GÝRÝÞ ve AMAÇ: Meme kanseri; Türkiye’de kadýn kanserleri arasýnda en sýk görülen tiptir. Bu çalýþmada nonspesifik þikayetleri olan ve fýrsatçý tarama yapýlan 40 yaþ altý kadýnlarda meme kanseri oranlarýný tespit etmeye çalýþtýk.
YÖNTEM ve GEREÇLER: Kasým 2011 ile Nisan 2015 arasýnda Ankara Güven Hastanesi Meme merkezine baþvuran 4112 hastaya öncelikli görüntüleme yöntemi olarak meme ultrasonografisi yapýldý. Geriye kalan 3403 (%82,8) olgu çalýþmaya dahil edilmiþtir. Bu kadýnlarýn rutin olarak klinik muayeneleri yapýlmýþ; daha sonra USG ile deðerlendirilmiþler ve gerekli görülen durumlarda baþka görüntüleme tekniklerine de baþvurulmuþtur. Biyopsilerin hepsi meme merkezinde USG eþliðinde yapýlmýþ ve olgularýn hepsinde kalýn iðne biyopsisi tercih edilmiþtir.
BULGULAR: Ultrasonografide þüpheli lezyon tespit edilen 292 (%8,6) hastaya ileri inceleme yapýlmýþtýr. Rutin meme muayenesi ve öncelikli görüntüleme yöntemi olarak ultrasonografi tercih edilmiþtir. Radyolojik inceleme sonrasý 62 hastaya (%1,8) kor biyopsi yapýlmýþ ve bunlarýn 14’ünde (%0,4) meme kanseri tespit edilmiþtir.
TARTIÞMA ve SONUÇ: Bizim çalýþmamýzda 40 yaþ altýnda herhangi bir þikâyeti olmayan ya da meme kanseri korkusu olan hastalarda meme kanserinin tespiti için ultrasonografi öncelikli görüntüleme yöntemi olarak kullanýlmýþtýr. Genç popülasyonun ve meme kanseri oranýnýn yüksek olduðu Türkiye’de meme kanserini erken evrede tespit edebilmek için ultrasonografinin öncelikli olarak kullanýlmasý gerektiðini düþünüyoruz.

INTRODUCTION: Breast cancer is the most common type of cancer in women in Turkey. In this study, we aimed to calculate the breast cancer detection rate in patients who have nonspecific complaints and younger than 40 years old in an opportunistic screening population.
METHODS: A total of 4112 breast ultrasonographies were performed as an initial imaging modality in women between 18 to 39 years old who applied to Ankara Güven Hospital Breast Unit during November 2011 and April 2015. 3403 (82.8%) cases were included for further examination. Routine breast examinations of these women were done and ultrasonography was performed as the initial imaging procedure. Patients who have lesions that need biopsy had mammography and some of them magnetic resonance ýmagýng before the biopsy procedure and than core needle biopsy with ultrasonography guidance was performed in all of the cases.
RESULTS: Ultrasonography demonstrated 292 (8.6%) suspicious lesions for further evaluation. After the radiological evaluation was done, core needle biopsy was performed in 62 (1.8%) of these cases and breast cancer was diagnosed in 14 of them (0.4%).
DISCUSSION AND CONCLUSION: In our study, the ultrasonography was used first for breast cancer diagnosis in women under the age of 40 who did not have any complaint or applied for control due to breast cancer fear. Ýn Turkey, which has a high young population and therefore faced with breast cancers under the age of 40, the breast ultarsonography has a great role primarily for catching breast cancers in this age group at an early stage.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý metastatik pankreas kanserinin tedavisinde gemsitabin-sisplatin (GP) kombine kemoterapisine (KT) karþý gemsitabin (G) kemoterapisinin etkinliðini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Nisan 2005 ile Kasým 2015 tarihleri arasýnda merkezimizde histopatolojik olarak adenokarsinom tanýsý almýþ metastatik pankreas kanserli hastalarda progresyonsuz saðkalýma (PS) ve genel saðkalýma (GS) etki eden faktörler (klinikopatolojik özellikler, tedaviler, bazal tümör markýrlarý, serum albümin, kreatinin ve bilirubin düzeyleri) retrospektif olarak deðerlendirildi.
BULGULAR: Üç kür ve üzerinde KT alan toplam 99 hastanýn (74 hasta GP, 25 hasta G) yanýt deðerlendirmesi yapýldý. Gruplar demografik özellikleri açýsýndan karþýlaþtýrýldýðýnda kombine KT alan hastalar daha genç, daha iyi ECOG performans skoruna ve daha az komorbid hastalýða sahipti. Hastalarýn %41.4’ü progresyondan sonra ikinci basamak KT almýþ olup, bu G grubunda %28.0, GP grubunda ise %45.9’du. GP ve G gruplarý arasýnda GS farký saptanmadý (sýrasýyla; 8.3 aya karþý 6.0 ay, P=0.13). Ortanca PS GP alan hastalarda G alan hastalara kýyasla daha uzundu (sýrasýyla; 5.1 ay ve 3.9 ay, P=0.01) ve bu fark çok deðiþkenli analizle de doðrulandý. ECOG performans skoru daha iyi (8.3 aya karþý 6.3 ay) ve ikinci basmak KT alan hastalar (12.1 aya karþý 5.9 ay ) daha uzun GS ile iliþkili saptandý.
TARTIÞMA ve SONUÇ: Gemsitabin-sisplatin tedavisi ile daha iyi PS elde edilirken GS farký istatiksel olarak anlamlý deðildi. Taný anýnda ECOG performans durumunu daha iyi ve ikinci basamak KT alabilen hastalar daha iyi genel sað kalýma sahiptir.

INTRODUCTION: The purpose of this trial was to evaluate the efficacy of gemcitabine (G) alone versus gemcitabine plus cisplatin (GP) in the treatment of metastatic pancreatic cancer. METHODS: In ninety-nine patients with a histopathologically confirmed diagnosis of metastatic pancreatic cancer from April 2005 to December 2015, factors affecting progression-free (PFS) and overall survival (OS) (clinicopathological features, treatments, basal tumor markers, serum albumin, creatinine and bilirubin levels) were retrospectively evaluated.
METHODS: In ninety-nine patients with a histopathologically confirmed diagnosis of metastatic pancreatic cancer from April 2005 to December 2015, factors affecting progression-free (PFS) and overall survival (OS) (clinicopathological features, treatments, basal tumor markers, serum albumin, creatinine and bilirubin levels) were retrospectively evaluated.
RESULTS: Response evaluations were performed in 99 patients (74 patients for GP group, 25 patients for G group) who received three cycles and more chemotherapy (CT). When the groups were compared in terms of their demographic characteristics, the patients in the group receiving GP were younger with a better performance status and had less comorbid disease. About 41.4% of the patients received second line CT after progression (28.0% in the G group, 45.9% in the GP group). The median OS was 8.3 months in the GP group and 6.0 months in the G group (P=0.13). The median PFS was 5.1 months in the GP group and 3.9 months in the G group (P=0.01). In multivariate analysis, combination CT was associated with longer PFS (5.1 vs. 3.9 months). Patients with a good performance status (8.3 vs. 6.3 months), and those who received second-line CT (12.1 vs. 5.9 months ) were associated with longer OS.
DISCUSSION AND CONCLUSION: Compared with G, GP significantly improved PFS without any significant difference in OS. Patients with a good performance status and those receiving second-line CT had longer median OS.

GÝRÝÞ ve AMAÇ: Göz Hastalýklarý polikliniðine göz kapaðýnda kitle nedeniyle baþvuran ve ameliyat edilen olgularýn retrospektif olarak klinik ve histopatolojik sonuçlarýný deðerlendirmek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Göz Hastalýklarý polikliniðine Mart 2012- Mart 2016 yýllarý arasýnda göz kapaðýnda kitle nedeniyle baþvuran ve ameliyat edilen 50 olgunun klinik ve histopatolojik sonuçlarý retrospektif olarak deðerlendirildi. Olgularýn yaþý ve cinsiyeti, kitlenin lokalizasyonu ve histopatolojik tanýlarý kaydedildi
BULGULAR: Çalýþmaya dahil edilen 50 olgunun 28’ i (%56) kadýn, 22’ si (%44) erkek idi. Olgularýn yaþ ortalamasý 54,3 (9- 89) yýl idi. Eksize edilen göz kapaðý tümörlerinin histopatolojik sonuçlarý deðerlendirildiðinde; 13 olgu (%26) malign, 37 olgu (%74) benign olduðu görüldü. Malign olanlardan 10 olgu (%76.9) bazal hücreli karsinom (BHK), 2 olgu (%15.3) skuamoz hücreli karsinom (SHK), bir olgu ise malign epitelyal (%7.6) tümördü. Benign tümörlerde ise; 13 olgu (%35.1) skuamoz papillom, 5 olgu (%13) nevüs, 4 olgu (%10.8) seboreik keratoz, 3 olgu %(8.1) verruka vulgaris, 2 olgu (%5.4) hemanjiom, 2 olgu (%5.4) epidermal kist, 1 olgu (%2.7) pilomatrikoma, 1 olgu (%2.7) ksantolezma, 1 olgu (%2.7) dermoid kist, 1 olgu (%2.7) moll gland kist, 1 olgu (%2.7) epidermal nodul, 1 olgu (%2.7) fibroepitelyal polip, 1 olgu (%2.7) sebaseöz adenom, 1 olgu (%2.7) duktal kist idi.
TARTIÞMA ve SONUÇ: Hastanemize baþvuran göz kapaðý kitllerinin büyük çoðunluðu benign karakterde idi. Malign göz kapaðý türmörleri içerisinde bazal hücreli karsinom, benign göz kapaðý tümörlerinden ise skuamöz papillom en yaygýn alt tanýyý oluþturmaktaydý.

INTRODUCTION: To evaluate the clinical and histopathologic results of the patients who were admitted to theOphthalmology clinic due to a mass on the eyelids retrospectively.
METHODS: Clinical and histopathologic results of 50 patients who were admitted to ophthalmology polyclinic between March 2012 and March 2016 were evaluated retrospectively. The age and sex of the cases, localization of the mass, and histopathological diagnosis were recorded.
RESULTS: Twenty - eight (56%) women and 22 (44%) men were included in the study. The mean age of the cases was 54.3 (9-89) years. When the histopathological results of excised eyelid tumors are evaluated; 13 cases (26%) were malignant and 37 cases (74%) were benign. Malignant tumors were basal cell carcinoma (BHK) in 10 cases (76.9%), squamous cell carcinoma (SHC) in 2 cases (15.3%) and malignant epithelial tumor (7.6%) in one case. Benign tumors were squamous papilloma in 13 cases (35.1%), nevus in 5 cases (10.8%), seborrheic keratosis in 3 cases (8.1%), verruca vulgaris in 2 cases (5.4% (2.7%) epidermal nodule, 1 (2.7%) epidermal nodule, 1 case (2.7%) xanthole, 1 case (2.7%) dermoid cyst, 1 case (2.7%) fibroepithelial polyp, 1 case (2.7%) sebaceous adenoma and 1 case (2.7%) ductal cyst.
DISCUSSION AND CONCLUSION: The majority of eyelid masses who applied to our hospital were benign. Basal cell carcinoma in malignant eyelid tumors and squamous papilloma in benign eyelid tumors were the most common subtypes.

GÝRÝÞ ve AMAÇ: Apendiks, eskiden karsinoid tümör olarak adlandýrýlan nöroendokrin tümörlerin (NET) en sýk görüldüðü yerlerden biridir. Çoðunlukla semptomsuz olup apendektomi veya diðer abdominal ameliyatlar sonrasýnda insidental olarak saptanýr. Bu çalýþmada akut apandisit ön tanýsý ile apendektomi uygulanan hastalarýn patoloji sonuçlarý incelenerek NET saptanan hastalar deðerlendirildi.
YÖNTEM ve GEREÇLER: Ocak 2015 - Aralýk 2016 tarihleri arasýnda hastanemizde akut apandisit ön tanýsý ile opere edilen 586 hastanýn dosyasý ve apendektomi piyeslerine ait patoloji sonuçlarý retrospektif olarak incelendi. Hastalarýn yaþ, cinsiyet ve histopatolojik tanýlarý ile apendiks NET olarak rapor edilen olgularýn makroskopik tümör bulgu durumu, tümör yeri, tümör boyutu, cerrahi sýnýr, Ki 67 indeksi, mitotik indeks ve sonraki tedavileri deðerlendirildi.
BULGULAR: Hastalarýn 365' i erkek 228' i kadýn olup, yaþ ortalamasý 28.2 (1- 88) idi. Üç hastada (% 0.5) iyi diferansiye NET saptandý. Bu üç hastaya ait spesmenlerde akut apandisit tespit edilmedi. Hastalarýn yaþlarý 15, 35 ve 48 idi. Tümör boyutlarý 0.4, 0.6 ve 1.2 cm idi. Tüm olgularda tümör distal yerleþimli idi. Cerrahi sýnýr iki hastada negatif bir hastada pozitif idi. Her üç hastada Ki 67 proliferasyon indeksi % 2' den az ve mitotik indeks <2/10 Hpf idi. Cerrahi sýnýr pozitif olan hastaya ameliyat sonrasý 1. ay sað hemikolektomi yapýldý. Diðer iki hasta takip önerilerek taburcu edildi.
TARTIÞMA ve SONUÇ: Apendiks NET’ lere histopatoloji öncesinde taný koymak oldukca zordur. Yaþam beklentisi iyi olmakla birlikte senkron veya metakron kolorektal malignite geliþme olasýlýðý unutulmamalýdýr.

INTRODUCTION: The appendix is one of the common sites of neuroendocrine tumor (NET) which was formerly called as carcinoid tumor. It is mostly asymptomatic and incidentally detected after appendectomy or other abdominal operations. In this study, pathology results of patients which underwent operation for acute appendicitis and diagnosed as NET were evaluated.
METHODS: The files and pathology results of 586 patients which were operated for acute apandicitis in Recep Tayyip Erdoðan University Educational and Research Hospital between January 2015 and December 2016 were evalýuated retrospectively. The age, gender, histopathological diagnosis of the patients and the macroscopic tumor findings, tumor site, tumor size, surgical margin, Ki 67 index, mitotic index and subsequent treatments of the cases that was reported as appendicitis were evaluated.
RESULTS: 365 of the patients were male and 228 female. The mean age was 28.2 (1-88). Well differentiated NET was detected in three patients (0.5%). Acute appendicitis was not detected in the specimens of these three patients. The ages of the patients were 15, 35 and 48 years. Tumor sizes were 0.4, 0.6 and 1.2 cm. In all cases, the tumor was on distal site. The surgical margin was negative in two patients and positive in one patient. Ki 67 proliferation index was < 2% and mitotic index <2/10 Hpf in all three patients. Right hemicolectomy was performed in the first month after surgery in the patient with positive surgical margin. Two other patients were offered follow-up and discharged.
DISCUSSION AND CONCLUSION: It is difficult to diagnose appendix NET before histopathological examination. Life expectancy is well in these patients. However the possibility of development of synchronous or metachronous colorectal malignancies should not be forgotten.

GÝRÝÞ ve AMAÇ: Hematoloji yatan hasta servisi hastalarý çeþitli kemoterapötikler, antibiyotikler ve diðer ilaçlarla tedavi edilebilirler. Hematoloji yatan hasta servisi hastalarý tümör lizis önlenmesi, kemoterapötik toksisitesi önlenmesi gibi nedenlerle bazen intravenöz olarak hidrate de edilmelidirler.
YÖNTEM ve GEREÇLER: Çalýþma, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi Hematoloji Yatan Hasta Servisi’nde hematoloji yatan hasta servisinde 01/01/2017 (Ay / gün / yýl) ve 01/15/2017 tarihleri arasýnda herhangi bir zamanda (01/01/2017 ve 01/15 / 2017 tarihleri dahil) takip edilmiþ 49 hastayý içerdi. Hastalarýn potasyum düzeyleri, kreatinin düzeyleri ve hastalýk türleri elektronik hasta dosyasý sisteminden geriye dönük olarak kaydedildi.
BULGULAR: 49 hastanýn 22(≈45%) 'si yatan hasta servisindeki takiplerinde hipokalemi yaþadý. Tüm hastalarýn 4(≈8%)’ü yatan hasta servisindeki takipte 3 mmol/l seviyesi altýnda (< 3 mmol/l) hipokalemi yaþadý. Tüm hastalarýn 9(≈18 %)'u kreatinin seviyesi 1,2 mg/dL üzerini (> 1,2 mg/dL) yaþadý.
TARTIÞMA ve SONUÇ: Hematoloji yatan hasta servisinde hipokalemi nadir olmayabilir. Hastalar böylece yatan hasta servisindeki takip sürecinde potasyum düzeyleri ve böbrek fonksiyon testleri açýsýndan da kontrol edilmelidirler.

INTRODUCTION: Hematology inpatient unit patients could be treated with various types of chemotherapeutics, antibiotics, and other drugs. Hematology inpatient unit patients should be also sometimes intravenously hydrated for the reasons such as tumor lysis syndrome prevention and chemotherapeutic toxicity prevention. Hereby, we aimed to search about the frequency of potassium and creatinine level disorders in an hematology inpatient unit.
METHODS: All the data included 49 patients who were followed in the Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital Hematology Inpatient Unit at anytime between 01/01/2017(Month/day/year) and 01/15/2017(the dates 01/01/2017 and 01/15/2017 included). The potassium levels, creatinine levels and disease types of the patients were recorded retrospectively from the electronical patient file system.
RESULTS: Of the 49 patients, 22(≈45%) had experienced hypokalemia during their follow-up in the inpatient unit. 4 (≈8%) of the all patients had experienced hypokalemia below the level of 3 mmol/l (< 3 mmol/l) during the follow-up in the inpatient unit. 9 (≈18 %) of the all patients had experienced creatinine level over 1,2 mg/dL (> 1,2 mg/dL).
DISCUSSION AND CONCLUSION: Hypokalemia may not be rare in hematology inpatient unit. So that, patients should also be checked for the potassium levels and renal function tests during the follow-up in the inpatient unit.

GÝRÝÞ ve AMAÇ: FcγRIIaile FcγRIIIa gen polimorfizmi bulunan diffüz büyük B hücreli lenfomalý olgularýn R-CHOP tedavisine yanýtýný araþtýrmak amacýyla çalýþma planlandý.
YÖNTEM ve GEREÇLER: CD20+ diffüz büyük B hücreli lenfoma tanýlý 90 hastanýn (47 Kadýn,43 Erkek) FcγRIIa ve FcγRIIIa gen polimorfizmi qPCR ile bakýldý. Hastalara 6 kez R-CHOP tedavisi verildikten sonra tedaviye yanýt ve toplam ömür süreleri deðerlendirildi.
BULGULAR: FcγRIIa ile FcγRIIIa gen polimorfizmi bulunan olgularda tedaviye yanýt ve toplam ömür süresinin diðerlerinden istatistiksel olarak farklý olmadýðý saptandý.
TARTIÞMA ve SONUÇ: Diffüz büyük B hücreli lenfomalý hastalarýmýzda FcγRIIa ile FcγRIIIa gen polimorfizminin tedaviye yanýt ve toplam ömür süreleri üzerine etkisi olmadýðý görülmüþtür. Malign filloid tümörler veya epitelyal tümör içeren filloid tümörler, onkoplastik cerrahi teknikleri ile negatif cerrahi sýnýrla rezeke edilebilir. Böylece, filloid tümörlerde onkolojik ve kozmetik olarak baþarýlý sonuçlar elde etmek mümkündür.

INTRODUCTION: A study was planned to investigate the response of diffuse large B-cell lymphomas with FcγRIIa and FcγRIIIa, gene polymorphism to R-CHOP therapy.
METHODS: Total 90 patients (47 female and 43 male) with CD20 + diffuse large B-cell lymphoma diagnosed with FcγRIIa and FcγRIIIa gene polymorphism by qPCR technique. The response was assessed by treatment with six cycles of R-CHOP treatment and the overall survival of cases diagnosed with polymorphism was calculated.
RESULTS: There was no statistically significant difference in response to treatment between FcγRIIa and FcγRIIIa gene polymorphism and other cases.
DISCUSSION AND CONCLUSION: Diffuse large B-cell lymphoma with FcγRIIa and FcγRIIIa gene polymorphism has no effect on to overall survival as a result of treatment response.

GÝRÝÞ ve AMAÇ: Tekrarlayýcý el postür ve hareketleri el ve el bileðinde bazý kas iskelet sistemi hastalýklarýna yol açabilir. Kaynakçýlar yaptýklarý iþin doðasý nedeniyle bu hastalýklar için risk taþýrlar. Kaynakçýlarda Karpal Tünel Sendromu(KTS), Dupuytren Kontraktürü(DK), Tetik parmak(TP) ve DeQuervein Tendiniti(DQT) ve ganglion sýklýðýnýn araþtýrýlmasý planlandý.
YÖNTEM ve GEREÇLER: Hastanemize baþvuran 20 kaynakçýnýn yaþ, çalýþma süresi, çalýþýrken dominant kullandýklarý elleri kaydedildi. Kaynakçýlar KTS, DK, TP, DQT semptomlarý ve bu semptomlarýn þiddeti açýsýndan sorgulandý. Tüm hastalar bir ortopedi uzmaný tarafýndan muayene edildi. Fizik muayene bulgusu olan hastalar elektromiyografi(EMG) ile nörofizyolojik olarak da deðerlendirildi.
BULGULAR: Yaþlarý 30-54 arasýnda deðiþen, tümü erkek, 20 kaynakçý çalýþmaya dahil edildi. Hastalarýn yaþ ortalamasý 45,7±6.5, kaynakçý olarak ortalama çalýþma süresi ise 24.7± 8.3 yýl idi. On altý hasta(%80) baþvuru da subjektif el ve el bileði þikayeti belirtirken, 4(%20) hastanýn þikayeti yoktu. Ortalama þikayet süresi 2.3±1(1-5) yýldý. 8 hasta þikayetlerinin kaynak yaparken arttýðýný belirtiyordu. Ortopedik muayenede ayný hastada bir ya da daha fazla bulgu olmak üzere 5 hastada tenar atrofi, 10 hastada Tinel, 5 hastada Phalen Testi pozitiflikleri saptandý. 1 hastada TP,1 hastada DK ve 2 hastada DQT ve 3 hastada ganglion kisti saptandý. EMG ile deðerlendirilen 16 hastanýn 3’ünde hafif, 2'inde orta, 1 hastada þiddetli tek taraflý KTS bulgularý, bilateral þikayeti olan bir hastada aktif olan elde orta diðer elde hafif KTS bulgusu saptandý.
TARTIÞMA ve SONUÇ: KTS kaynakçýlarda önemli bir iþgücü kaybý nedenidir, bu meslek grubunda hastalýðýn belirtileri hakkýnda bilinç düzeyinin arttýrýlmasý yoluyla hastalýðýn erken taný ve tedavisinin saðlanmasý hastalýðýn neden olduðu iþgücü kaybýný azaltacaktýr.

INTRODUCTION: Repetitive hand postures and movements can lead to some musculoskeletal system diseases in the hand and wrist. Welders carry risks for these diseases because of the nature of the work they are doing. It is planned to investigate the frequency of Carpal Tunnel Syndrome (CTS), Dupuytren Contracture (DK), Trigger finger (TP), DeQuervin Tendinitis (DQT) and 3 as ganglions in the welders.
METHODS: Twenty welders who applied to my hospital were recorded as age, duration of study, use of dominant in working.They were questioned for the symptoms of CTS, DK, TP, DQT and the severity of these symptoms. All patients were examined by an orthopedist. Patients with pathological physical examination findings were assessed neurophysiologically by electromyography (EMG)
RESULTS: A total of 20 welders, aged 30-54, all male, were included in the study. The mean age of the patients was 45.7 ± 6.5 years and the average duration of the working as welder was 24.7 ± 8.3 years. Sixteen patients (80%) had subjective hand and wrist complaints while 4 (20%) patients had no complaints. The mean duration of complaints was 2.3 ± 1 (1-5) years. 8 patients stated that their complaints increased when they were welding. Orthopedic examination revealed tenor atrophy in 5 patients, tinel positivity in 10 patients, phalen test positivity in 5 patients. Two patients were diagnosed as DQT, 1 as TP, 1as DD and 3 as Ganglions. Sixteen patients evaluated by EMG; unilateral mild CTS was detected in 3, unilateral moderate in 2, severe unilateral CTS findings in 1 patient, moderate in dominant, mild CTS in non-dominant hand of a patient who had bilateral complaints.
DISCUSSION AND CONCLUSION: CTS is a major cause of labor loss in welders, providing early diagnosis and treatment of the disease through increased awareness of the disease's symptoms in this occupational group will reduce labor force loss caused by the disease

GÝRÝÞ ve AMAÇ: 6 yýldan fazla süren bu çalýþmada, malign plevral efüzyonlarda farklý kateterler ile uygulanan kimyasal plörodezin etkinliði karþýlaþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Bir gruba 28 F göðüs tüpü, diðer gruba da 8 F kateter konularak tetrasiklin ile kimyasal plörodez uygulandý. Daha sonra bu gruplar belli bir zaman içinde tedavi baþarýsý açýsýndan karþýlaþtýrýldý.
BULGULAR: Toplam 80 hasta deðerlendirildi. 28 F göðüs tüpü takýlan hastalarda göðüs boþluðuna ilk ve ikinci kez sklerozan ajan verilmesiyle elde edilen baþarý %90 ve %100 iken ayný oranlar 8 F kateter takýlan hastalarda %60 ve %100 olarak elde edildi. 8 F kateter takýlan hastalarda %15 rekürrens görüldü.
TARTIÞMA ve SONUÇ: 28 F göðüs tüpü ile uygulanan plörodez, 8 F kateter ile uygulananlar ile karþýlaþtýrýldýðýnda daha kýsa sürede uygulanma ve daha yüksek baþarý oranýna sahiptir. Bu baþarý, plevral efüzyonun daha geniþ çaplý kateter ile daha kolay ve çabuk drenajýna ve plevral zarlara daha çabuk ulaþým ile daha geniþ yüzeyine etki etmesine baðlanabilir.

INTRODUCTION: In this study over a 6-year period, a comparison was made of the efficacy of chemical pleurodesis applied with different catheters to patients with malignant pleural effusion.
METHODS: Thoracostomy was applied with a 28F catheter to one group and with an 8F catheter to the other and chemical pleurodesis was performed with tetracycline. The groups were compared in respect of the duration and success of the treatment.
RESULTS: A total of 80 patients were evaluated. In the patients applied with 28F catheter, success in the first adminstration of sclerosing agent to the thoracic cavity was obtained in 90% and in 100% in the second adminstration. For the group applied with 8F catheter these rates were calculated as 60% and 100%. Recurrence was seen at the rate of 15% in the 8F catheter group.
DISCUSSION AND CONCLUSION: Pleurodesis was obtained in a shorter time and with a higher success rate with applications made with a 28F catheter compared to the 8F catheter. This success can be considered due to the provision of easier drainage with the larger diameter catheter and an earlier and wider area of contact of the pleural membranes.

GÝRÝÞ ve AMAÇ: Jinekomasti, glandüler, duktal veya adipozal bileþenlerin artmasý sonucu erkek meme dokusunun iyi huylu büyümesidir. Bu çalýþmada, jinekomasti tedavisinde cerrahýn intraoperatif deðerlendirmesine baðlý olarak konvansiyonel liposuctiondan yapýldýktan sonra glandüler eksizyon gereksinimini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: 2013 ve 2017 yýllarý arasýnda jinekomasti nedeniyle ameliyat edilen erkek hastalarýn tibbi kayýtlarý retrospektif olarak incelendi. Tüm jinekomastili erkek memeleri liposuction yöntemi ile ameliyat edildikten sonra cerrahlarýn intraoperatif deðerlendirmesine baðlý olarak ihtiyaç duyulan memelere glandüler eksizyon da uygulandý.
BULGULAR: 52 erkekte (ortalama 25.61 yýl, ortalama takip: 21.5 ay) toplam 99 meme (5 tek taraflý, 47 bilateral) ameliyat edildi. Toplam 71 (% 71.7) memeye sadece liposuction uygulandý. Geriye kalan 28 (% 28.2) meme, liposuction ve ardýndan glandüler eksizyon ile ameliyat edildi. Tek baþýna liposuction uygulanan 8 (% 11.2) memede, takiplerde revizyon ihtiyacý olduðu görüldü ve 6 ay sonra glandüer eksizyon uygulandý. Duktal eksizyon ile ameliyat edilen 8 meme eklendiðinde, 99 memenin 36'sýna (% 36.3) liposuction + rezeksiyon uygulanmýþtýr.
TARTIÞMA ve SONUÇ: Retrospektif olarak yapýlan bu çalýþmada görülmüþtür ki jinekomasti nedeniyle ameliyata alýnan memelerin yaklaþýk olarak üçte ikisinde liposuction tek baþýna yeterli bir cerrahi saðlarken üçte birinde liposuction ile beraber glandüler eksizyon gerekmektedir. Ýntraoperative olarak liposuction sonrasý fizik muayene ile bariz glanduler doku kalmýþ hastalarda glandüler eksizyon uygulamasýndan kaçýnýlmamalýdýr.

INTRODUCTION: Gynecomastia refers to benign enlargement of male mammary tissue as a result of an increase of glandular, ductal, or adiposal components. In this study, we aimed to investigate the need of glandular excision after conventional liposuction in gynecomastia based on the intraoperative evaluation of surgeons.
METHODS: We reviewed the medical records of males who were operated for gynecomastia between 2013 and 2017. Although all breasts were operated with the liposuction, a glandular excision was also applied to the breasts that were needed depending on the surgeon’s intraoperative evaluation.
RESULTS: A total of 99 breasts (5 unilateral, 47 bilateral) were operated in 52 males (mean age 25.61 years, mean follow-up: 21.5 months). A total of 71 (71.7%) breasts were operated with liposuction alone. The remaining 28 (28.2%) breasts were operated with liposuction followed by glandular excision. Only 8 (11.2%) breasts that underwent liposuction alone needed a revision with glandular re-excision 6 months later. When 8 breasts operated with ductal excision were added, 36 (36.3%) of 99 breasts were operated with liposuction+resection.
DISCUSSION AND CONCLUSION: This retrospective study showed that liposuction alone provided satisfactory results in about two thirds of breasts with gynecomastia whereas glandular re-excision becomes necessary in addition to liposuction in a third of patients. Glandular excision should not be avoided when an obvious glandular tissue remained in intraoperative physical examination following liposuction.

GÝRÝÞ ve AMAÇ: Eritrosit daðýlým aralýðý (RDW) anemi ayýrýcý tanýsýnda kullanýlan basit ve ucuz bir parametredir fakat diðer hastalýklarla iliþkisi giderek artan oranda bildirilmektedir. Transplantasyon pratiðinde en sýk kullanýlan hematopoietik kök hücre kaynaðý periferik kandýr ve kök hücre mobilizasyonunu etkileyen birçok faktör tanýmlanmýþtýr. Çalýþmamýzda RDW ile üründeki CD34+ hücre sayýsý araþýnda bir iliþki bulmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya 50 hasta dahil edildi. Tanýlar multipl miyelom (n=32), non Hodgkin lenfoma (n=9), Hodgkin lenfoma (n=6), primer amiloidoz (n=1), Waldenström makroglobulinemisi (n=1) ve germ hücreli testis tümörü (n=1) idi. Mobilizasyon rejimleri siklofosfamid+granülosit koloni stimule edici faktör (G-CSF), tek baþýna G-CSF, etoposid+G-CSF ve kurtarma tedavisi+G-CSF þeklindeydi. RDW’nin üründeki CD34+ kök hücre sayýsýna etkisini deðerlendirmek için 16 eþik deðer alýnarak hastalar 2 gruba ayrýldý.
BULGULAR: Periferik kan ve üründeki CD34+ hücre sayýsý açýsýndan 2 grup arasýnda istatistiksel olarak anlamlý farklý bulunmamasýna raðmen RDW’si yüksek olan grupta sayýlar daha düþüktü. RDW ile periferik kan ve üründeki CD34+ hücre sayýsý arasýnda korelasyon saptanmadý.
TARTIÞMA ve SONUÇ: Bildiðimiz kadarýyla çalýþmamýz kanser hastalarýnda RDW ile kök hücre mobilizasyonu arasýndaki iliþkiyi deðerlendiren ilk çalýþmadýr. Sonuçlarýmýz kök hücre mobilizasyonunun RDW’nin anemi dýþý kullaným alanlarýndan biri olabileceðini düþündürmüþtür.

INTRODUCTION: The red cell distribution width (RDW) is a simple and unexpensive parameter for differential diagnosis of anemias. However, the number of articles mentioning about the relationship between RDW and human disorders is increasing. In transplantation practice, peripheral blood is the most common source of hematopoietic stem cells and many factors affect the success of mobilization. In this study, we tried to find a relationship between increased RDW and CD34+ cell count in the harvest.
METHODS: Fifty patients were included in the study. Diagnosis were multiple myeloma (n=32), non Hodgkin lymphoma (n=9), Hodgkin lymphoma (n=6), primary amyloidosis (n=1), Waldenstrom’s macroglobulinemia (n=1) and testicular carcinoma (n=1). Mobilization regimens were cyclophosphamide plus granulocyte colony stimulatig factor (G-CSF), G-CSF alone, etoposide plus G-CSF and salvage chemotherapy plus G-CSF. RDW was not correlated with peripheral blood CD34+ cell count and CD34+ cell count in the harvest. Above 16% was set as a cut-off for increased RDW and patients were divided into 2 groups.
RESULTS: Although peripheral blood CD34+ cell count and CD34+ cell count in the harvest were not different statistically between 2 groups, the numbers were lower in the increased RDW group. RDW was not correlated with peripheral blood CD34+ cell count and CD34+ cell count in the harvest in both groups.
DISCUSSION AND CONCLUSION: To our knowledge, this is the first study evaluating the relationship between RDW and stem cell mobilization in cancer patients. It seems reasonable to use RDW far beyond the differential diagnosis of anemias and stem cell mobilization can be a potential candidate.

GÝRÝÞ ve AMAÇ: Bu araþtýrmanýn amacý, artroskopik omuz cerrahisi uygulanan hastalarda ultrason eþliðinde interskalen brakiyal pleksus blok (ÝSBPB) ve genel anestezi (GA) sonrasý postoperatif intravenöz hasta kontrollü analjezi (HKA) uygulamalarýnýn postoperatif erken dönemde (24 saat) görsel analog skorlarýný (VAS) karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Bu retrospektif bir çalýþmadýr. Çalýþmaya, Aðustos 2016 ile Aðustos 2017 tarihleri arasýnda elektif artroskopik omuz cerrahisi için ÝSBPB + GA (Grup ÝSBPB) ve GA (Grup GA) uygulanan 98 hasta dahil edildi. Postoperatif 30 dk, 2., 6., 12. ve 24. saatlerde dinlenme ve aktivite sýrasýndaki görsel analog skalasý (VAS) ile aðrý skorlarý, tüketilen toplam morfin miktarý ve ilk analjezi gereksinimi zamaný hasta kontrollü analjezi cihazý ile deðerlendirildi.
BULGULAR: Hastalarýn demografik özellikleri benzerdi (p>0.05). Dinlenme ve aktif VAS skorlarý açýsýndan zaman açýsýndan iki grup arasýnda istatistiksel olarak anlamlý fark vardý (p <0.001). VAS skorlarý ÝSBPB grubunda ilk 12 saatte GA grubuna göre daha düþüktü (p <0.001). Toplam tüketilen morfin miktarý daha düþüktü ve analjezi gereksinimi zamaný ÝSBPB grubunda GA grubuna göre çok daha fazla idi (p <0.001). Ancak iki grup arasýndaki komplikasyonlarda anlamlý fark yoktu (p <0.05).
TARTIÞMA ve SONUÇ: Artroskopik omuz ameliyatý sonrasý aðrý düzeyi, ÝSBPB'nin aðrý kesici ilaç tedavisinde GA'ye üstün etkisi olduðunu, ancak ÝSBPB'nin postoperatif komplikasyonlar açýsýndan GA'ye benzer olduðunu gösterilmiþtir.

INTRODUCTION: The aim of this research was to compare postoperative early stage (24 hours) visual analogue scores (VAS) following ultrasound-guided interscalen brachial plexus block (ISBPB) and postoperative intraveunos patient controlled analgesia (PCA) after general anesthesia (GA) in patients undergoing arthroscopic shoulder surgery.
METHODS: This was a retrospective study. The subjects included 98 patients who underwent ISBPB+ GA (Group ISBPB) and GA + iv PCA (Group GA) for elective arthroscopýc shoulder surgery between August 2016 and August 2017. Postoperative visual analogue scale (VAS) pain scores at rest and during activity at 30th min, 2, 6, 12 and 24th hours, the total amount of morphine consumed, the first analgesia requirement time were evaluated by postoperative patient controlled analgesia (PCA) devices.
RESULTS: The demographic characteristics of the patients were similar (p>0.05). There was a statistically significant difference between the two groups in terms of resting and active VAS scores according to time (p<0.001). The VAS scores were lower in the ISBPB group in the first 12 hours than in the PCA group (p<0.001). Total amount of consumed morphine were lower, and the first analgesia requirement time were much more in the ISBPB group than in the PCA group (p<0.001). However, there was no significant difference in complications between the two groups (p<0.05).
DISCUSSION AND CONCLUSION: Pain levels after arthroscopýc shoulder surgery showed that ISBPB had a superior effect to GA in providing pain relief, but ISBPB was similar to GA in terms of postoperative complications.

GÝRÝÞ ve AMAÇ: Gastrointestinal mukozal malign melanomlarda BRAFV600E mutasyon varlýðý ve olgularýn klinik özelliklerini incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ankara Yýldýrým Beyazýt Üniversitesi Atatürk Eðitim ve Araþtýrma Hastanesi Patoloji bölümünde 2006-2015 yýllarý arasýnda taný almýþ malign melanomlar retrospektif olarak taranarak mukozal melanomlar ve bunlar içerisinden gastrointestinal malign melanom olgularý elde edilmiþ ve arþiv bloklarýndan hazýrlanan kesitlerde gerçek zamanlý PCR yöntemi ile BRAFV600E mutasyonu araþtýrýlmýþtýr. Ayný zamanda bu olgularýn klinik özellikler gözden geçirilmiþtir.
BULGULAR: Mukozal Malign Melanom tanýsý alan 14 olgunun 6’sý gastrointestinal yerleþimli idi. Bu olgular 54-84 yaþ aralýðýnda olup tümör 4’ü rektum, 2’si ince barsak lokalizasyona sahipti. Olgularýn tamamýnda PCR yöntemi ile çalýþýlan BRAF-V600E mutasyonu yalnýzca ince barsak yerleþimli ve omentum metastazý olan 1 olguda izlenmiþtir.
TARTIÞMA ve SONUÇ: BRAF-V600E mutasyonu var olan tek olguda tümör multi odaklar halinde geliþim göstermiþ olup bu nedenle mukozal metastaz düþünülmüþtür. Primer kutanöz ve oküler melanomlar gastrointestinal sisteme sýk olarak metastaz yapabilmektedir. Ancak primer odaðý saptamak her zaman mümkün olmayabilir. Primer gastrointestinal melanomlar da çok nadir olup genetik açýdan da kutanöz melanomlardan farklý özellikler içerebilir.

INTRODUCTION: We aimed to investigate BRAF V600E mutation in gastrointestinal mucosal melanomas and patients’ clinical outcomes.
METHODS: The melanomas which were diagnosed at Ankara Yýldýrým Beyazýt University/ Atatürk Education and Research Hospital between 2006 and 2015 were retrospectively screened for mucosal melanomas. Gastrointestinal malignant melanomas were obtained from these cases. BRAF V600E mutation analysis is performed to a total of 6 gastrointestinal melanoma cases by real time PCR method. In addition clinical characteristics of these cases have beeen reviewed.
RESULTS: Six of the 14 patients with mucosal melanoma were gastrointestinal. There were cases of rectum and 2 cases of small bowel, and patients were between 54- 84 years. BRAF V600E mutation was detected in one of the small bowel localized case with omentum metastasis.
DISCUSSION AND CONCLUSION: The only case with BRAF V600E mutation was multifocal therefore mucosal metastatis is considered in this case. Primary cutaneous and ocular melanomas can frequently metastasize to the gastrointestinal tract. However, it may not always be possible to identify the primary tumor. Primary gastrointestinal melanomas are very rare and genetically different from cutanous melanomas.

GÝRÝÞ ve AMAÇ: Bu çalýþmada iki farklý yüksek vaka sayýlý üroloji kliniðinde iki farklý yöntemle yapýlan perkütan nefrolitotomi(PNL) sonuçlarýný karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Kasým 2016- Kasým 2017 tarihleri arasýnda Ankara Dr. Abdurrahman Yurtaslan Onkoloji Eðitim ve Araþtýrma Hastanesi supine pozisyonda yapýlan 45 PNL olgusu ile Ankara Atatürk Eðitim ve Araþtýrma Hastanesi Üroloji Kliniklerinde prone pozisyonda PNL yapýlan 45 hastanýn verileri retrospektif olarak deðerlendirildi. Çalýþmaya vücut dýþý þok dalgasý ile taþ kýrma tedavisi ve retrogradeintrarenal cerrahiye uygun olmayan taþ boyutu 1.5cm’den büyük taþ nedeniyle PNL yapýlan hastalar çalýþmaya dahil edildi.
BULGULAR: Her iki grup yaþ, cinsiyet daðýlýmý, taþýn olduðu taraf, taþ lokalizasyonu, taþ boyutu, taþ volümü, parankim kalýnlýðý, taþ dansitesi, giriþ lokalizasyonu, fluroskopi süresi, kanama miktarý, nefrostomi kalýþ süresi ve hastanede kalýþ süresi özellikleri açýsýndan istatistiksel olarak benzer idi. Nefrostomi takýlma oraný supine PNL grubunda istatistiksel olarak anlamlý derecede daha yüksek idi (%88,8’e karþý %71,1, p=0,035). Buna karþýlýk double J stent takýlma oraný prone PNL grubunda istatistiksel olarak anlamlý derecede daha yüksek idi (%42,2’ye karþý %22,2, p=0,042). Toplam cerrahi süresi supine PNL grubunda istatistiksel olarak anlamlý derecede daha kýsa idi (p=0,01). Perioperatif komplikasyon oranlarý karþýlaþtýrýldýðýnda komplikasyon izlenmeme oraný prone PNL grubunda istatistiksel olarak anlamlý derecede daha yüksek idi (%82,2’ye karþý %68,9, p=0,007).
TARTIÞMA ve SONUÇ: Böbrek taþlarýnýn tedavisinde supine ve prone pozisyonlar benzer taþsýzlýk oraný, hastanede kalýþ süresi ve kanama oranlarýna sahiptir. Prone pozisyonda yapýlan PNL’ye göre supine pozisyonda yapýlan PNL cerrahisi yaklaþýk 15 dakika daha kýsa sürmektedir. Ancak supine pozisyonda komplikasyon oraný nispeten daha fazladýr.

INTRODUCTION: Introduction: In this study, we aimed to compare outcomes of two different percutaneous nephrolitotomy methods in two different high volume urology clinics.
METHODS: Data of 45 patients who underwent supine PNL in Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research hospital and 45 patients who underwent prone PNL in Ankara Atatürk Training and Research hospital were evaluated retrospectively. Patients who underwent PNL for>1.5 cm renal stone and who unfit for extracorporeal shock wave lithotripsy and retrograde intrarenal surgery enrolled to this study.
RESULTS: Both groups are statistically similar in terms of age, gender, stone lateralization, stone localization, stone diameter, stone volume, renal parenchyme thickness, stone density, access localization, fluoroscopy time, bleeding, nephrostomy removal time and hospitalization time. Nephrostomy placement rate was statistically significant higher in supine PNL group (88.8% vs. 71.1%, p=0.035). Incontrast, double j stent placement rate was statistically significant higher in prone PNL group (42.2% vs. 22.2%, p=0.042). Total surgery time was shorter in supine PNL group (p=0.01). When perioperative complication rates compared, the rate of no complication was statistically higher in prone PNL group (82.2% vs. 68.9%, p=0.007).
DISCUSSION AND CONCLUSION: For treatment of kidney stones, supine and prone positions have similar stone free rates, hospitalization and bledding rates. According to prone position PNL, in supine position PNL surgery takes about 15 minutes shorter. However, complication rate is relatively higher in supine position.

Ýntraoperatif radyoterapi (IORT), kanser tedavisi için yeni bir modalitedir. IORT, tümörün direk görülmesi ve bu alana radyoterapi tedavisi esasýna dayanmaktadýr. Bir seferde, yüksek doz radyasyon, tümör yataðýna, rezidü tümör dokusuna ya da sýnýrlý bölgesel lenf noduna uygulanmaktadýr. IORT; cerrah, anesteziyolog, radyoterapist, radyolog, patolog ve cerrahi destek ekibi tarafýndan multidisipliner bir yaklaþým gerektirir.
Hastanemizde Kasým 2012’den itibaren mobil Mobetron (intraoperatif incorporated SantaClara CA ) cihazý ile IORT tedavisi uygulanmaktadýr. Bu hastalar IORT uygulanabilme kriterlerine göre seçilmektedir ve önceden toplanan IORT konseyinde multidisipliner olarak deðerlendirilmektedir. Anesteziyolog da bu konseyin bir üyesidir ve karar aþamasýndan baþlayarak IORT tedavisinin her aþamasýnda yer almaktadýr. Ameliyathane ortamýnda yüksek doz ýþýn tedavisi alacak olan hastanýn preoperatif hazýrlýðý, izolasyonu, ýþýnlama sýrasýnda pozisyonu, monitörizasyonu önem taþýr. Anesteziyologlar IORT hastalarýnýn optimal þartlarda operasyona alýnmasýný saðlamalýdýr. Operasyon sýrasýnda damar yollarýnýn, kablolarýn, solunum devrelerinin hastanýn pozisyon deðiþikliklerinde sabit kalmasýný saðlayacak önlemler alýnýr. Iþýnlama sýrasýnda ventilasyonun durdurulduðu zamanlarda, hastalarýn solunum parametrelerinin korunmasý önem taþýmaktadýr. Bu iþlemler sýrasýnda anesrezi altýndaki hastalar operasyon odasýnda izole olduðundan, kontrol odasýndan monitörizasyonun dikkatli bir þekilde takip edilmesi önemlidir. IORT uygulamalarý için izole býrakýlmak zorunda olan hastanýn güvenliðinden anesteziyolog sorumludur ve güvenli bir anestezi saðlamak için; hastanýn hazýrlanmasýndan, rahat bir postoperatif dönem geçirmesine kadar her aþamada görev yapar. Yazýmýzda Kasým 2012’den günümüze kadar IORT uygulanmýþ 111 kanser hastasýndaki anestezi deneyimlerimizi paylaþmayý amaçladýk.

Intraoperative radiotherapy (IORT) is a new modality for cancer treatment. IORT depends on direct visualisation of the tumour and administration radiotherapy to the involved area. Single high dose radiation is applied to tumour bed, residual tumour tissue or limited regional lymph node. IORT treatment requires a multidisciplinary approach by the surgeon, anesthesiologist, radiotherapist, radiologist, pathologist and surgical support team.
Since November 2012, IORT treatment with mobile Mobetron (intraoperatively incorporated Santa Clara) is performed in our hospital. These patients are selected according to the IORT application criteria and previously are evaluated as multidisciplinary in the collected IORT council. The anesthesiologist is the member of this council and takes place from the decision process to all stage of the IORT treatment. The preoperative preparation, isolation, position during irradiation and monitorization of the patient who will receive high doses of radiation therapy in the operating room are crucial for the anesthesia. Anesthesiologists should ensure that IORT patients are operated under optimal conditions. During the operation, precautions is taken to ensure that vessel routes, cables, and respiratory circuits remain constant during patient position changes. When ventilation is stopped during irradiation, patients' respiratory parameters are protected. Since patients are isolated under anesthesia in operating room, it is important to follow the monitor carefully from the control room. The anesthesiologist is responsible for safety of the patient who has to be isolated for IORT applications and to ensure safe anesthesia; from the preparation of the patient until comfortable postoperative period. In this review we aimed our experinces of anesthesia in 111 cancer patients who were given IORT theraphy since november 2012 until today.

Over kanseri tedavisinde nüks hastalýðýn yönetimi son derece önemlidir. Çünkü rekürrens paterni over kanserinin ayrýlmaz bir parçasýdýr. Günümüzde nükslerin yönetiminde tekrarlayan cerrahiler ve çeþitli kemoterapi basamaklarý kullanýlmaktadýr. Sekonder, Tersiyer ve Kuarterner cerrahi giriþimler nüks epitelyal over kanserlerinin ayrýlmaz parçalarýdýr. Günümüzde bu konularý ele alan prospektif çalýþma bulunmamaktadýr. Sekonder sitoredüksiyonla ilgili retrospektif çalýþmalar belirli bir düzeyi yakalamýþtýr. Sekonder sitoredüksiyonun etkinliðinde rezidü tümör dokusu, hastalýksýz saðkalým süresi ve rekürrens lokalizasyonlarý hasta seçiminde ve saðkalýmda önemli parametreler gibi görülmektedir. Tersiyer ve kaurterner sitoredüksiyon cerrahisinin etkinliði ile ilgili yeterli çalýþma yoktur. Mevcut az sayýdaki çalýþmalarda rezidü tümör miktarýný 0 veya <1cm’ in altýna indirecek etkin bir cerrahinin yapýlmasýnýn temel nokta olduðu eðilimi vardýr. Fakat her üç cerrahi yaklaþým içinde sunulan veriler son derece heterojendir. Hasta sayýlarý, tümörün evresi ve histolojik daðýlýmlarý, rekürrens daðýlýmlarý, sitoredüksiyon tanýmlarý ve takip süreleri farklýdýr. Bu heterojenite içinde bias kaçýnýlmazdýr. Sonuçta cerrahlar kendince ameliyat yapabilecekleri hastalarý opere etmekte ve bu hastalar salvage kemoterapisine göre iyi yaþamaktadýr. Tüm çalýþmalarda maksimum sitoredüksiyonun prognostik rolü vurgulansa da bu maksimalite biyolojik olarak daha iyi huylu tümörlerde elde edilmiþ olabilir. Ayrýca tüm çalýþmalarda ne kadar hastanýn çalýþma dýþý býrakýldýðý yazýlmamaktadýr. Mevcut seriler uzun zamanda toplanmakta zamanla deðiþen cerrahi tecrübe, teknik altyapý ve kemoterapi protokollerini içermemektedir. Çalýþmalarýn çoðunda pre ve postoperatif dönemde hangi kemoterapi protokollerinin verildiði bilgisi üzerinde durulmamaktadýr. Bir diðer dezavantaj ise yaþam kalitesi ile ilgili çalýþmalarýn olmamasýdýr. Radikal cerrahi sonrasý tüm çalýþmalar yaþam oranlarýna odaklanmýþtýr. Bu derlemenin amacý rekürren epitelyal over kanserinde sekonder, tersiyer ve kuarterner sitoredüksiyon cerrahi ile ilgili yapýlmýþ sýnýrlý sayýdaki çalýþmayý deðerlendirmek, çelýþmalarýn eksik yönlerini ortaya koymak ve bunlar ýþýðýnda ilerdeki çalýþmalara ýþýk tutmaktýr.

Management of recurrent disease is extremely important in ovarian cancer treatment. Today, recurrent surgeries and various chemotherapy steps are used in the management of recurrences. Secondary, tertiary and quaternary surgeries are integral parts of recurrent epithelial ovarian cancers. Currently, there are no prospective studies addressing these issues. Retrospective studies about secondary cytoreduction have reached a certain level. It seems like residual tumor tissue, duration of disease-free survival and recurrence locations in the efficacy of secondary cytoreduction are important parameters in patient selection and survival. There is insufficient study about the efficiacy of tertiary and quarternary cytoreduction surgery. In the few studies available, the main point is tendency to perform an effective surgery that reduce the amount of residual tumor below 0 or 1 cm. But the data presented in all three surgical approaches is highly heterogeneous. Patient numbers, tumor stage and histologic distribution, recurrence distributions, definition of cytoreduction and follow-up time are different. Bias is inevitable within this heterogeneity. As a result, surgeons operate patients with their own capabilities and these patients survive better than patients treated with salvage chemoterapy. Although the prognostic role of maximal cytoreduction is emphasized in all studies, this maximality may have been obtained from biologically more benign tumors. In addition, it does not mention how many patients are left out of work in all studies. Current series do not include surgical experience that change over time, technical infrastructure and chemotherapy protocols. Most of the studies do not focus on which chemotherapy protocols are given in the pre- and postoperative period. Also there are no studies on quality of life. All studies after radical surgery focus on survival rates.Our aim is to evaluate studies on secondary, tertiary, and quarternary cytoreductive surgery, to reveal missing aspects of studies and to contribute future studies.

Akciðer kanseri dünya genelinde erkek ve kadýnlarda ikinci sýklýkta görülen, her iki cinsiyette en sýk ölüme yol açan kanser türüdür. Epidermal büyüme faktörü reseptörü (EGFR) hücre dýþýnda ligand baðlanma ve hücre içi tirozin kinaz bölümleri olan transmembran glikoproteinlerdir. Erlotinib, Gefitinib, Afatinib, Lapatinib gibi ajanlar EGFR’nin hücre içi tirozin kinaz bölümü aktivasyonunu inhibe etmektedir. Bu ajanlar genellikle iyi tolere edilirler. Tedavi sýrasýnda cilt toksisitesi olarak en sýk cilt düküntüsü görülmektedir. Erlotinib tedavisi ile iliþkili alopesi görülebilen bir durumdur. Ýleri yaþ, bayan hastalarda uzun süreli tedavi ile karþýmýza çýkabilir. Skatrisyel ve skatrisyel olmayan alopesi þeklinde görülebilmektedir. Biz bu çalýþmamýzda erlotinib kullanýmý ile iliþkili alopesi geliþen olgumuzu sunduk.

Lung cancer is the second most common cancer type in men and women worldwide, and the most frequent type of cancer that causes death in both sexes. Epidermal growth factor receptor (EGFR) is a transmembrane glycoprotein that has extracellular ligand binding and intracellular tyrosine kinase segments. Agents such as Erlotinib, Gefitinib, Afatinib, Lapatinib inhibit the activation of the intracellular tyrosine kinase domain of EGFR. These agents are usually well tolerated. Skin rash is the most common skin toxicity during treatment. Alopecia related to erlotinib therapy is a condition that can be seen.. Elderly and female patients may be confronted with long-term treatment. It can be seen as a cicatricial and non-cicatricial alopecia. In this study, we tried to present our case that developing alopecia related to the use of erlotinib.

Epidermal büyüme faktörü reseptörü (EGFR) inhibitörleri, malign epitelyal tümörlerin tedavisinde yaygýn olarak kullanýlmaktadýr. Bu ajanlarýn kullanýmýnda en sýk gözlenen yan etki cilt toksitesi iken trikomegali nadir görülen bir yan etkidir. Burada, metastatik kolon karsinomu nedeniyle panitumumab kullanan ve trikomegali geliþen 48 yaþýndaki kadýn olgu literatür eþliðinde sunulmuþtur.

Epidermal growth factor receptor (EGFR) inhibitors are widely used in the treatment of malignant epithelial tumors. Trichomegaly is a rare side effect while skin toxicity is the most common side effect of using these agents. In here, a 48-year-old female with trichomegaly using panitumumab due to metastatic colon carcinoma was presented in the literature.

Filloid tümör (FT), tüm meme tümörlerinin %1'inden azýný oluþturan nadir bir fibroepitelyal neoplazmdýr ve fibroepitelyal neoplazmlarýn % 2-3'ünü oluþturur. FT'ün malign transformasyonu genellikle stromal komponentin de gerçekleþir ve epitelyal komponentde malign transformasyon nadiren görülür. DCIS, LCIS veya invaziv tümörler nadiren de olsa epitelyal komponent kaynaklý olabilir. Biz benign bir FT'de ortaya çýkan duktal karsinoma in situ (DCIS) olgusunu sunuyoruz. 38 yaþýnda multipar kadýn hasta, sol meme üst dýþ kadranda sýnýrlarý belirsiz, düzensiz þekilli, sert, palpabl bir kitle þikayetiyle baþvurmuþ. Bu kitleden poliklinik koþullarýnda, ultrason eþliðinde kor biyopsi yapýldý ve biyopsi sonucu DCIS komponenti içeren benign FT olarak geldi. Hastaya segmental mastektomi uygulandý. Patoloji sonucu, duktal karsinoma in situ (DCIS) ile birliktelik gösteren benign filloids tümör þeklinde geldi. DCIS, epitelyal komponentin geniþ bir alaný (epitelyal komponentin % 70'i) içinde gözlendi. Cerrahi sýnýr tümörden 1 mm uzaktaydý. Hastaya re-eksizyon uygulandý, ancak cerrahi sýnýr yakýn geldi, bu nedenle hastaya implant rekonstrüksiyonu ile subkutan mastektomi uygulandý. Büyük boy filloid tümörler, Malign filloid tümörler veya epitelyal tümör içeren filloid tümörler, onkoplastik cerrahi teknikleri ile negatif cerrahi sýnýrla rezeke edilebilir. Böylece, filloid tümörlerde onkolojik ve kozmetik olarak baþarýlý sonuçlar elde etmek mümkündür.

Phyllodes tumor (PT) is a rare type of biphasic fibroepithelial neoplasm that accounts for <1% of all breast tumours and represents 2-3% of fibroepithelial neoplasms. Malignant transformation of PT usually occurs in the stromal component, and is rare in the epithelial component. DCIS, LCIS or invasive tumors might be due to epithelial component. We report a case of ductal carcinoma in situ (DCIS) occurring with in a benign PT. A 38-year-old multipar woman applied to an other medical center with compliants of a firm, palpable, irregularly-shaped lump with an ill-defined margin in the outer upper quadrant of the left breast. An ultrasound-guided core biopsy of this lump was done on an outpatient basis and the biopsy findings were benign PT with a DCIS component. The patients has undervent segmental mastectomy. The patology results were benign phyllodes tumor with Ductal Carcinoma In situ (DCIS). DCIS was also observed in a wide area of epithelial component (70% of epithelial component). The surgical margin were 1 mm away from the tumor. The patients had re-excision operation, however the surgical margin was still closed the margin so the patient had subcutaneous mastectomy with implant reconstruction. Large sized phyllodes tumors, malign phyllodes or epithelial tumors within phyllodes tumor can be resected with negative surgical margin with oncoplastic surgery techniques. Thus, it is possible to obtain successful results both in oncologic and cosmetically in phyllodes tumors.

Gastrik duplikasyon kistleri gastrointestinal sistemin nadir konjenital anomalilerindendir. Hastalarýn çoðu kusma, iþtahsýzlýk ve beslenme bozukluðu ile baþvurur. Olgularýn yarýsý ilk yaþ içerisinde taný alýr. Bu çalýþmada akut batýn sebebi ile baþvuran ve gastrik duplikasyon kisti saptadýðýmýz on yaþýnda ki bir olgu sunulmuþtur. Çocuklarda nadir görülen gastrik duplikasyon kistlerinin akut batýn nedeni olarak karþýmýza çýkabileceði akýlda tutulmalýdýr.

Gastric duplication cyst is a rare congenital anomaly of the gastrointestinal system. Patients are mostly presented with vomiting, anorexia and malnutrition. Half of the cases are diagnosed in the first year of life. In this study, we report a 10 year old girl with gastric duplication cyst that was presented as acute abdomen.

Ýntravasküler fasiit küçük ve orta çaplý damarlarýn duvar ve lümenlerini tutan, reaktif myofibroblastik hücre proliferasyonudur. Nodüler fasiitin daha nadir görülen bir varyantýdýr. Benign bir lezyon olmasýna raðmen sýklýkla malign tümörler ile karýþabilmektedir. Bu olgu sunumunda 54 yaþýnda bir bayan hastanýn sað memesinden eksize edilen lumpektomi spesimeninde intravasküler fasiit olgusu sunulmuþtur.

Intravascular fasciitis is a reactive myofibroblastic proliferation that involves wall and lumen of small to medium-sized vessels. It is a rare variant of nodular fasciitis. Although its benign nature, it can be often confound with malignant tumors. In this report we present a case of intravascular fasciitis from a 54 year old female patients lumpectomy removed from the right breast.

Anjiomyolipoma renal tümörlerin yaklaþýk %5’ini oluþturur. Benign karekterde olduklarýndan, taný konmadan önce büyük boyutlara ulaþabilirler. Kitle boyutu 4 cm’den küçük lezyonlar çoðunlukla asemptomatiktir. Boyutu 4 cm’den büyük lezyonlarda intratümöral ya da perinefritik hemoraji riski artar ve lezyon semptomatik hale gelebilir. Tedavi yaklaþýmlarý, tümörün boyutuna ve komplikasyonlarýna baðlý deðiþir. Ultrasonografi ve bilgisayarlý tomografi, kitlenin boyutu, iç yapýsý ve komplikasyonlarýnýn deðerlendirilmesinde, böylelikle böbrek koruyucu cerrahi yaklaþýmlara yön vermesinde deðerlidir. Biz olgumuzda spontan retroperitoneal kanamaya neden olmuþ 13 cm boyutundaki renal anjýomyolýpomayý sunmayý amaçladýk

Angiomyolipomas form approximately 5% of renal tumors. Because of their benign character, they may reach extensive sizes before the diagnosis. They are usually asymptomatic if the tumor size is less than 4 cm. Ýn angiomyolipomas greater than 4 cm, there is an increased risk of intratumoral or perinephritic hemorrage and patients may be come symptomatic. Therapeutic approach, differs with respect to size of the tumor and complications. Ultrasonography (US) and computed tomography (CT) are important in evaluating the tumor size, internal structure of tumor and complications. Ýn that way, nephron sparing surgery can be planned. We aimed to present a case of spontaneous retroperitoneal hemorrhage, in a patient with 13 cm renal anjiomyolipoma.

Gastrointestinal stromal tümörler gastrointestinal sistemin en yaygýn görülen mezenkimal tümörleridir. Kontrastlý bilgisayarlý tomografi, tedaviye yanýtý deðerlendirmede en yaygýn kullanýlan yöntemdir. Hedefli tedaviler tümör yapýsýnda bazý deðiþikliklere neden olabilir. Lezyon vaskülaritesinde azalma, kavitasyon ve intratümöral kanama, imatinib tedavisi sonrasý hastalarda herhangi bir boyut azalmasý olmadan bile görülebilen bazý deðiþikliklerdir. Çeliþkili olarak, kistik deðiþiklik ve intratümöral kanama nedeniyle bazý durumlarda geçici bir boyut artýþý görülebilir. Gastrointestinal stromal tümörlerde Choi ve arkadaþlarý tarafýndan alternatif tümör yanýt kriterleri geliþtirilmiþtir. Choi ve arkadaþlarý Yanýtýn deðerlendirilmesinde sadece tümör boyutunun deðil tümör yoðunluðunun da önemli olduðunu gösterdiler. Bu çalýþmada biz gastrointestinal stromal tümör tanýsý alan, imatinib ile tedavi edilen 67 yaþýnda erkek hastayý sunduk. 3 aylýk imatinib tedavisinden sonra, yanýt deðerlendirilmesinde karaciðer lezyonlarý progresyon olarak rapor edilmiþti.

Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract. Contrast-enhanced computed tomography is the most commonly used for evaluating response to treatment. Targeted therapies may cause some changes in tumor structure. Reduced lesion vascularity, cavitations, and intratumoral hemorrhage are some changes in patients after imatinib therapy, even without any size reduction. Paradoxically, a transient increase in size may be seen in some cases due to cystic change and intratumoral hemorrhage. Alternative tumor response criteria were developed by Choi et al. in gastrointestinal stromal tumor. Choi et al. showed that not only the tumor size but also the tumor density are important in evaluating the response. In this study, we presented a 67-year-old male patient treated with imatinib receiving a gastrointestinal stromal tumor diagnosis. After 3 months of imatinib treatment, liver lesions were reported as progression in response assessment.