastalardan %50sinde sigarayý býrakma, %30unda aktif içici ve %20sinde hiç sigara kullanmamýþ olma öyküsü vardý. Primer kanser ile ilgili yapýlan tedaviye yanýt ve ikincil geliþen kanserin süresi arasýnda istatistiksel olarak anlamlý bir iliþki saptanmadý (p=0.36).Gruplarýn tamamýnda sað kalým süresi 24 ay senkron grupta, 12 ay metakron grupta belirlendi.
SONUÇ: Primer hastalýktan sonra özellikle ilk 2.5 yýl içinde yakýn takip ve hastalara sigara içiciliðinin býraktýrýlmasýnýn teþvik edilmesi önem taþýmaktadýr.

OBJECTIVE: This study aimed to investigate clinical characteristics and prognosis of secondarily developed lung tumors in the cases having different system malignancy and to evaluate the relationship with the primary tumor.
METHODS: Between January 2002- December 2010 thirty patients diagnosed as second primary lung cancer have been included in the study. The patients were grouped according to lung cancer development time; synchronous group (n: 7 patients, 16.7%) and metachronous group (n: 23 patients, 83.3%).
RESULTS: Second cancer was detected in 50% of the patients within the first 2.5 years. Majority of patients had extra pulmonary cancer history concerning their relatives (43.3%). The rate of quitting smoking among all patients before the diagnosis of lung cancer was 50 %, current smoker rate was 30 % and never smoker was 20%. There was no statistical relationship between the response to treatment of first cancer and the duration of cancer developed secondarily (p=0.36). The overall survival of groups was found 24 months (95% confidence interval: 18.30 months) and 12 months (95% confidence interval: 10-14 months) respectively for synchronous and metachronous groups.
CONCLUSION: Close follow-up on pulmonary system especially within the first 2.5 years after primary disease and encouragement on quitting smoking is important.

AMAÇ: Bu çalýþmada alt ekstremite liposarkomlarý hakkýnda bilgi vermek,tedavi yönetimi ve hastalarýn ortalam yaþam süreleri hakkýnda klinik tecrübelerimizin paylaþýlmasý amaçlanmýþtýr.
YÖNTEMLER: Retrospektif bir çalýþmadýr.1986-2010 yýllarý arasýnda minimum takip süresi 5 yýl ve daha fazla olan 59 hastanýn dosyalarý ve radyolojik görünütleri incelenmiþtir.
BULGULAR: Bizim çalýþmamýzda literatürün aksine en sýk görülen liposarkom alttipi miksoid liposarkom oalrak belirlenmiþtir. Low grade liposarkom olan 10 hasta sadece marginal rezeksiyon ile tedavi edilip nüks izlenmemiþtir. Hiçbir hastaya neoadjuvan radyoterapi verilmemiþtir. Adjuvan Radyoterapi ise intermediate grade ve high grade liposarkom olan diðer 49 hastaya verilmiþtir. High grade liposarkom olan 4 hastada akciðer metastazý gözlenmiþtir. Miksoid lposarkom olan 2 hastada ise ekstremite metastazý gözlenmiþtir.
SONUÇ: Miksoid liposarkom alttipinin kliniðimizde en fazla oranda görülmesinin sebebinin, low grade liposarkomlarýn lipom gibi birçok kinikte tedavisinin yapýlmasý olarak düþünüyoruz. Neoadjuvan radyoterapinin cerrahiyi tedaviyi zorlaþtýrabileceðinden verilmemiþtir. Nükslerin çoðunlukla ilk 2 yýl içinde görülmektedir bundan dolayý ilk 2 yýl boyunca hastalarýn sýký takip edilmelidir.

OBJECTIVE: The purpose of this study is to give the information on the outcome, management and survivability of patients with low extremity liposarcoma.
METHODS: This study is a retrospective study. All the patients were seen and managed between 1986 and 2010. Their records were retrieved and analyzed for this study. Fiftynine cases were identified to have the follow up of minimum 5 years and complete documentation.
RESULTS: In our study, the most common variant of the liposarcom is mixoid liposarcoma in spite of literature. Ten patients who have low grade liposarcom were treated with marginal resection. Recurrence wasn’t observed. We didn’t perform neoadjuvant radiotherapy. Two patients who have high grade liposarcoma underwent neoadjuvant chemotherapy. Adjuvant radiotherapy was given 49 patient who have intermediate or high grade liposarcoma. Four patients who have high grade liposarcoma were presented with lung metastases. Two patients who have myxoid liposarcoma were presented with extremity metastates.
CONCLUSION: We thought that, low grade liposarcomas had been treated at other small clinics as lipom so in our series the myxoid liposarcoma is the most common subtype. Neoadjuvant radiotherapy can get difficult surgery done. Recurrence usually was presented in two years after first surgery. So patients must be followed frequently during two years.

AMAÇ: Bu çalýþmada alt göz kapaðýna ektropiyon nedeniyle cerrahi tedavi uyguladýðýmýz hastalardaki sonuçlarýmýzý deðerlendirmek amaçlandý.
YÖNTEMLER: Aðustos 2008 ve Haziran 2011 yýllarý arasýnda kliniðimizde ektropiyon operasyonu uygulanmýþ 28 hastanýn kayýtlarý retrospektif olarak tarandý. Hastalarýn yaþý, cinsiyeti, cerrahi öncesi ve sonrasý görme keskinliði, ektropiyonun derecesi kaydedildi. Uygulanan cerrahi teknik, cerrahi sonrasý tedaviler ve cerrahiye baðlý oluþan komplikasyonlar not edildi.
BULGULAR: Çalýþmaya Ankara Onkoloji Hastanesi Göz Hastalýklarý Bölümünde ektropiyon cerrahisi uygulanmýþ 28 hasta alýndý. Bu hastalarýn 18’i erkek, 10’u kadýndý. Ortalama yaþ 63,2 yýl olup 31 ile 81 arasýnda yaþ daðýlýmý deðiþmekteydi. Hastalarýn ortalama takip süresi 14 (7–22) aydý. 28 Hastanýn 10'u sað alt göz kapaðý, 11'i sol alt göz kapaðý, 7'si bilateral alt göz kapaðýndan opere edildi. Ektropiyon etyolojisinde sýrasýyla involüsyonel (n=17), skatrisyel (n=7), mekanik (n=4) faktörler yer almaktaydý. Ýnvolüsyonel ektropiyon olgularýnda Kuhnt-Szymanowski tekniðinin Smith modifikasyonu, skatrisiyel ektropiyon olgularýnda vertikal uzatma (cilt grefti veya lokal fleple ile), mekanik ektropiyon olgularýmýzda ise mukozal greft ve yanak veya alýn rotasyon flebi ile kombine onarým yapýldý.
SONUÇ: Kliniðimizde ektropiyon cerrahisi genellikle involüsyonel sebeplerle uygulandý. Ýnvolüsyonel sebeplerle oluþan ektropiyon cerrhisinde Kuhnt-Szymanowski tekniðinin Smith modifikasyonu ile baþarý oranýnýn çok yüksek olduðu saptandý. Alt göz kapaklarý, fonksiyonel olarak göz küresini korumalarý yanýnda, estetik olarak da önemli yapýlardýr bu yüzden deformitelerinin onarýmlarý titiz bir çalýþmayý gerektirdiði unutulmamalýdýr.

OBJECTIVE: We tried to evaluate the results of the patients that had inferior eye lid ectropium surgery.
METHODS: The records of 28 patients that had ectropium surgery in our clinic between August 2008 ve June 2011 were examined retrospectively. The age, gender, visual acuity before and after surgery and the grade of the ectropium were recorded. The performed surgical method, applied treatments after surgery and the complications due to surgery were all noted.
RESULTS: 28 patients that had ectropium surgery in Ankara Oncology Hospital Eye Clinic were included in the study. 18 of them were male, 10 of them were female. Average age was 63,2 years old and the distribution of the age was between 31 and 81years. The average follow up period of the patients were 14(7-22) months. The 10 of the 28 patients were operated from right inferior eye lid, 11 from left inferior eye lid and 7 from bilateral inferior eye lid.
The etiology of the ectropium includes respectively involutional, (n=17), scatrical (n=7) and mechanical(n=4) factors. Kuhnt-Szymanowski technique with Smith modification, vertical elongation(skin greft or local fleb) and combinated repair with mucosal greft and cheek or forehead fleb was performed respectively in involutional, scatrical and mechanical ectropium cases.

CONCLUSION: Ectropium surgery was performed especially for involutional reasons in our clinic. Kuhnt-Szymanowski technique with Smith modification was found more successful in involutional ectropium cases. Inferior eye lids are important functionally in protecting eye ball as well as esthetically in appearance so it is important not to forget to be sensitive in repairment of their deformities.

AMAÇ: Bu çalýþmanýn amacý dahiliye uzmanlarý ile anestezi uzmanlarý arasýnda sýrt ve boyun aðrýlarýný içeren miyofasyal aðrý sendromu (MAS) oluþumunu karþýlaþtýrmaktýr
YÖNTEMLER: Çalýþmaya 54’ü anestezi uzmaný (ortalama yaþ 30.7±3.4) ve 57’si (ortalama taþ 29.6 ±3.7) dahiliye uzmaný olmak üzere toplam 111 týp doktoru dahil edilmiþtir
Her iki grup arasýnda demografik özellikler, risk faktörleri, Görsel Analog Skala, Nottingham Saðlýk Profili ve Beck Depresyon Skalasý karþýlaþtýrýlmýþtýr.
BULGULAR: MAS anestezi uzmanlarýnda dahiliye uzmanlarýna göre belirgin olarak daha sýk bulunmuþtur (p=0.001). Beck Depresyon Skalasý deðerleri belirgin olarak daha yüksek ve Nottingham Saðlýk Profili deðerleri de MAS olan kiþilerde belirgin olarak daha düþük bulunmuþtur (p<0.001).
SONUÇ: MAS’ýn anestezi uzmanlarýnda, dahiliye uzmanlarýna göre daha sýk olduðunu söyleyebiliriz. Ek olarak, MAS yaþam kalitesini olumsuz yönde etkileyen bir parametredir. Daha iyi bir yaþam kalitesine ulaþmak için altta yatan risk faktörleri önlenmelidir.

OBJECTIVE: The aim of this study was to compare the myofascial pain syndrome occurrence involving neck and back in anesthetist specialist with internal specialist.
METHODS: A total of 111 medical doctors were included in this study. There were 54 anesthetists (a mean age of 30.7±3.4) and 57 internal specialists(a mean age of 29.6±3.7). Demographic features, risk factors, Visual Analog Scale, Nottingham Health Profile and Beck Depression Scale were compared between the groups.
RESULTS: MPS was significantly more frequently seen in anesthetists than internal specialists (p=0.001). Beck Depression Scale values were significantly higher and Nottingham Health Profile values were significantly lower in subjects with MPS (all p<0.001). Moreover, sleep and posture disorders were found to be more common in subjects with MPS (all p<0.001).
CONCLUSION: MPS is more frequently seen in anesthetists than internal specialists. Additionally, MPS is a parameter affecting the quality of life adversely. In order to achieve better quality of life, the underlying risk factors should be prevented.

Kolorektal kanser görülme sýklýðý yaþla artmaktadýr. Geriatrik hastalarda kardiyorespiratuar ve serebrovasküler sistemlerde eþlik eden hastalýklar daha sýk bulunmaktadýr. Bu hastalarda yüksek ASA skorlarý, anatomik zorluklar ve cerrahi riskler anesteziyolojist tarafýndan yönetilmelidir.
Anestetiklerin patofizyolojik etkilerinin daha iyi anlaþýlmaya baþlanmasý ile kolorektal kanser cerrahisi geçirecek hastalarýn anestezisini ve analjezisini saðlamakta rejyonel anestezi teknikleri kullanýmý gündeme gelmiþtir.
Bu yazýda rejyonel anestezi tekniklerinin kolorektal kanser hastalarýnda uygulamalarýnýn avantaj ve dezavantajlarý hakkýnda güncel bilgilerin sunulmasý amaçlanmýþtýr.

The incidence of colorectal cancer increase with age. Geriatric patients have more comorbid medical conditions including cardiorespiratory and cerebrovascular diseases. Thus, high ASA scores, anatomical deformities and surgical risks should be managed by anesthesiologists. More common using of regional anesthetic tecniques to provide anesthesia and analgesia fort he patients undergoing colorectal cancer surgery has became a current issue with the better understandings on the pathophysiologic effects of the anaesthetic agents.
In this article, we aimed to discuss the advantages and disadvantages of regional anesthetic tecniques in patients undergoing colorectal cancer surgery.

Bu çalýþma periorbital kitle eksizyonu sonrasý rekonstrüksiyon uygulanan ve komplikasyon geliþmiþ olan 6
ilginç hastayý içermektedir. Hasta verileri retrospektif olarak deðerlendirildi. Postoperatuvar ekimoz geliþen, deðiþik yaþlarda üç hasta
takip edildi. Ýlk hasta 17 yaþlarýnda idi ve orbita laterali-kaþ hizasýnda dermoid kist eksizyonu
uygulanmýþtý. Sistemik bir hastalýk mevcut deðildi. Sadece takip uygulandý. Diðer iki hasta ileri
yaþta idi ve bilateral ekimoz geliþmiþti. Diðer bir vaka ileri yaþta fleple rekonstrüksiyon sonrasý
nekroz geliþen hasta idi. Vakada greft uygulanarak sorunsuz iyileþme elde edildi. Diðer iki vaka
primer sütürasyon sonrasý geliþen skar ile dikkat çekten hastalardý. Skarýn derecesine göre
cerrahi veya takip uygulandý. Ýyi planlanmýþ ve uygulanmýþ periokuler rekonstrüksiyonlarda da
komplikasyon görülebilmektedir. Yakýn hasta takibi yapýlmalý ve gereken tedaviler
gecikmeksizin uygulanmalýdýr.

This study includes 6 interesting cases who developed complications after reconstructive surgery due to periorbital mass excision. Patients' data were evaluated retrospectively.
Three patients with different ages,who developed ecchymoses postoperatively, were followed up.
The first patient was 17 years old and dermoid cyst excision was performed on the lateral side of orbita at the eye brow level. This patient did not have any systemic disease and was simply followed up.
Other two patients were at advanced age and both of them developed ecchymoses bilaterally..
Another patient was also at advanced age and developed necrosis following reconstruction with skin flap. In this case, by graft application complete healing was succeeded uneventfully..

Two other cases drew attention due to scar development after primary suturation. According to the degree of scar formation, surgery or follow up was performed.
Complications could be seen even after well planned and performed periocular reconstructions.
Close follow up and abrupt treatment are essential.

Medulloblastom çocukluk çaðýnýn ikinci en sýk görülen ve en malign beyin tümörüdür. Yetiþkinlerde ise oldukça nadir rastlanýr. Medulloblastom tanýlý hastalar tedavi öncesi standart risk ve yüksek riskli olmak üzere iki gruba ayrýlýr. Cerrahi rezeksiyonu takiben kraniospinal radyoterapi (KSRT) tedavinin temelini oluþturur. Günümüzde tedaviye kemoterapinin eklenmesi saðkalýmýn artmasýna katkýda bulunmuþtur. Ayrýca kemoterapinin eklenmesi ile total radyoterapi dozu da düþürülmüþtür. Tedavide yeni kemoterapik ajanlarýn geliþtirilmesi ve yeni radyoterapi teknikleri hastalarýn uyumunu arttýrmýþtýr.

Medulloblastoma is the second most common and most malignant brain tumor in children. But in adults medulloblastomas occur rarely. The patients with medulloblastoma are stratified two groups before treatment: avarage risk and high risk. Surgical resection followed by craniospinal irradiation (CSI) has been the mainstay of medulloblastoma therapy. In recent years, chemotherapy has been introduced to reduce the total dose of radiation and increase the survival rate. The new radiotherapy techniques and chemotherapy agents increase compliance to treatment.

Giriþ:

Adenoid kistik karsinom (ACC), memenin nadir görülen neoplazmlarýndandýr. Tüm meme karsinomlarýnýn %0.1’ini oluþturmaktadýr.
Adenoid kistik karsinomlar memede izlenen diðer histolojik alt tiplerine göre çok iyi prognoza sahiptirler.Uzak metastaz ve lenf nodu tutulumu çok nadirdir. Sýklýkla östrojen reseptörü (ER), progesteron reptörü(PR) ve cerbB2 statusu negatif olarak tespit edilmektedir.

Olgu:

Kýrksekiz yaþýnda premenapozal kadýn hasta sol memede ele gelen kitle nedeniyle doktora baþvurmuþ.
Hastaya memedeki lezyon için through-cut biyopsi uygulandý. Biyopsi sonucunun adenoid kistik karsinom olarak gelmesi üzerine hastaya modifiye radikal mastektomi operasyonu uygulandý. Operasyon materyalinin patolojik incelemesi orta derecede diferansiye adenoid kistik karsinoma ile uyumlu olarak tespit edildi. Tümör boyutu 4.8 cm ve aksiller diseksiyon sonucu 48 lenf nodu negatif olarak tespit edildi. Tümörün immünohistokimyasal özellikleri triple negatif (ER, PR ve c-erbB2) olarak deðerlendirildi.

Sonuç:
ACC’ler çoðunlukla ER(-),PR (-) ve CERBB2(-) hormon statusu ile ender görülen meme karsinomlarýdýr.
ACC’ler nadir görülen meme karsinomlarý olduðundan ve yeterli klinik çalýþma bulunmadýðýndan tedavi opsiyonlarý sýnýrlýdýr.

Background:
Adenoid cystic carcinoma (ACC), one of the rarest neoplasia of the breast, constitutes 0.1% of all breast carcinomas. The prognosis of ACC is very good compared to other histological subtypes of breast carcinoma. Lymph node involvement and distant metastasis are very infrequent. Estrogen receptor (ER), progesterone receptor (PR) and c-erbB2 (also known as HER-2/neu) are typically negative.

Case
A fourty eight year-old premenauposal women was admitted to hospital with a mass on the upper outer quadrant of her left breast. Since the result of through-cut biopsy of this suspicious lesion was consistent with adenoid cystic carcinoma, modified radical mastectomy with axillary lymph node excision was applied. Pathological examination revealed a moderately differantiated adenoid cystic carcinoma of the breast. The size of invasive tumor component was 4.8 cm in its greatest dimension. Immunohistochemical analysis was consistent with triple negative phenotype ( ER,PR and c-erbB2 negative).

Conclusion:
ACC is a rare type of human breast carcinoma with ER, PR and c-erbB2 negative phenotype. They usually show an excellent prognosis however there is no well defined treatment options for ACC since the rarity of clinical studies in such kind of unusual histological subtypes of breast carcinomas.

Daha önce Kaposi Sarkomu tanýsý alan bir hastanýn tanýdan bir yýl sonra supraklaviküler fossada geliþen lenfadenopatisinden görüntüleme eþliðinde ince iðne aspirasyonu ile örnekleme yapýlmýþtýr. Aspirasyon sitolojisinde büyük doku fragmanlarý yanýsýra daha küçük hücre kümeleri izlenmiþtir. Gevþek gruplarda iðsi hücreler yuvarlak-oval nükleuslu, açýk mavi renk sitoplazmalý izlenmiþ ve Kaposi sarkomu tanýsý verilmiþtir. Lenf düðümünün Kaposi sarkomu tutulumunda ince iðne aspirasyon sitolojisi bulgularý literatür eþliðinde gözden geçirilmiþtir.

Image guided fine needle aspiration from the supraclavicular lymph node of a patient with prior Kaposi sarcoma diagnosis was performed. In the aspiration cytology large tissue fragments and small cell clusters were seen. In looser clusters spindle cells with round to oval nuclei with light blue cytoplasms were seen and Kaposi sarcoma diagnosis was given. Fine needle aspiration cytology findings of Kaposi sarcoma in lymph nodes is reviewed with the literature.

Nazofarinks bölgesinde en sýk saptanan kanser nazofarinks karsinomudur. Genellikle, lenf nodu metastazý taný anýnda ve boyundaki lenf nodu bölgelerinde saptanmaktadýr. Nazofarinks kanserinde, nazofarinkste de kitle olmadan uzak lenf nodu metastazý saptanmasý çok sýk görülen bir durum deðildir. 48 yaþýnda erkek hasta servikal ve sað aksiller kitle þikayetiyle hastaneye baþvurdu. Fizik muayenede bilateral servikal lenf adenopati (LAP) ve sað aksiller LAP saptandý. Servikal LAP eksizyonel biyopsi patolojisinde indiferansiye karsinom metastazý gösterildi. Radyolojik deðerlendirmede bilateral serviakl LAP, nazofarinkste kalýnlaþma ve humerusta kemik metastazý gösterildi. Metastatik indiferansiye karsinom ve primeri nazofarinks olarak kabul edildi ve kemoterapi baþlandý. Tama yakýn cevap alýndý. 4 ay sonra progresyon nedeniyle ikinci basamak tedavi verildi ve tama yakýn yanýt elde edildi. Takipte sað aksiller LAP (3X2.1 cm) geliþmesi üzerine lenfoproliferatif hastalýk gibi diðer etiyolojileri ekarte etmek amacýyla eksizyonel biopsi yapýldý. Histopatolojik özelliklerin birinci histopatolojik özelliklerle benzer olmasý nedeniyle keratinize nazofarinks karsinom metastazý düþünüldü. Aksiller LAP metastazý nazofarinks kanserinde nadiren oluþabilmektedir. Özellikle belli bir süredir remisyonda izlenen kanserli hastalarý deðerlendirirken beklenmedik nüks paterniyle karþýlaþýlacak olursa ikincil primer tümörler akýlda tutulmalýdýr. Bu hastalarda ikinci biyopsinin birinci biyopsi ile beraber deðerlendirilmesi faydalý olabilir.

Nasopharyngeal carcinoma is the most frequent tumor type arising in the nasopharynx. Lymph node metastases are predominantly seen at diagnosis in lymphnode regions of neck. Nasopharynx carcinoma presenting with distant lymphadenopathy (LAP) rather than a prominent nasopharyngeal mass is not common.We describe a 48-year old man admitted to the hospital with cervical and right axillary mass. In physical examination, he had a 3x2cm right axillary lymphadenopathy (LAP) and bilaterally cervical LAPs. An exisional cervical LAP biopsy histopathology revealed undifferentiated carcinoma metastasis. On radiological evaluation, he had bilaterally cervical LAPs and nasopharyngeal thickening and bone metastasis on his right humerus. He was considered as metastatic undifferentiated carcinoma with highly probable primary as nasopharynx carcinoma. He was given chemotherapy. He achieved near complete response. After 4 months of follow-up, he had again second line therapy with near complete remission. In follow-up period, he developed right axillary LAP (3x2,1cm). An exisional biopsy of the right axillary LAP was performed to rule out other etiologies, such as lymphoproliferative disease. Histopathology had similar histopathological properties with the first cervical biopsy giving rise to thought of keratinizing nasopharynx carcinoma metastasis.Axillary LAP might occur rarely in nasopharynx carcinoma. Secondary primary tumors should be also kept in mind while evaluating the cancer patients with an unexpected relapsing pattern especially in those followed-up with remission for a while. Evaluation of the second biopsy material with the first one seems to be helpful in these patients.

Yetmiþ yaþýnda kadýn sað inguinal bölgede akýntýlý þiþliði olmasý üzerine baþvurdu. Lezyon biyopsisi malign melanomla uyumluydu. Toraks ve batýn görüntülemelerinde metastaz bulgularý mevcuttu. Birinci basamak temozolomid sonrasý lezyon bölgesinde progresyon nedeni ile palyatif radyoterapi uygulandý. BRAF-V600E mutasyonu nedeni ile vemurafenib baþlandý. Tedavinin ikinci ayýnda çok iyi kýsmi yanýt elde edildi. Tedavinin 5. ayýnda sol akciðerde lokal progresyon izlenirken diðer bölgelerde kýsmi yanýtý devam ediyordu. Palyatif radyoterapi sonrasý vemurafenib tedavisine devam edildi.

A 70 year-old women admitted to our hospital with a swelling and discharge of the right inguinal site. Biopsy results was consisted with malignant melanoma. Imaging of thorax and abdomen showed metastatic disease. After first-line temozolamide treatment, palliative radiotherapy was applied to primary site because of progression. After detection of BRAF-V600E mutation, vemurafenib treatment was initiated. Treatment response to vemurafenib was very good partial response after second months of the treatment. Although locally progression of the left lung was seen after fifth months of therapy, partial response remained on the other sites, she was still on the treatment with vemurafenib.

Spinal metastaz malignitelerde sýk görülen bir bulgu olmasýna raðmen intradural ekstrameduller metastazý (IDEM) çok nadirdir. Biz 55 yaþýnda erkek hastada lomber omurgada intradural metastaz ile presente olan akciðerin büyük hücreli nöroendokrin karsinom olgusunu sunuyoruz.

Although spinal metastasis is a common finding in malignancies, however intradural extramedullary metastasis (IDEM) is very rare. We report a 55-year-old man, known case of a large cell neuroendocrine carcinoma of the lung with IDEM in lumbar spine.

Ankilozan Spondilit (AS), omurga, sakroiliak eklem ve komþu dokularýn inflamasyonu ile karakterize, kronik otoimmün, ilerleyici bir kollajen doku hastalýðýdýr. AS, genel anestezi ve rejyonel anestezi uygulamalarýnda karþýlaþýlabilecek sorunlar nedeniyle anesteziyologlar için özel öneme sahiptir. Bu yazýda hemoroidektomi operasyonu planlanmýþ hastaya uyguladýðýmýz kaudal blok yöntemini sunmayý amaçladýk.
Yirmi yýl önce AS tanýsý almýþ, 71 yaþýndaki erkek hastaya kaudal blok ile hemoroidektomi operasyonu yapýlmasý planlandý. Hastanýn preoperatif deðerlendirmesinde ASA 2, mallampati 2 ve boyun eklem hareketlerinde kýsýtlýlýk mevcuttu. Hastaya prone pozisyonunda 12cc. %0,5 izobarik bupivakainle kaudal blok uygulandý. Operasyon sýrasýnda ve sonrasýnda hastada herhangi bir komplikasyon gözlenmedi. Sonuç olarak ankilozan spondilitli hastalarda anogenital bölge cerrahilerinde kaudal blok uygulamasý uygun bir yaklaþým olabilir.

Ankylosing spondylitis (AS), is a chronic, progressive, otoimmune collagen tissue disease characterized by spine, sacroiliac, joint and neighboring tissue inflammation. AS is important for anaesthesiologists due to the problems that can occur during the application of general anesthesia and regional anesthesia. In this paper, we aim to present the caudal block method that we applied to a patient who is planned to have a hemorrhoidectomy operation.
We planned to perform a hemorrhoidectomy operation with caudal block method to a 71 year-old patient who was diagnosed as AS 20 years ago. Preoperative evaluation of patients showed that ASA 2, mallompati 2 and neck joint mobility was limited. The caudal block anesthesia is applied to the patient at prone position with 12 cc, 0.5% isobaric bupivacaine. No complications were observed in patients in intraoperative or post-operative period. In conclusion, caudal block method is a convenient approach in anogenital region operations for patients with ankylosing spondylitis.

Sindaktili; 2000 canlý doðumda bir görülme oraný ile konjential el deformiteleri içerisinde en sýk rastlanýlan ve literatürde tanýmlanma zamaný eski Yunan hekimlerine kadar uzanan, ancak klinik prezentasyon olarak pek çok farklý þekli bulunmasý nedeniyle sýnýflamalarda uzlaþma saðlanamamýþ bir deformitedir.
Farklý klinik prezentasyonlar ve eþlik eden diðer durumlar nedeni ile 2012 yýlýnda sendromik olmayan sindaktili tipleri fenotipik özellikleri de göz önünde bulundurularak 9 farklý tip ve subtipler olarak yeni bir sýnýflama ile literatüre dahil edilmiþtir.
Vaka sunumumuzdaki 48 yaþýndaki ailesel sindaktili öyküsü bulunmayan kadýn hastamýz, tipik olan 4. parmak hipoplazisi bulunmamasý ve 5. parmak orta falanks ve distal falanks üzerinde 2 adet canlý týrnak bulunmasý ile literatürde nadir görülen bir prezentasyon ile çýkmýþtýr.
Vaka planlamasý için yapýlan dijital anjiografide tüm vasküler yapýlar doðal olarak izlenmiþtir. Distalde yeterince veb dokusu bulunan olgumuzda; Yao ve arklarýnýn tanýmladýðý yöntemle subkutan pedikül üzerinde, V insizyonla cilt kaldýrýlarak komisür oluþturuldu.
Cerrahi sonrasý, yara yeri ve dolaþým problemi görülmeyen hastanýn; 1 yýllýk takibinde ek sorun gözlenmedi.

Syndactyly is the most common congenital hand defect, syndactyly occurs at a rate of 1 in 2000 live births. It had described by the ancient Greek doctors. Syndactyly could have many different clinical presentations; and so that there has not any consensus for the classification.
By the year 2012 non syndromic syndactyly types have been classified in nine groups according to their phenotypes.
Our article is about a syndactyly case which had seen at a 48 year old female patient with a unique clinical presentation. The presentation of the hand is different from the literature because she had no 4th finger hypoplasia and she had two viable nails on the middle and distal phalanx of the 5th finger.
We did the operation by the technique which had described by Yao et al as creating a commissure on the subcutane pedicle by a V incision.
There is not any complication and skin problem after the surgery as a one year follow up.

Osteoid osteom, nadir görülen benign kemik tümörlerindendir. Tedavide cerrahi nidus eksizyonunun sonuçlarý yüz güldürücüdür ve tedavi sonrasý nüks oluþumu çok nadirdir. Bu yazýda tibia alt uçta eksizyon yapýlan osteoid osteom olgusunun tedaviden 7 yýl sonra ortaya çýkan nüksü sunuldu.

Osteoid osteoma seen between a rare benign bone tumors; Although promising treatment relapse after treatment but is very rare in focus. At the upper end of the tibia 7 years after excision made the same focus new osteoid osteoma. Relapse cases were presented.

43 yaþýnda bir erkek karýn aðrýsý ve hematemez ile kabul edildi. Hasta Endoskopik biopsi ile Mide karsinomu tanýsý aldý ve Total Gastrektomi yapýldý.Gastrektomi'nin 6.gününde, baþ aðrýsý ve çift görme yakýnmasý oldu.Beyin MRI bilateral serebellar hemisferde kontrast artýþý ve Leptomeningeal kalýnlaþma gözlendi.Birinci Serebrospinal sývý muayenesinde maliðn hücre gözlenmedi,Ýkinci inceleme maliðn hücre þüphesi içermekteydi.Hastanýn Leptomeningeal Karsinomatosis ile uyumlu klinik ve Radyolojik deðerlendirmelerinden dolayý, Ýntratekal Kemoterpi uygulandý ve Hastanýn nörolojik semptomlarý düzeldi.

A 43 year-old man admitted with abdominal pain and hematemesis. He diagnosed with gastric cancer by endoscopic biopsy and total gastrectomy was carried out. On the sixth day of gastrectomy he complained about headache and diplopia. Magnetic resonance imaging of the brain showed leptomeningeal thickening and contrast enhancement of bilateral cerebellar hemisphere. First cerebrospinal fluid examination revealed no malignant cells, the second one was suspicious for malignant cells. Because of the radiological and clinical evaluation of the patient compatible with the Leptomeningeal Carcinomatosis, intrathecal chemotherapy was performed and his neurological symptoms were improved.

Ellidört yaþýnda erkek hastaya ailesel kolon kanseri öyküsü nedeni ile yapýlan kolonoskopide multipl polip saptandý. Patolojide multipl polipte adenokarsinom saptanmasý ve aile öyküsünün de olmasý üzerine total kolektomi yapýldý. Total kolektomi patolojisinde multisentrik kolon adenokarsinomu ve grade 1 apendiks nöroendokrin tümör saptandý. Literatürde senkron multisentrik kolon adenokarsinomu ve appendiks nöroendokrin tümörü birlikteliði nadiren bildirilmiþtir, hastamýz bu nedenle özellik arzetmektedir.

Fifty four year-old men with a family history of colon cancer diagnosed multiple colonic poliposis upon colonoscopy. Since pathology of colonic biopsy yielded adenocarcinoma, together with a family history of colon cancer, total colectomy was done. Histopathology of colectomy showed multisentric colonic adenocarcinoma together with grade 1 neuroendocrine tumor of the appendix. Our patient was unique because of the rarity of the coincidence of colonic adenocarcinoma and appendix neuroendocrine tumor.