GÝRÝÞ ve AMAÇ: Bu çalýþmada mide kanserli hastalarda 13q21'de sýklýkla amplifiye bölge üzerinde yer alan KLF5 geninin ekspresyon seviyesinin tanýsal ve prognostik önemini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Gastrik adenokarsinomlu 35 hasta çalýþmaya alýndý ve KLF5 mRNA hem normal hem de tümörlü mide dokularýnda gerçek zamanlý qPCR ile belirlendi.
BULGULAR: Sonuçlarýmýz, KLF5'in tümör dokularýnda normal mide mukozasý örneklerinden daha fazla aþýrý eksprese olduðunu göstermiþtir (P <0.01). Farklý derecelerde lenf nodu metastazý olan hastalarda KLF5 ekspresyonundaki deðiþikliðin, sýnýrlý istatistiksel anlamlýlýk düzeyinde farklý olduðu bulundu (P = 0.052). Lenf nodu metastazlý hastalarda, düþük lenf düðüm metastazý hastalarýna kýyasla, aþýrý lenf nodu metastazý olan hastalarda KLF5 aþýrý ekspresyonu vardý.
TARTIÞMA ve SONUÇ: Sonuçlarýmýz, KLF5'in gastrik tümör geliþimi ve ilerlemesindeki rolünü geniþletmeye katkýda bulunabilir.

INTRODUCTION: In this study we aimed to investigate the diagnostic and prognostic significance of the expression level of KLF5 gene located frequently on amplified region of 13q21 in patients with gastric cancer.
METHODS: Thirty five patients with gastric adenocarcinomas were enrolled in this study and KLF5 mRNA were quantified by real-time qPCR both in normal and tumoral gastric tissue samples.
RESULTS: Our results showed that KLF5 is significantly over-expressed in tumor tissues than normal gastric mucosa samples (P<0.01). Fold change of KLF5 expression in patients with different degree of lymph node metastasis were found to be different at a level of limited statistical significance (P=0.052).Patients with increased lymph node metastasis had KLF5 over-expression when compared to patients with lower lymph node metastasis.
DISCUSSION AND CONCLUSION: Our results may contribute to expand the role of KLF5 in gastric tumor development and progression.

GÝRÝÞ ve AMAÇ: Bu çalýþmada, duktal karsinoma in situ (DKÝS) tanýlý hastalarda meme koruyucu cerrahi (MKC) ve adjuvan radyoterapi (RT) sonrasý lokal yineleme sonuçlarý, prognostik faktörler araþtýrýlmýþ ve Eastern Cooperative Oncology Group (ECOG) E5194 çalýþmasý ile karþýlaþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: DKÝS tanýsý 96 hasta geriye dönük olarak deðerlendirilmiþtir. Lokal kontrolü etkileyen prognostik faktörler (yaþ, tümör boyutu, cerrahi sýnýr, nükleer grad, komedo nekroz varlýðý, reseptör durumu) araþtýrýlmýþ ve ECOG E5194 çalýþmasýna göre tanýmlanmýþ olan düþük riskli gruplar, lokal kontrol açýsýndan karþýlaþtýrýlmýþtýr.
BULGULAR: Hastalar ortanca 62 ay (8-139) ay takip edilmiþtir. Hastalýk yinelemesi 5 hastada geliþmiþ: 2 (%2.1)’si invaziv meme karsinomu, 3’ü (%3.1) DKÝS’dir. On yýllýk lokal kontrol %89 olmuþtur. Lokal hastalýk yinelemesinde 50 yaþýn altý, Östrojen (ER) reseptör negatifliði, c-erb-B2 pozitifliði anlamlý bulunmuþtur (sýrasýyla p=0.020, p=0.014, p=0.022). 50 yaþ altý için alt grup analizi yapýlmýþ: ER negatifliði ve c-erb-B2 pozitifliði lokal yinelemeyi arttýran faktörler olmuþtur (sýrasýyla p=0.024, p=0.046). ECOG çalýþmasýna göre düþük riskli grup olarak kabul edilen Grup 1 ve Grup 2 ve bu iki grup ile bu iki gruba dahil olmayanlar karþýlaþtýrýlmýþ; her iki karþýlaþtýrmada fark saptanmamýþtýr (p>0.05).
TARTIÞMA ve SONUÇ: DKÝS’da lokal kontrolü etkileyen prognostik faktörler yaþ ve hormon reseptör durumu olmuþtur. ECOG çalýþmasýna göre tanýmlanmýþ düþük riskli gruplarda adjuvan RT eklenmesinin 10 yýlda mutlak olarak %10 katký saðlamýþtýr.

INTRODUCTION: In this study, local recurrence rates and prognostic factors was investigated in patients with ductal carcinoma in situ (DCIS) after breast conserving surgery (BCS) and adjuvant radiotherapy (RT) and compared with Eastern Cooperative Oncology Group (ECOG) Study E5194.
METHODS: Totally 96 patients were evaluated retrospectively. Prognostic factors that might influence local control (age, tumor size, surgical margins, nuclear grade, comedo necrosis, hormone receptor status) were investigated. The eligibility criteria of ECOG 5194 were stratified into two groups as in the original study and were compared for local control.
RESULTS: The median follow-up time was 62 ay (8-139) months. Local recurrence was observed in 5 patients who had 2 (%2.1) invasive carcinoma and 3 (%3.1) DCIS. Ten years local control rate was 89%. In the recurrence of local disease, the age of 50 years, estrogen (ER) receptor negativity, c-erb-B2 positivity was found to be significant (respectively p=0.020, p=0.014, p=0.022). According to the ECOG study, Group 1 and Group 2, which are considered to be low risk groups, and these two groups were compared with those who were not included in these two groups; there was no difference in both comparisons (p> 0.05).
DISCUSSION AND CONCLUSION: Prognostic factors affecting local control in DCIS have been age and hormone receptor status. When 10-year results were compared with the ECOG 5194, adjuvant RT produced an absolute difference of 10% in low-intermediate and high grade in local control.

GÝRÝÞ ve AMAÇ: Bu çalýþmada iki basamak standart tedavi almýþ metastatik kolorektal kanser (mKRK) tanýlý hastalarda oksaliplatin ya da irinotekan bazlý rejimlerin yeniden verildiði (rechallenge) hastalar ile regorafenib alan hastalarýn gerçek yaþam verilerinin karþýlaþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Ocak 2010 ve Aralýk 2017 tarihleri arasýnda merkezimizde mKRK tanýsýyla takip edilen 427 hastanýn verileri retrospektif olarak deðerlendirilip, iki basamak stardart kemoterapi sonrasý progresyon nedeniyle rechallenge kemoterapi (n: 40) veya regorafenib (n: 21) alan 61 hasta çalýþmaya alýndý.
BULGULAR: Medyan takip süresi 7.1 aydý (aralýk; 2.2–41.6). Hiçbir hastamýzda tam yanýt gözlenmez iken parsiyel yanýt rechallenge grubunda %17, regorafenib grubunda ise %5 olarak bulundu (p=0.2). Rechallenge grubunda ortanca genel saðkalým (GSK) 9.6 ay (%95 CI 7.3–13.3) iken regorafenib grubunda 7 ay (1.9–17) olup istatistiksel olarak fark yoktu (Hazard oraný [HR]: 1.05; %95 Güven aralýðý [GA] 0.5–2.1, p=0.9). Ortanca progresyonsuz saðkalým da (PSK) her iki grupta benzerdi (sýrasýyla; 4.7 ay ve 3.1 ay, HR: 1.45; 95% GA 0.82–2.5, p=0.1). Rechallenge grubundaki hastalar önceki tedavilerinde tedavisiz süre (TS) <6 ay ve ≥6 ay olarak ayrýldýðýnda TS ≥6 ay olan grupta ortanca PSK (sýrasýyla 6.7 ay ve 4 ay, p=0.4) ve GSK (10.3 ve 7.1 ay, p=0.1) numerik olarak daha iyi olsa da bu fark istatistiksel olarak anlamlý deðildi.
TARTIÞMA ve SONUÇ: Bulgularýmýza göre rechallenge tedavi ile regorafenib benzer etkinliktedir. Bu verilere dayanarak kötü prognozlu olan bu hasta grubunda rechallenge tedavi üçüncü basamakta alternatif bir tedavi seçeneði veya önerilen tedaviler ile progrese olan hastalarda sonraki basamaklarda tercih edilebilecek bir rejim olabilir. Ancak hasta sayýmýzýn azlýðý ve çalýþmamýzýn retrospektif olmasý nedeniyle bu konuda çok sayýda hasta içeren prospektif çalýþmalara ihtiyaç vardýr.

INTRODUCTION: In this study, we aimed to compare the results of regorafenib with those of oxaliplatin or irinotecan based rechallenge therapy as the third-line treatments for metastatic colorectal cancer (mCRC).
METHODS: Between January 2010 and December 2017, data of 427 mCRC patients were evaluated retrospectively. Sixty one mCRC patients who received regorafenib (n: 21) or rechallenge therapy (n: 40) as third-line setting were included.
RESULTS: Median follow-up was 7.1 months (range; 2.2–41.6). While no complete response was observed in any of our patients, the partial response was 17% in the rechallenge group and 5% in the regorafenib group (p=0.2). In the Rechallenge group, the median OS was 9.6 months (95% CI 7.3–13.3), while in the regorafenib group 7 months (1.9–17) there was no statistically significant difference (HR: 1.05; 95% CI 0.5–2.1, p=0.9). Median progression-free survival (PFS) was similar in both groups (4.7 and 3.1 months, HR: 1.45; 95% CI 0.82–2.5, p=0.1). Although median PFS (6.7 months and 4 months, p = 0.4) and OS (10.3 and 7.1 months, p = 0.1) were numerically better in treatment free-interval (TFI) ≥6 months group, this difference was not statistically significant.
DISCUSSION AND CONCLUSION: According to our findings, regorafenib with rechallenge treatment is similar activity. Based on these data, rechallenge therapy in this patient group with poor prognosis may be an alternative treatment option in the third step or a regimen that can be preferred in the next steps in the patients who are scheduled with the recommended treatments. However, due to the small number of our patients and the retrospective nature of our study, prospective randomized trials with large number of patients are needed in this area.

GÝRÝÞ ve AMAÇ: Sinoviyal sarkom (SS) çocukluk çaðýnýn en sýk rabdomyosarkom dýþý yumuþak doku sarkomu olmakla birlikte eriþkin yaþ grubunda daha sýk görülür. Çalýþmamýzda merkezimizde izlenen SS tanýlý çocuk hastalarýn klinik bulgu ve tedavi sonuçlarýný geriye dönük olarak incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi Çocuk Hematoloji Onkoloji Kliniði’nde 1993 ile 2017 yýllarý arasýnda SS tanýsý almýþ hastalar deðerlendirildi. Hastalarýn klinik özellikleri, aldýklarý tedaviler ve tedaviye yanýtlarý incelendi.
BULGULAR: Kliniðimizde izlenen 15 çocuk hastanýn verilerine ulaþýldý. Hastalarýn yaþ ortancasý 14,5 (13 – 17) yýldý, 14 hastada tümör ekstremite kökenliydi. Hastalar IRS gruplama sistemine göre deðerlendirildiðinde beþ hasta (%33,3) grup I, sekiz hasta (%53,3) grup II ve iki hasta (%13,3) grup III’tü. Ýlk remisyon saðlanan 12 hastanýn dördünde (%33) rölaps geliþti, üç hastada sadece akciðer, bir hastada akciðer ve eksternal iliak lenf düðümünde hastalýk tespit edildi. Hastalar ortanca 28 (5 – 85) ay izlendi, üç yýllýk olaysýz sað kalým %53,6, üç yýllýk genel sað kalým %73 olarak hesaplandý. Hastalarýn IRS gruplarýna göre üç yýllýk genel sað kalýmlarý karþýlaþtýrýldýðýnda IRS grup I; %75, IRS grup II; %100 ve IRS grup III’te %0’dý (p; <0,001).
TARTIÞMA ve SONUÇ: Çocukluk çaðýnda SS yeterli cerrahi yapýlamadýðýnda prognozu oldukça kötü bir tümördür. Remisyon saðlanan hastalarda bile akciðer en sýk relaps yeridir, kontrollerde küçük akciðer nodülleri tespit edildiðinde akciðer relapsý açýsýndan dikkatli izlenmelidir. Ülkemizde yapýlacak çok merkezli çalýþmalarla çocukluk çaðý SS hakkýnda genel geçerliliði olan veriler elde edilebilir.

INTRODUCTION: Synovial sarcoma (SS) is generally observed in adults, however it is the most common non-rhabdomyosarcoma soft tissue sarcoma during childhood. In our study we reviewed pediatric patients with SS followed in our clinic retrospectively.
METHODS: Patients with SS diagnosed between 1993 and 2017 in Ankara Oncology Training and Research Hospital included into the study. Their files were reviewed retrospectively, clinical presentation, treatments and response of patients to treatment were investigated.
RESULTS: We analyzed data of 15 pediatric patients. Median age of patients was 14.5 (13 – 17) years, in 14 patients tumor was located in extremities. When we grouped patients based on IRS staging; five patients (33.3%) were in group I, eight patients (53.3%) were in group II, and two patients (13.3%) were in group III. Four (33%) of the 12 patients that in first remission relapse occurred; in three patients there was isolated lung relapse and in one patient relapse was from lung and external iliac lymph node. Patients were followed median 28 (5 – 85) months, three years event free survival was 53.6%, and overall survival was 73%. When we compared three years overall survival of patients based on IRS staging; 75% in IRS group I; 100 % in IRS group II; and 0% in IRS group III (p; <0.001).
DISCUSSION AND CONCLUSION: Prognosis of synovial sarcoma during childhood is very bad if surgery is not performed. In patients with remission lung is the most common region for relapse, and patients should be followed carefully for relapse if unspecified small pulmonary nodules are detected. Multi centric studies with more patients should be performed to get more valid information about our country.

GÝRÝÞ ve AMAÇ: Kolorektal kanser (KRK)’ in erken evrede tespiti mortalite ve morbidite azalmasýnýn yaný sýra tedavi maliyetlerini de düþürmektedir. Tarama programlarý ile prekanseröz lezyonu veya erken evre tümörü saptamak münkündür. Bu çalýþmada Rize ili Kanser Erken Teþhis Tarama ve Eðitim Merkezince KRK tarama programýna alýnan ve gaitada gizli kan testi (GGKT) pozitif saptanarak merkezimize yönlendirilen hastalarýn kolonoskopi bulgularý ve klinikopatolojik verileri incelenerek tarama programýnýn etkinliði deðerlendirilmiþtir.
YÖNTEM ve GEREÇLER: GGKT sonucu pozitif saptanan 144 hasta çalýþmaya dahil edildi. Veriler hasta dosyalarýndan retrospektif olarak tarandý. Çalýþma kapsamýnda hastalarýn yaþ, cinsiyet gibi demografik verileri ile endoskopide saptanan bulgular, anal fizik muayene bulgusu, histopatolojik sonuçlar, GGKT pozitiflik oraný, polip + kanser saptanma oraný ve kanser saptanma oranlarý tespit edildi.
BULGULAR: Çalýþmada hastalarýn 74’ ü (% 51.4) erkek, 70’ i (% 48.6) kadýn ve yaþ ortalamasý 60.1 (min 50-max 70) idi. Toplamda 109 hastada (% 75.7) kolonoskopik bulgular normal idi. 31 hastada (% 21.5) GGKT pozitifliðinin sebebi hemoroid/anal fissür idi. Kolonoskopisi pozitif olanlardan 21 hastada (% 14.6) polip, 7 hastada (% 4.9) kolon divertikülü, 5 hastada (% 3.5) nonspesifik inflamasyon ve 2 hastada (% 1.4) makroskopik tümör saptandý. GGKT pozitiflik oraný % 1.2 (n: 144), polip + kanser saptanma oraný % 0.19 (n: 23) ve kanser saptanma oraný % 0.017 (n: 2) idi.
TARTIÞMA ve SONUÇ: Ýmmünokimyasal testler modern toplum tarama programýnda KRK için tercih edilen seçenektir. Çalýþmamýzda katýlýmcý sayýsý, test pozitifliði ve malignite tespit oranlarý oldukça düþük saptanmýþtýr. Toplumun GGKT gerekliliði konusunda bilinçlendirilerek teþvik edilmesi ve GGKT’ lerin doðru uygulanmasý tarama programlarýnýn baþarýya ulaþmasýna katký saðlayacaktýr.

INTRODUCTION: Early detection of colorectal cancer (CRC) reduces mortality and morbidity, and reduces treatment costs. It is possible to detect precancerous lesion or early stage tumor with screening programs. In this study, the efficacy of the screening program was evaluated by examining colonoscopy findings and clinicopathological data of the patients who were taken to CRC screening program by Rize province Cancer Early Diagnosis Screening and Training Center and who were referred to our clinic with positive fecal occult blood test (FOBT) result.
METHODS: A total of 144 patients with positive FOBT (Wondfo One Step Fecal Occult Blood Test, Biotech Co.Ltd., Guangzhou, China) results were included in the study. Data were retrospectively reviewed from patient files. Demographic data of age and gender, endoscopic findings, anal physical examination findings, histopathological results, FOBT positivity rate, polyp + cancer detection rate and cancer detection rates were evaluated.
RESULTS: In this study, 74 of the patients (51.4%) were male and 70 (48.6%) were female and the mean age was 60.1 (min 50-max 70). In 109 patients (75.7%) colonoscopic findings were normal. Hemorrhoid / anal fissure was the cause of FOBT positivity in 31 patients (21.5 %). Colonoscopy positive patients were as follows; polyp in 21 patients (14.6 %), colonic diverticulum in 7 patients (4.9 %), nonspecific inflammation in 5 patients (3.5 %) and macroscopic tumor in 2 patients (1.4 %). FOBT positivity rate was 1.2 % (n: 144), polyp + cancer detection rate was 0.19% (n: 23) and cancer detection rate was 0.017% (n: 2).
DISCUSSION AND CONCLUSION: Immunochemical tests are the preferred choice for CRC in modern screening program. In our study; the rates of participants, test positivity and malignancy were found to be quite low. Promoting and encouraging public awareness of the need for FOBT and the correct implementation of FOBTs will contribute to the success of screening programs.

GÝRÝÞ ve AMAÇ: Paratiroid tümörleri; Paratiroid adenomu, atipik paratiroid adenomu ve paratiroid karsinomu þeklinde üç gruba ayrýlarak sýnýflandýrýlabilir. Paratiroid karsinomu bunlar içerisinde en az görülenidir. Paratiroid karsinomu, tüm kanserlerin yaklaþýk %0,005’ini, primer hiperparatirodi vakalarýnýn ise yaklaþýk %1‘ini oluþturur. Biz de bu çalýþmada, çok sýk rastlanmayan paratiroid karsinomu ile ilgili deneyimimizi paylaþmak istedik.
YÖNTEM ve GEREÇLER: Ankara Numune Eðitim Araþtýrma Hastanesi Genel Cerrahi Servisinde 2008-2015 yýllarý arasýnda paratioid adenomu ön tanýsý ile opere edilen 375 hasta içerisinden patoloji sonucu paratiroid karsinomu ve karsinom–adenom ayrýmý net yapýlamayan 12 hasta retrospektif olarak incelendi.
BULGULAR: Hastalarýn 5’i(%41,6) erkek, 7’si(%58,4) kadýn olarak izlendi. Yaþ ortalamasý 54,5 (±8,40) yaþ aralýðý 41 ile 68 arasýndaydý. Preoperatif kalsiyum deðeri ortalama 12,3(±1,33) mg/dL ve 10,9 ile 15,3 arasýndaydý. Patoloji sonucu; 4 hastanýn paratiroid karsinomu, 4 hastanýn paratiroid neoplazmý, 3 hastanýn malign potansiyeli belirlenemeyen paratiroid neoplazmý, 1 hastanýn malignite ekarte edilemedi, þeklinde idi. Hastalarýn ortalama takip süresi 61,8 ay (±17,05) ve 35 ile 96 ay arasýnda idi. 1 hasta kemoterapi aldý ve ayný hasta takiplerinde 55. ayda exitus oldu.
TARTIÞMA ve SONUÇ: Preoperatif olarak þiddetli hiperkalsemi semptomu olanlarda, kalsiyum deðerleri 14mg/dL’den yüksek olanlarda, parathormon seviyesinin anlamlý biçimde yüksek olduðunda ve paratiroid bezinin palpe edildiði durumlarda paratiroid karsinomlarýndan þüphelenilir. Paratiroid karsinomu tedavisinde boyun eksplorasyonu, tümörün un-blok çýkarýlmasý ve ayný taraf tiroide lobektomi yapýlmasý gerekir. Patoloji sonuçlarý malignite açýsýndan þüpheli ise yakýn takip edilebilir.

INTRODUCTION: Parathyroid tumors can be divided into three groups: parathyroid adenoma, atypical parathyroid adenoma and parathyroid carcinoma. Parathyroid carcinoma is the less common one among these. Parathyroid carcinomas account for approximately 0,005% of all cancers and 1% of primary hyperparathyroidism cases. In this study, we wanted to share our experience of parathyroid carcinoma which is not common.
METHODS: Of 375 patients who were operated with pre-diagnosis of parathyroid adenoma in Ankara Numune Training and Research Hospital Department of General Surgery between 2008 and 2015; 12 patients whose pathology result could not clearly identify a parathyroid carcinoma and could differentiate a carcinoma from an adenoma were examined retrospectively.
RESULTS: Of the patients; 5 (41,6%) were observed to be male and 7 (58,4%) were observed to be female. Mean age was 54,5 (±8,40) and the age range was between 41 and 68. Mean preoperative calcium value was 12,3(±1,33) mg/dL and the range was between 10,9 and 15,3. The pathology results were as “a parathyroid carcinoma” in 4 patients, “a parathyroid neoplasm” in 4 patients, “a parathyroid neoplasm with undetermined malignant potential” in 3 patients and “malignancy could not be discarded” in 1 patient. Mean follow-up duration of the patients was 61,8 months (±17,05) and the range was between 35 and 96 months. 1 patient received chemotherapy and the same patient died on the month 55 during follow-ups.
DISCUSSION AND CONCLUSION: In those with severe preoperative hypocalcemia symptoms, those with a calcium value higher than 14mg/dL, in cases when parathormone level is significantly higher and in cases when parathyroid gland is palpated, parathyroid carcinomas are suspected. For treatment of a parathyroid carcinoma, neck exploration, en-bloc removal of the tumor and ipsilateral lobectomy of thyroid are required. If pathology results are suspicious in regard to malignancy, and then the patient is closely followed-up.

GÝRÝÞ ve AMAÇ: Mesane tümörü hastalarýnda re-Transüretral rezeksiyon operasyonun baþarýsýný ve rezidüel mesane tümörü saptamayý etkileyen faktörlerin deðerlendirilmesi hedeflendi.
YÖNTEM ve GEREÇLER: Ocak 2008 - Temmuz 2018 tarihleri arasýnda mesane tümörü nedeni ile hastanemiz üroloji kliniðinde multipl tümör, yüksek dereceli tümör, T1 tümörleri, tamamýyla rezeke edilememiþ tümörler ve patoloji örneklerinde kas dokusu tanýmlanamamasý gibi nedenlerden dolayý 2-6 hafta içinde re-TUR yapýlan 94 hasta retrospektif olarak deðerlendirildi.
BULGULAR: Ýlk TUR’da T1 evre mesane tümörü, yüksek dereceli ve 30mm’den büyük tümörü olan olgularda re-TUR da rezidüel tümör dokusu saptanma oraný istatistiksel olarak anlamlý tespit edildi (p<0.05).
TARTIÞMA ve SONUÇ: Re-TUR; ek patoloji bilgisi ile yeni veya doðrulanmýþ evreleme imkaný saðlar, iyileþtirilmiþ sonuçlarla tedavi planýný deðiþtirebilir, rezidü tümörleri ortadan kaldýrma imkaný saðlar, intravezikal tedaviye yanýtý kolaylaþtýrýr, deðerli prognostik bilgiler ve önemli derecede saðkalým oraný saðlar.

INTRODUCTION: To evaluate the success of re-TUR operation in bladder tumor patients and to evaluate the factors affecting the determination of residual bladder tumor.
METHODS: Between January 2008 and July 2018, the cause of bladder tumor was defined as re-TUR within 2-6 weeks due to multiple tumor, high grade tumors, T1 tumors, totally unresectable tumors in the urology clinic of our hospital, 94 patients were evaluated retrospectively.
RESULTS: In cases with T1 stage bladder tumors, high grade tumors larger than 30mm after the first TUR, the rate of detection of residual tumor tissue in re-TUR was statistically significant (p <0.05).
DISCUSSION AND CONCLUSION: Re-TUR; provide new or verified staging with additional pathology information, change the treatment plan with improved outcomes, enable the removal of residual tumors, facilitate intravesical care response, provide valuable prognostic information and a significant survival rate.

GÝRÝÞ ve AMAÇ: Kanser tedavisindeki geliþmeler ve yenilikler sayesinde hemen hemen tüm kanser türlerinde saðkalýmda artýþlar dikkat çekmektedir. Metastatik hastalarda dahi uzun saðkalým süreleri olanaklý hale gelmiþtir. Sonuç olarak karþýmýza uzun süredir deðiþik evrelerde kanser tanýsý ile yaþamýný sürdürmüþ ancak sürekli saðlýk hizmetine ihtiyaç duyan bir hasta grubu çýkmaktadýr. Bu çalýþma ülkemizde gastrointestinal sistem malignitesi tanýlý hastalara sunulan Evde Saðlýk Hizmetleri (ESH)’nin ülkemizdeki faaliyet sürecinin deðerlendirilmesi amacý ile planlanmýþtýr.
YÖNTEM ve GEREÇLER: 2011-2017 yýllarý arasýnda ösafagus, mide, ince barsak, kolon, rektum, karaciðer, pankreas ve safra yolu malign neoplazmý tanýsý almýþ hastalara sunulan ESH kapsamýnda ulaþýlan hasta, yapýlan vizit sayýlarý ve hizmet sunan ekip sayýlarý deðerlendirildi.
BULGULAR: Nörolojik ve psikiyatrik hastalýklar, kardiyovasküler hastalýklar ve ortopedik hastalýklardan sonra kanser hastalarý ESH’ni en sýk alan 4. grup hastalýðý oluþturmaktadýr. Türkiyede 2011 yýlýnda, toplam 593 hizmet ekibi ile baþlayan ESH’inde, 2017 yýlýna gelindiðinde ekip sayýsýnýn 662’ye yükseldiði görülmektedir. 2011 yýlýnda toplam yapýlan vizit sayýsý 344.014 iken 2017 yýlýnda bu rakam 10.917.965 olarak gerçekleþmiþtir. 2011 yýlýnda 7278 vizit, kanserli hastalar için yapýlmýþ iken 2017 yýlýnda bu rakam 74.261 dir. Toplam GIS maligniteli hasta vizit sayýsý 7 yýl içerisinde 89.389 olarak gerçekleþmiþtir.
TARTIÞMA ve SONUÇ: GIS malignitesi olan hastalara verilen evde bakým vizitlerinin sayýlarýnýn, malignitelerin insidansý ile doðru orantýlý olduðu görülmektedir. Buna göre kolon, mide ve pankreas kanserli hastalar en çok vizit yapýlan hastalardýr. ESH kapsamýnda vizit sunulan hasta sayýsýnýn yýllar içerisinde kademeli bir artýþ gösterdiði görülmektedir. ESH’nin bakanlýk politikasý haline getirilmesi, ekip sayýlarýnýn arttýrýlarak hizmete ulaþmanýn kolaylaþmasý ve gerek saðlýk profesyonelleri, gerekse hasta ve yakýnlarý tarafýndan farkýndalýðýn artmýþ olmasý bu artýþýn temel sebepleri olarak karþýmýza çýkmaktadýr.

INTRODUCTION: Improvements and innovation in cancer treatment led to prolongation of survival in almost every cancer type. Longer survival of even patients with metastasis has become possible. As a result, there is an increasing number of patients who have survived with the diagnosis of cancer in different stages in need of continuous health support. This is study is designed to evaluate the process of Home Health Services (HHS) provided to patients with gastrointestinal cancers in our country.
METHODS: Patients with a diagnosis of esophageal, gastric, small intestine, colon, rectum, hepatic, pancreatic or bile duct malignancy between 2011 and 2017 were reviewed for HHS coverage, home visit frequency and HHS-providing medical staff.
RESULTS: Cancer patients are the fourth, after patients with neuropsychiatric disorders, cardiovascular diseases, and orthopedic disorders, that receive HHS support. HHS has started in 2011 with 593 teams in Turkey. The number of teams providing HHS increased to 662 by the end of the year 2017. Total home-visits have dramatically risen from 344,014 to 10,917,965 during a 7-year period. Home-visits to cancer patients have also increased from 7,278 in 2011 to 74,261 in 2017. A total of 89,389 home-visits were made to patients with gastrointestinal cancers.
DISCUSSION AND CONCLUSION: The number of home-visits to patients with gastrointestinal cancers had increased as the incidence of these diseases increased. Data show that colon, gastric and pancreatic cancer patients were among the most visited patients. The number of home-visits by HHS departments showed a steady increase in years. The main reasons for this increase are that the HHS has become a ministerial policy, the number of teams has increased and the access to service has been facilitated and the health professionals and the patients and their relatives had increased awareness.

GÝRÝÞ ve AMAÇ: Tamamlatýcý ve geleneksel týp (TGT) ürünleri, çocukluk çaðý döneminde birçok kronik hastalýkta modern tedavinin yanýnda aileler tarafýndan kullanýlabilmektedir. Özellikle beslenme ürünleri ve bitkisel tedaviler TGT uygulamalarý içinde sýk kullanýlan, yan etki ve ilaç etkileþimi geliþme riski yüksek olanlardýr. Çalýþmamýzda çocukluk çaðý yaþ grubu hematoloji hastalarýnda beslenme ürünleri ve bitkisel tedavi kullaným sýklýðý ve iliþkili faktörleri incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çocuk Hematoloji Kliniði’nde takip edilen hematolojik kanser veya kronik hematolojik hastalýðý olan 1 – 20 yaþ arasý 138 hastanýn ebeveynlerinden çalýþma anketlerini doldurmalarý istendi.
BULGULAR: Yaþ ortancasý 9 (1 – 20) yýl olan hastalarýn 91’i (%65,9) maliyn, 47’si (%34,1) beniyn bir tanýyla izlenmekteydi. Yetmiþ bir (%51,4) hasta en az bir TGT beslenme ürünü kullanýrken 67 (%48,6) hasta böyle bir ürün hiç kullanmamýþtý. Hastalarýn 47’si sadece bir ürün, 20’si iki ve dördü üç ürün kullanmýþtý. Toplamda 21 çeþit ürün kullanýldýðý öðrenildi. En sýk kullanýlan beþ ürün; keçiboynuzu pekmezi (39 hasta), arý sütü (13 hasta), üzüm çekirdeði ekstresi (9 hasta), üzüm pekmezi (7 hasta) ve polendi (6 hasta). Yirmi yedi hastada (%38) ürünlerin doktorlarýnýn bilgisi dýþýnda kullandýðý öðrenildi. Hasta tanýlarýnýn beniyn veya maliyn olasýna göre beslenme ürünü kullanýmý karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý þekilde maliyn tanýlý hastalarda beniynlere göre kullanýmýn daha fazla olduðu görüldü (sýrasýyla; %61,5, %31,9, p; 0,001).
TARTIÞMA ve SONUÇ: Çocukluk çaðýnda hematoloji hastalarý arasýnda özellikle maliyn bir tanýya sahip olanlarda bitkisel tedavi ve beslenme desteði kullanýmý sýktýr ve bir kýsmýndan hastalarýn sorumlu doktorlarýnýn da haberi yoktur. Hastalarýn kliniklerde takiplerinde bu tür destekler alýp almadýklarýnýn rutinde sorulmalý, hastalarýn kullandýklarý ürünler hakkýnda önyargýdan uzak rasyonel öneriler verilmelidir.

INTRODUCTION: Complementary and traditional medicine (CTM) has been used in many chronic diseases during childhood by parents. Herbal medicines and nutrient supplements are the most common used CTM therapies, besides they have increased risk of side effects and drug interaction. In our study, we aimed to investigate frequency of herbal medicine and nutrient supplement usage and associated factors in pediatric patients with hematological diseases.
METHODS: Parents of 138 children with a hematological cancer or chronic hematological disease who were between 1 – 20 years of age filled the study questionnaire
RESULTS: Median age of patients were 9 (1 – 20) years, 91 (65.9%) of patients were with malign and 47 (34.1%) of patients were with benign diseases. Seventy one (51.4%) of patients have used minimum one CTM nutrient supplement or herbal medicine. Forty seven patients used only one product, 20 patients used two products and four of the patients used three products. Totally 21 kinds of CTM therapies have been used. Most commonly used five herbal medicine and nutrients supplements were; carob molasses (39 patients), gelee royale (13 patients), grape seed extract (9 patients), grape molasses (7 patients), and pollen (6 patients). Twenty seven (38%) of patients used products without permission of their doctors. When we compared frequency of CTM nutrient support or herbal medicine usage in patients with malign and benign diseases, statistically significantly patients with malign diseases have tendency to utilize these products (61.5%, 31.9%, p; 0.001, respectively).
DISCUSSION AND CONCLUSION: Herbal medicine and nutrient support usage is common in pediatric patients with hematological diseases, especially if patients have malign diseases. Some of the patients have been using these products without permission of their responsible doctors. During follow-up of patients with hematological diseases doctors should ask patients if they use CTM therapies, and should give rational advices without prejudice about CTM therapies.

GÝRÝÞ ve AMAÇ: Bu çalýþmada amaç CyberKnife stereotaktik radyocerrahi-radyoterapi uygulanan vestibuler schwannom hastalarýnýn klinik, radyolojik ve toksisite verilerinin sunulmasýdýr.
YÖNTEM ve GEREÇLER: Çalýþma, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi Radyasyon Onkolojisi Kliniði’nde Haziran 2009 - Eylül 2014 tarihleri arasýnda vestibuler schwannom tanýsý ile CyberKnife® (Accuray, Sunnyvale) cihazýnda stereotaktik radyocerrahi ve stereotaktik radyoterapi uygulanan hastalarýn klinik ve radyolojik deðerlendirmeleri bununla birlikte tedavi öncesi ve son kontrollerine ait iþitme deðerlendirmesi (Gardner-Robertson skalasý), 7. kranial sinir motor fonksiyon deðerlendirmesi (House-Brackmann skalasý), 5. kranial sinir duyu muaynesi sonuçlarý ile toksisite deðerlendirmesi yapýlmýþtýr.
BULGULAR: Lokal kontrol, radyolojik stabil veya regresif hastalýk olarak tanýmlandý ve tüm hastalarýn son kontrollerinde %100 olarak saptandý. GRS ve HB skoru tedavi öncesi deðerleri tedavi sonrasý deðerlerinden istatistiksel olarak anlamlý farklý bulunmuþtur (p= 0,042 ve p= 0,046).Trigeminal toksisite %7 oranýnda saptanmýþtýr.
TARTIÞMA ve SONUÇ: Çalýþmada lokal kontrol oranlarý literatür ile benzerlik göstermekle birlikte trigeminal toksisite oraný yüksek bulunmuþtur. Doz ve fraksiyon þemalarýnýn optimizasyonu için prospektif çalýþmalara ihtiyaç duyulmaktadýr.

INTRODUCTION: The current study was done by means of clinical and radiological evaluations of vestibular schwannoma patients who treated with stereotactic radiosurgery or stereotactic radiotherapy using Cyberknife® (Accuray, Sunnywhale, USA).
METHODS: Between June 2009 and September 2014,30 vestibular schwannoma patients were treated in Dr. AY. Ankara Oncology Training and Research Hospital, Department of Radiation Oncology. The patients were assessed before and after radiotherapy retrospectively, for hearing capacity (via Gardner-RobertsonScale), motor function of cranial nerve 7. (via House-Brackmannscale),the sensorial function of cranial nerve 5.
RESULTS: Local control was defined as radiologically stable or regressive disease and achieved for all of the patients at the last control (%100). Preradiotherapy mean values of GRS and HB scores were both statistically different from post radiotherapy mean values (p=0,042 and p=0,046, respectively). Trigeminal toxicity was determined as 7%.
DISCUSSION AND CONCLUSION: When the study results were interpreted, while the local control results were found similar with the literature, trigeminal nerve toxicity values were higher than the reported results. Prospective studies are needed to optimize dose and fraction schedules.

GÝRÝÞ ve AMAÇ: Hepatosellüler kanser (HSK) sýklýkla kronik karaciðer hastalýðý ve siroz zemininde geliþen agresif bir tümördür. Bölgemizde farklý etyolojilere baðlý olarak geliþen hepatosellüler kanserin epidemiyolojik, klinik ve tümör özelliklerinin karþýlaþtýrmalý olarak incelenmesi amaçlandý.
YÖNTEM ve GEREÇLER: 2000-2015 yýllarý arasýnda hastanemiz gastroenteroloji bölümüne baþvuran 18 yaþ ve üstü, uluslararasý kabul görmüþ histolojik veya non-invazif kriterlere göre (EASL, AASLD) HSK tanýsý olan hastalar çalýþmaya dahil edildi. Çalýþmaya 377 hasta alýnmýþ olup demografik, klinik ve laboratuar verileri retrospektif analiz edildi. Hastalar etyolojik nedenlerine göre gruplandýrýldý.
BULGULAR: Hastalarýn yaþ ortalamasý 58.70±12.50 yýl olup, %82.2'si erkekti. Hastalarýn büyük çoðunluðu þehir merkezinde yaþamakta olup, %67.6'sýnýn eðitim seviyesi ilkokul veya daha düþük seviyedeydi. Hastalarýn %87'sinde HSK’nýn siroz zemininde geliþtiði görüldü. Etiyolojik nedenlere baktýðýmýzda ise hastalarýn %57.8’i HBV’ye, % 15.6’sý HDV’ye, % 8.2’si HCV’ye, % 18.3’ü non-viral nedenlere baðlý geliþtiði görüldü. Viral etiyolojilere baðlý HSK geliþen hastalarda ortalama enfeksiyon süresi 9.38±9.08 yýl olup, % 23.6’sý antiviral tedavi almaktaydý. Hastalarýn %72'sinin Child-Pugh skoru B ve C olarak deðerlendirildi.
TARTIÞMA ve SONUÇ: Viral hepatitler, HSK geliþiminde en önemli risk faktörü olup, HSK sýklýkla siroz zemininde geliþmektedir. Bu nedenle kronik viral hepatitli ve siroz hastalarýnýn takip ve taramasý büyük önem taþýmaktadýr. Bölgemizde HSK’lý hastalarýn anti-viral tedavi kullanma oranlarýnýn düþüklüðü ve yüksek Child-Pugh skoru ile baþvurmalarý bu konunun hala önemini koruyan ciddi bir saðlýk problemi olduðunu göstermektedir. Viral hepatitler ile ilgili farkýndalýðýn arttýrýlmasý, aþý programlarýna hastalarýn teþviki ile HSK prevalansýnýn azaltýlacaðý aþikar olup, siroz geliþen hastalarda da düzenli takip programlarýyla daha erken evrede HSK tanýsý konup daha efektif tedavi seçenekleriyle uzun süreli sað kalým elde edilecektir.

INTRODUCTION: Hepatocellular carcinoma (HCC) is an aggressive tumor that frequently occurs in the setting of chronic liver disease and cirrhosis. In this study, we aim to evaluate the etiologic factors associated with Hepatocellular carcinoma and their role on the clinical outcome and prognosis of the disease.
METHODS: A total of 377 patients were included in the study. Patient files were retrospectively analyzed. HCC was diagnosed based on radiologic, histologic, clinical and laboratory findings. Patients were grouped according to etiology.
RESULTS: The mean age of the patients was 58.70±2.50 years and 82.2% of them were male. The vast majority of the patients were living in the city center, and 67.6% of them had primary education or lower education level. It was seen that HCC developed in cirrhosis base in 87% of the patients. When we looked at the etiologic factors, 57.8% of the patients were found to develop due to HBV, 15.6% to HDV, 8.2% to HCV and 18.3% to non-viral causes. The mean duration of infection was 9.38±9.08 years and 23.6% were taking antiviral treatment in patients with HSC due to viral etiology.
DISCUSSION AND CONCLUSION: Viral hepatitis is the most important risk factor for the development of HCC, and HCC often develops on the basis of cirrhosis. Therefore, the follow up and treatment of patients with chronic viral hepatitis and cirrhosis is of great importance. Patients with HCC in our region with low rates of anti-viral treatment and high Child-Pugh score suggest that this is still a serious health problem that is still important. Increased awareness of viral hepatitis is evident when the incidence of HCC is reduced by vaccination programs, and patients with cirrhosis will be diagnosed with HCC at an earlier stage with regular follow-up programs and will have a long-term survival benefit with more effective treatment options.

GÝRÝÞ ve AMAÇ: Postoperatif komplikasyonlarla hýzlý ve etkin mücadele etmek için cerrahi giriþime özgü olan ve olmayan komplikasyonlarýn bilinmesi ve bunlara yönelik önlemlerin alýnmasý gerekir. Bu çalýþmada amacýmýz postanestezik bakým ünitesinde (PABÜ) en sýk karþýlaþýlan postoperatif komplikasyonlarý ve prediktif faktörleri belirlemekti.
YÖNTEM ve GEREÇLER: Elektif þartlarda operasyona alýnan, 18-70 yaþ arasý 1000 hasta çalýþmaya alýndý. Hastalar ilk 24 saat boyunca kardiyovasküler, solunum, nöromüsküler, gastrointestinal, nörolojik ve diðer komplikasyonlar için izlendi. Hastalarýn yaþ, cinsiyet, ASA skorlarý, preoperatif risk faktörleri, operasyon süresi, anestezi yöntemleri, postoperatif aðrý skorlarý ve postanestezik bakým ünitesinde kalýþ süreleri kayýt edildi.
BULGULAR: Postoperatif en sýk kardiyovasküler sisteme ait komplikasyonlar (%24) ve gastrointestinal sistem komplikasyonlarý (%14) gözlendi. Kombine spinal epidural anestezi uygulanan hastalarda hipotansiyon ve taþikardi sýklýðý ve spinal anestezi sonrasý bradikardi görülme sýklýðý daha yüksek bulundu. (p<0,05). Preoperatif hipertansiyon mevcut olan hastalarda postoperatif hipertansiyon geliþme insidansýnýn 3,6 kat daha fazla olduðu görüldü (p=0,001). Bulantý, genel anestezi alan hastalarda yüksek orandaydý (% 19,8). Uzun operasyon süresinin postoperatif bradikardi, taþikardi ve aritmi insidansýný etkilediði saptandý (p<0,05). Yüksek ASA skoru ile kardiyovasküler ve solunum sistemi komplikasyonlarý arasýnda pozitif korelasyon mevcuttu.Yaþ, ASA skoru, preoperatif sistemik hastalýk varlýðý ve operasyon süresinin PABÜ’de kalma süresi etkileyen faktörler olduðu saptandý.
TARTIÞMA ve SONUÇ: Çalýþmamýzda, en sýk karþýlaþýlan postoperatif komplikasyonun kardiyovasküler sistem ait komplikasyonlar olduðu saptandý. Aðrý ve bulantý-kusma insidansýnýn literatüre benzer þekilde yüksek oranda olduðu görüldü. Kardiyovasküler ve solunum komplikasyonlarýnýn PABÜ’de kalma süresini uzattýðý saptandý. Yaþ, eþlik eden komorbiditelerin varlýðý ve ASA skorlamasý olasý komplikasyonlarýn belirleyicileri olarak bulundu. Bu risk faktörlerinin varlýðý hem anestezi hem cerrahi ekip için uyarýcý olmalýdýr.

INTRODUCTION: In order to fight postoperative complications quickly and effectively, it is necessary to know the complications that are specific or not specific to the surgical procedure and to take precautions against them. Our aim in this study was to determine the most common postoperative complications and predictive factors in the postanesthetic care unit (PACU).
METHODS: A total of 1000 patients between 18-70 years of age undergoing elective surgery were included in the study. Patients were monitored for cardiovascular, respiratory, neuromuscular, gastrointestinal, neurologic and other complications during the first 24 hours of the operation. Patients' age, gender, ASA scores, preoperative risk factors, duration of operation, anesthesia methods, postoperative pain scores and duration of stay in the postanesthetic care unit were recorded.
RESULTS: Postoperative cardiovascular complications (24%) and gastrointestinal system complications (14%) were observed most frequently. The incidence of hypotension and tachycardia in patients undergoing combined spinal epidural anaesthesia and the incidence of bradycardia after spinal anesthesia was higher (p <0,05). The incidence of postoperative hypertension development was 3,6 times higher in patients with preoperative hypertension (p = 0.001). Nausea was higher in patients receiving general anesthesia (19,8%). It was found that the long operation time effected postoperative bradycardia, tachycardia and arrhythmia incidence (p <0,05). There was a positive correlation between high ASA scores and cardiovascular and respiratory complications.
DISCUSSION AND CONCLUSION: In our study, the most common postoperative complications were cardiovascular system complications. It was seen that the incidence of pain and nausea-vomiting was similarly high in the literature. It was found that the cardiovascular and respiratory complications extended the duration of stay in PACU. Age, presence of accompanying comorbidities, and ASA scoring were found to be determinants of possible complications. The presence of these risk factors should be stimulating for both the anesthesia and the surgical team.

GÝRÝÞ ve AMAÇ: Sensori-nöral iþitme kaybý (SNÝK) olan hastalarda þiddetli iç kulak malformasyonlarýnýn saptanma oraný, yüksek çüzünürlüklü temporal kemik bilgisayarlý tomografisi (TKBT) vizüel deðerlendirmesine ayrýntýlý ölçüm teknikleri eklenmesi ile arttýrýlabilir.
YÖNTEM ve GEREÇLER: Çalýþmaya 2008-2010 yýllarý arasýnda TKBT çekilen 48 hasta dahil edilmiþtir. Bunlarýn 24'ü SNÝK dýþý otolojik problemler ile baþvurmuþken diðerlerinde konjenital SNÝK bulunmaktadýr. 4 sýralý multidedektör BT ile 1,2 mm kesit kalýnlýðýnda aksiyel görüntüler alýnmýþtýr. Rekonstrükte edilen koronal görüntüler 0,6 mm kesit kalýnlýðýnda oluþturulmuþtur. Tüm iç kulak yapýlarýnýn sayýsal ölçümleri ve vizüel deðerlendirmeleri yapýlarak SNÝK bulunan ve bulunmayan gruplar arasýnda karþýlaþtýrýlmýþtýr.
BULGULAR: SNÝK bulunan hastalarda TKBT' nin sadece vizüel yöntemlerle incelenmesinde 7 hastada anomali saptanmýþtýr. Buna raðmen ölçüm yönteminin elenmesi ile 24 hastanýn 15'inde anomali saptanmýþtýr. Bu anomaliler; 3 kohlear hipoplazi, 3 kohlear hiperplazi, 5 lateral semi-sirküler kanal hiperplazisi, bir superior semi-sirküler kanal displazisi, bir posterior semi-sirküler kanal displazisi, beþ vestibüler hiperplazi, 5 bitiþik internal akustik kanal olarak görülmektedir. Vizüel deðerlendirmeye göre sayýsal deðerlendirmede 8 hastada daha anomali saptanmýþtýr.
TARTIÞMA ve SONUÇ: TKBT'de vizüel deðerlendirmeye sayýsal ölçüm tekniðinin eklenmesi SNÝK olan hastalarda anomali saptama oranýný arttýrmaktadýr.

INTRODUCTION: The detection rate of moderate inner ear malformations in patients with sensori neural hearing loss (SNHL), can be increased with detailed measurement techniques of high definition temporal bone computed tomography (TBCT), in addition to visual evaluation.
METHODS: Fourtyeight patients who had TBCT between 2008-2010 were included in our study. Twenty-four of these had otological problems without SNHL while the others had congenital SNHL. Axial images were taken with 1,2mm slice thickness with four sequential multidetector CT. Reconstructed coronal images were obtained with 0,6mm slice thickness. The quantitative measurements and visual evaluation of inner ear structures were made and compared between the groups with and without SNHL.
RESULTS: Anomalies were detected in 7 patients with only visual evaluating of the TBCT of SNHL patients. Whereas 15 of 24 patients showed inner ear abnormalities with measurement correlations. These anomalies were; three cochlear hypoplasia, three cochlear hyperplasia, five Lateral Semi-circular Channel hyperplasia, one Superior Semi-circular Channel displasia, one Posterior Semi-circular Channel displasia, five vestibuler hypoplasia, two vestibuler hyperplasia, five narrow internal acustic channel in 15 patients. Quantitative evaluation detected more anomalies in eight patients when compared to visuel inspection.
DISCUSSION AND CONCLUSION: Quantitative measuremet techniques when added to visual evaluation of TBCT in patients with SNHL increased the detection rate of anomalies.

GÝRÝÞ ve AMAÇ: Osteolitik kemik metastazlý otuzdört hasta iki farklý 10fr×3 Gy ve 5fr×4 Gy’lik doz-fraksiyon þemasý sonrasý, tedavi cevabý yönünden kemik mineral dansitesi ve aðrý yanýtý yönünden deðerlendirmek için çalýþmaya alýndý.
YÖNTEM ve GEREÇLER: Hastalarýn 18’i 10fr×3 Gy’lik ve 16’sý 5fr×4 Gy’lik radyoterapi tedavi kollarýna alýnmýþtýr. Palyatif aðrý tedavisi etkinliðinin deðerlendirilmesinde hastanýn kendi deðerlendirmesi esas alýnýlarak; 1. gün‘den 15. güne kadar günlük, son olarak 45. gün olmak üzere VAS aðrý skalasý yönünden deðerlendirildi. BMD tedavi öncesi ve tedaviden sonraki 6. ay olmak üzere DXA (dual enerji X-ray absopsiyometri) ile iki kez ölçüldü.
BULGULAR: Aðrýnýn cevabýnda iki farklý doz-fraksiyon þemasýnda da zamanla istatistiksel anlamlý azalma olmasýna raðmen, iki grup arasýnda istatistiksel bir fark bulunamadý (p=0,387). 10fr×3 Gy’lik doz-fraksiyon þemasýnda osteolitik alanlarda BMD’de ortalama %23,4’lük istatistiksel olarak anlamlý bir artýþ görülürken (p<0,0001), 5fr×4 Gy’lik doz-fraksiyon þemasýnda da BMD’de ortalama %19,9’lik anlamlý bir artýþ tespit edildi (p<0,0001). Ýki farklý doz-fraksiyon þemasý arasýnda tedavi cevabý yönünden BMD’de istatistiksel olarak anlamlý bir fark bulunamamýþtýr (p>0,605).
TARTIÞMA ve SONUÇ: Osteolitik kemik metastazlarýnda iki farklý 10fr×3 Gy ve 5fr×4 Gy’lik doz-fraksiyon þemasý sonrasý aðrý cevabý ve BMD yönünden birbirine üstünlükleri bulunmamýþtýr. Kemik mineral dansitometre ölçümleri, radyoterapi tedavi cevabýný bölgesel olarak daha hassas ve objektif olarak gösterebilmektedir.

INTRODUCTION: Thirty - four patients with osteolytic bone metastasis were included in the study to evaluate bone mineral density and pain response in terms of treatment response after two different 10fr × 3 Gy and 5fr × 4 Gy dose-fraction schemes.
METHODS: 18 of the patients have taken 10fr×3 Gy and 16 of them have taken 5fr×4 Gy radiotherapy treatment. Having taken the patient’s self evaluation as basis in the pain tratment efficiency; the pain intensity is evaluated with respect to VAS pain scale from 1st day to 15 day daily, and finally at 45th day. BMD is measured with DXA (dual energy X-ray absorptiometry) two times; before treatment and after 6 months.
RESULTS: Even though there is a significant statistical decrease in the two different dose-fraction treatment with respect to time, no difference is found between the two groups (p=0.387). It is evaluated that BMD has a 23.4% increase in the 10fr×3Gy dose-fraction treatment group (p<0.0001); where it has a 19.9% increase in the 5fr×4 Gy dose-fraction treatment group (p<0.0001). There is not a significant difference with respect to treatment response between the two dose-fraction treatment groups.
DISCUSSION AND CONCLUSION: No predominance is found with respect to pain response and BMD between 10fr×3 Gy and 5fr×4 Gy dose-fraction treatment groups. Bone mineral density measurements locally indicates radiotherapy response more precisely.

GÝRÝÞ ve AMAÇ: Bu çalýþmada akciðer kanserli hastalarda koagulasyon testlerindeki deðiþikliklerin saðkalým ve uzak organ metastazý üzerine etkisi araþtýrýldý.
YÖNTEM ve GEREÇLER: Çalýþmamýz, hastanemiz radyasyon onkolojisi kliniðine baþvuran primer akciðer kanseri tanýsý almýþ hastalarýn verileri retrospektif deðerlendirilerek yapýldý. Yaș, cinsiyet, histopatolojik taný, metastaz durumu ile koagulasyon test deðerleri ve yaþam süresi arasýnda iliþki analiz edildi.
BULGULAR: Çalýþmaya toplam 342 hasta dahil edildi. Hastalarýn %18.4’ü küçük hücreli akciðer kanseri (KHAK) iken %81.6 küçük hücreli dýþý akciðer kanseri (KHAK) tanýsýna sahipti. KHDAK’li hastalarda en sýk görülen histopatolojik alt tip Adenokarsinom (%45.0) idi. Tüm hastalar için uzak organ metastaz oranlarýna bakýldýðýnda hastalarýn %44.4’ünde uzak organ metastazý yokken, %55.6’sýnda uzak organ metastazý vardý. KHAK’li hastalarýn %65.1’i, KHDAK’lý hastalarýn ise %53.4’ü uzak organ metastazý olan ileri evre olgulardý. Hastalarýn %18.4’ünde beyin metastazý varken, %81.6’sýnda ise beyin metastazý yoktu. Koagulasyon testlerinden APTT, PT, INR, %PT ve fibrinojen deðerlerinin beyin metastazý durumu ve saðkalým üzerine istatistiksel anlamlý etkisi saptanmadý (p>0.05). Ancak beyin metastazý olanlarda, olmayanlarla karþýlaþtýrýldýðýnda INR ve %PT deðerlerinde istatiksel olarak anlamlýlýða yakýn oranda artýþ tespit edildi (sýrasýyla p=0.068, p=0.059).
TARTIÞMA ve SONUÇ: Akciðer kanseri olgularýnda koagulasyon testlerindeki uzama ile kan beyin bariyerinin de bozulduðu hipotezi ile iliþkili olarak beyin metastazý sýklýðýnda artýþ oluþabilir ancak daha fazla hasta sayýsýnýn olduðu geniþ kapsamlý çalýþmalara ihtiyaç vardýr.

INTRODUCTION: In this study, the effects of changes in coagulation tests on survival and distant organ metastasis in lung cancer patients were investigated.
METHODS: We retrospectively evaluated the data of patients who were diagnosed with primary lung cancer by our radiation oncology clinic. The relationship between age, sex, histopathological diagnosis, metastasis status and coagulation test values and lifespan were analyzed.
RESULTS: A total of 342 patients were included in the study. 18,4% of the patients had small cell lung cancer (SCLC), and 81,6% had non-small cell lung cancer (NSCLC). Adenocarcinoma (45.0%) was the most common histopathological subtype in patients with NSCLC. When distant organ metastasis rates were handled for all patients, while there weren’t distant organ metastasis in 44.4% of patients, distant organ metastasis was found out in 55.6% of the patients. 65.1% of patients with SCLC and 53.4% of patients with SCLC were in advanced stages with distant organ metastasis. 18.4% of the patients had brain metastasis, and 81.6% had no brain metastasis. There was no statistically significant effect of APTT, PT, INR, % PT which are among the coagulation tests, and fibrinogen values on brain metastasis status and survival (p> 0.05). However, in patients with brain metastases, increase in the ratio close to statistical significance the INR and% PT values was found (p = 0.068, p = 0.059, respectively) when compared to the non-men.
DISCUSSION AND CONCLUSION: In the case of lung cancer, an increase in the frequency of brain metastasis may be associated with the hypothesis that prolongation of the coagulation test and deterioration of the blood-brain barrier, but there is a need for extensive studies with more patients.

GÝRÝÞ ve AMAÇ: Retrokaval üreter (RÜ), üreterin vena kavanýn posteriorundan geçmesiyle karakterize, oldukça nadir görülen bir konjenital anomalidir.Retrokaval segmentin eksizyonu olmadan açýk cerrahi onarým ile tedavi ettiðimiz 8 olgunun verilerini sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: 2005-2018 yýllarý arasýnda kliniðimizde RÜ tanýsý ile opere edilen 8 hasta çalýþmaya dahil edildi. Hastalarýn demografik verileri, peri- ve postoperatif verileri hasta dosyalarýndan kaydedildi ve deðerlendirildi. Ayrýca hastalara uygulanan görüntüleme yöntemleri kaydedildi. Dinamik sintigrafideki T½ deðerinin pre- ve postoperatif deðerleri karþýlaþtýrýldý. Tüm hastalara açýk yöntemle retrokaval segmentin eksizyonu olmadan üreteroüreteral anostomoz uygulandý. Ýstatistiksel analiz için SPSS 22.0 kullanýldý ve p deðerinin 0.05'den küçük deðerleri, istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Hastalarýn 5'i erkek, 3'ü kadýndý. Ortalama yaþ 36.2 yýldý (25-48). Ortalama operasyon süresi 64 dakikaydý (58-92). Altý hastada (%75) baþvuru yakýnmasý yan aðrýsýydý. Ortalama hastanede yatýþ süresi 2.32 gündü. Postoperatif dönemde tüm hastalara kontrol amacýyla bilgisayarlý tomografi-ürografi ve nükleer týp çalýþmasý ile dinamik ve statik renal sintigrafi uygulandý. Hastalarýn preoperatif ve postoperatif statik sintigrafileri arasýnda istatistiksel anlamlý bir iliþki yoktu (p=0.741) ancak, dinamik renal sintigrafi farklýlýðý anlamlýydý (preoperatif ortalama T½ deðeri 25.7 dk, postoperatif ortalama T½ deðeri ise 14.4 dk, p=0.016).
TARTIÞMA ve SONUÇ: Retrokaval segmentte eksizyon yapýlmaksýzýn retrokaval üretere uygulanan re-anostomoz, minimal postoperatif morbidite, kýsa hastanede kalýþ süresi ile baþarýlý sonuçlar saðlamaktadýr.

INTRODUCTION: Retrocaval ureter (RU) is a rare congenital anomaly characterized by the passage of the ureter through the posterior of the vena cava. We aimed to present the data of 8 cases treated with open surgical repair without excision of the retrocaval segment.
METHODS: Eight patients who were operated with the diagnosis of RU in our clinic between 2005-2018 were included in the study. Demographic data, peri- and postoperative data of the patients were recorded and evaluated. In addition, imaging modalities were recorded. Pre- and postoperative values of T½ values in dynamic scintigraphy were compared. All patients underwent open ureterouretereral anostomosis without excision of the retrocaval segment. SPSS 22.0 was used for statistical analysis and p values less than 0.05 were considered statistically significant.
RESULTS: Five patients were male and 3 were female. The mean age was 36.2 years (25-48). The mean operation time was 64 minutes (58-92). Six patients (75%) presented with flank pain. The mean hospitalization duration was 2.32 days. In the postoperative period, all patients underwent computed tomography-urography and dynamic and static renal scintigraphy with nuclear medicine study. There was no statistically significant difference between preoperative and postoperative static scintigraphy values (p = 0.741), but dynamic renal scintigraphy difference was significant (T½ was 25.7 min. preoperatively and 14.4 min. postoperatively, p = 0.016).
DISCUSSION AND CONCLUSION: Re-anostomosis performed for the retrocaval ureter without any excision of the retrocaval segment yields successful results with minimal postoperative morbidity and short hospital stay.

GÝRÝÞ ve AMAÇ: Bu çalýþmada amaç operasyon öncesi görüntüleme yöntemleri ile kemik invazyonu þüphesi olan yumuþak doku sarkomu (YDS) olgularýnýn cerrahi tedavilerinin nasýl planlanmasý gerektiði ve klinik sonuçlara etkinliðinin araþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Hastanemizde 2005-2015 yýllarý arasýnda ameliyat ettiðimiz 96 YDS olgusu retrospektif olarak incelendi. Radyolojik görüntülemeler sonrasý kemik invazyonu þüphesiyle, 16 hasta çalýþmaya dahil edildi. Ortalama yaþ 56(18-81) idi. Bu olgulardan; 8 tanesi proksimal femur, 5 tanesi distal femur, 2 tanesi proksimal humerus ve 1 tanesi proksimal tibia yerleþimli idi. Ortalama takip süresi 22 ay(7-90) dý.
BULGULAR: Histoloji 7 hastada pleomorfik sarkom, 4 hastada liposarkom, 3 hastada sinovyal sarkom, 1 er hastada alveolar soft sarkom ve maliðn periferal sinir kýlýfý tümörü idi. Proksimal femur yerleþimli 8 olgudan 6’sýna, 5 distal femur yerleþimli olgudan 4’üne, proksimal humerus ve tibia yerleþimli 3 hastaya kemik doku ile birlikte geniþ tümör rezeksiyonu ve endoprotez ile rekonstrüksiyon yapýldý. Bu hastalardan ameliyat sonrasý patoloji kayýtlarýnda 3 hastada tümörün kemik doku ile devamlýlýðýnýn olduðu görüldü. Ortalama yaþam süresi 25(7-82) ay dý. Hastalarýn MSTS (Musculoskeletal Tumor Society) skorlarý proksimal femurda 90% (88%-94%), distal femurda 82% (70%-94%), proksimal humerusta 72 % (65%-76%) ve proksimal tibia için % 45 idi.
TARTIÞMA ve SONUÇ: Ameliyat öncesi görüntüleme tetkiklerinde kemik invazyon þüphesi olan YDS olgularýnýn cerrahi tedavisinde tümör kemik doku üzerinde serbest ve periosttan sýyrýlabiliyorsa, bitiþik kemik doku korunarak tümör geniþ olarak eksize edilmelidir. Fakat belirgin kemik dokuda destrüksiyon yapan, medullar tutulumu olan, sert-fikse ve kemiðin yarýdan fazlasýný çevrelemiþ olgularda ise tümör kemik doku ile birlikte çýkarýlmalý ve endoprotez ile rekonstrüksiyon yapýlmalýdýr.

INTRODUCTION: In this study, we aimed to analyze the clinical observation and surgical results of the patients having bone invasion suspected with imaging methods invasion with preoperatively having soft tissue sarcomas.
METHODS: We evaluated the retrospective results of 96 STS(soft tissue sarcoma) patients surgically treated between 2005-2015. 16 of these cases were suspected to have bone invasion radiologically. The mean age was 56(18-81). 8 cases were located in proximal femur, 5 were in distal femur, 2 in proximal humerus and one in proximal tibia. These patients were surgically treated with wide resection and reconstruction with endoprosthesis. Mean follow up was 22 months(7-90).
RESULTS: The histological types were: pleomorphic sarcoma in 7, liposarcoma(LS) in 4, synovial sarcoma(SS) in 3 and alveolar soft part sarcoma(ASPS) and malign peripheric nerve tumor(MPNT)in 1 patients. We recorded bone invasion in 6 of 8 proximal femur, 4 in 5 distal femur and 3 proximal humerus and 3 tibia located cases. Wound problems and infection were recorded in 3 and hip dislocation was recorded in one patient. MSTS scores were 90%(88%-94%) for proximal femur, 82%(70%-94%) for distal femur, 72%(65%-76%) for proximal humerus and 45% for proximal tibia.
DISCUSSION AND CONCLUSION: As a conclusion; periost invasion should be examined in patients with the diagnosis of softtissue sarcoma shaving bone medullar invasion with direct roentgenograms and MRI and if no periost invasion is detected, the tumor should be wriggled from the periost and the extremity should be salvaged.

GÝRÝÞ ve AMAÇ: Total Larenjektominin tat ve koku duyularý üzerine olan etkisinin deðerlendirilmesi
YÖNTEM ve GEREÇLER: Tat ve Koku duyularýnýn deðerlendirilmesi amaçlý kullandýðýmýz testler, kolay uygulanabilir ve noninvaziv testlerdir. Koku duyusunun deðerlendirilmesi CCCRC koku identifikasyon ve n-butanol eþik testi ile üç farklý konsantrasyonda ( düþük, orta, yüksek ) uygulanarak deðerlendirildi. Tat testi 4 ana solüsyon ( tatlý, acý, ekþi, tuzlu) ile deðerlendirildi. tat ve koku deðerlendirme sonuçlarý istatiksel olarak analiz edildi.

BULGULAR: Total larenjektomili hastalarda koku testleri ile anosmi ve þiddetli hiposmi tespit edildi. Bu 10 bulgular bize total larenjektomide koku duyusu bozukluðu meydana geldiðini gösterdi. tat testlerinde solüsyon yoðunluðu ve tada göre farklý sonuçlar görüldü, haastalar ekþi tadý tatlý, acý ve tuzludan daha iyi algýdadý.

TARTIÞMA ve SONUÇ: Total larenjektomi tat ve koku duyularýnda azalmaya neden olabildiði gözlemlenmiþtir.

INTRODUCTION: Evaluation of taste and smell senses alteration in total laryngectomy
METHODS: The materials which were used for evaluation of taste and smell senses were easily provided and the tests were non-invasive. The smell sense was evaluated by using CCCRC smell identification test and n-butanol thresold test where taste sense was evaluated by using 3 different concentrations (low-medium-high) of four main taste (sweet, bitter, sour and salty) solutions. Results of taste and smell evaluation tests were statistically analized.
RESULTS: Anosmia and severe hyposmia were evaluated in smell sense tests of total laryngectomy received patients. This finding shows the disfunction of smell sense in total laryngectomy. Different results of taste sense tests were found according to the kind and concentration of solutions; patients sensed sour solutions better than sweet, bitter and salty solutions.
DISCUSSION AND CONCLUSION: Total laryngectomy can causes decrease in olfactory functions and taste functions

GÝRÝÞ ve AMAÇ: Aneminin bir çok etken ajaný vardýr. Burada Türkiye’nin Akdeniz Bölgesi kýrsal bir alanýndaki insanlarýn demir eksikliði farkýndalýðýnýn ölçülmesi amaçlandý.
YÖNTEM ve GEREÇLER: Ankete 132 insan katýldý. Katýlýmcýlarýn hiçbirisi saðlýk çalýþaný deðildi. Anket çalýþmasý Aksu’nun kýrsal bir alanýnda yapýldý. Aksu, Antalya Ýli’nin bir ilçesidir. Antalya Ýli ise Türkiye’nin Akdeniz Bölgesi’nde bulunmaktadýr. Anket çalýþmasýnda 7 soru soruldu.
BULGULAR: 81 (≈61 %) katýlýmcý vücudun demir ihtiyacýnýn en çok kýrmýzý etten alýnabileceðini düþünüyordu. 42 (≈32 %) katýlýmcý vücudun demir ihtiyacýnýn en çok sebzelerden alýnabileceðini düþünüyordu. Ve 9 (≈7 %) katýlýmcý vücudun demir ihtiyacýnýn en çok meyvelerden alýnabileceðini düþünüyordu. Bunun yanýnda, 94 (≈71 %) katýlýmcý demir eksikliðine baðlý kansýzlýk olabileceðini biliyordu.
TARTIÞMA ve SONUÇ: Demir eksikliði anemisi (DEA) bir halk saðlýðý sorunudur. DEA hakkýndaki sosyal farkýndalýðý bilmek, DEA’yý azaltmak için sosyal programlar yapmada yararlý olabilir. Kýrsal alanlardaki insanlarýn demirden zengin besinler tüketilmesi konusundaki farkýndalýðýnýn arttýrýlmasý için saðlýk organizasyonlarý düzenlenmelidir.

INTRODUCTION: There are many causative agents of anemia. Hereby, it is aimed to evaluate the iron deficiency awareness of the people in a rural area of Turkey’s Mediterrenean Region.
METHODS: 132 people participated in the survey. None of the participants were health workers. The survey was conducted in a rural area of Aksu. Aksu is a district of Antalya Province. And, Antalya Province is in the Turkey’s Mediterrenean Region. 7 questions were asked in the survey.
RESULTS: 81 (≈61 %) participants thought that iron requirement of the body could be obtained mostly from the red meat. 42 (≈32 %) participants thought that iron requirement of the body could be obtained mostly from the vegetables. And 9 (≈7 %) participants thought that iron requirement of the body could be obtained mostly from the fruits. Besides, 94 (≈71 %) participants knew that iron deficiency could cause anemia.
DISCUSSION AND CONCLUSION: Iron deficiency anemia (IDA) is a public health problem. Knowing the social awareness about IDA may help to make social programs for reducing the iron deficiency anemia. Health organisations must be conducted to increase the awareness of people in rural areas about consuming iron rich foods.

GÝRÝÞ ve AMAÇ: Prostat kanseri nedeniyle yapýlan radikal prostatektomi (RP) olgularýnda, %14-90 oranýnda erektil disfonksiyon (ED) geliþebilmektedir. Bu olgularda ED geliþimi, cerrahi esnasýnda gerçekleþen nörovasküler hasara baðlýdýr. Çalýþmamýzda RP öncesi bakýlan trombosit ve eozinofil parametrelerinin, cerrahi sonrasý geliþebilecek ED’yi öngörmede prognostik bir önemi olup olmadýðýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2010-Aralýk 2016 yýllarý arasýnda RP yapýlan 181 hastanýn verileri retrospektif olarak incelendi. Hastalarda preoperatif dönemde bakýlan trombosit, ortalama trombosit hacmi (MPV), trombosit daðýlým aralýðý (PDW) ve eozinofil deðerleri kaydedildi. Preoperatif dönemde ve postoperatif kontrollerinde uyguladýðýmýz Uluslararasý Erektil Fonksiyon Ýndeksi ile, hastalar ED açýsýndan deðerlendirildi. Postoperatif 12. ayda ED deðerlendirilmesi yapýlmýþ olan 150 hastadan 128’inde RP öncesinde ED’nin olmadýðý belirlendi. Postoperatif dönemde ED geliþen 82 hasta Grup I’e, postoperatif ED geliþmeyen 46 hasta ise Grup II’ye dahil edildi.
BULGULAR: Yaþ (p=0.281) ve vücut kitle indeksi (p=0.851) açýsýndan gruplar arasýnda anlamlý farklýlýk bulunmadý. Grup I’de preoperatif dönemde bakýlan ortalama trombosit sayýsý (292.18±51.62 vs. 240.15±46.25, p<0.001), ortalama MPV deðeri (8.77±1.24 vs. 6.17±0.87, p<0.001) ve ortalama eozinofil sayýsý (0.57±0.16 vs. 0.47±0.10, p<0.001) daha yüksek bulunurken; ortalama PDW deðeri (16.21±1.84 vs.16.75±1.77, p=0.110) açýsýndan farklýlýk izlenmedi. ROC analizine göre, trombosit, MPV ve eozinofil için kestirim deðerleri sýrasýyla 242 (AUC: 0.783, p<0.001), 7.24 (AUC: 0.951, p<0.001) ve 0.5 (AUC: 0.675, p=0.001) olarak hesaplandý.Çok deðiþkenli analizde, RP sonrasý ED’yi öngörmede MPV ve eozinofil daha önemli baðýmsýz prediktif faktörler olarak gözlendi.
TARTIÞMA ve SONUÇ: RP öncesi bakýlan trombosit, MPV ve eozinofil deðerlerinin prostatektomi sonrasý geliþebilecek ED’yi öngörmede baðýmsýz prediktif faktörler olduðu görülmektedir. Bu parametreleri kullanarak, postoperatif daha erken dönemde penil rehabilitasyon uygulanmasý gerekecek hastalarýn belirlenebileceðini düþünmekteyiz.

INTRODUCTION: Erectile dysfunction(ED) may develop in 14-90% following radical prostatectomy(RP). Development of ED is due to neurovascular damage during surgery. In our study, we aimed to evaluate whether the platelet and eosinophil parameters are prognostic factors in predicting ED after prostatectomy.
METHODS: Data of 181 patients who underwent RP between January 2010 and December 2016 were analyzed retrospectively. In the preoperative period, platelet count, mean platelet volume (MPV), platelet distribution width (PDW) and eosinophil count were recorded. The patients were evaluated for ED according to the International Erectile Function Index in preoperatively and postoperatively. In the postoperative 12th month, ED was observed in 128 patients following RP. Among them, 82 patients with postoperative ED were included in Group I, and 46 patients without postoperative ED were included in Group II.
RESULTS: Age (p=0.281) and body mass index (p=0.851) had no significant difference between groups. In preoperative period, mean platelet count (292.18±51.62 vs. 240.15±46.25, p<0.001), mean MPV value (8.77±1.24 vs. 6.17±0.87, p<0.001) and mean eosinophil count (0.57±0.16 vs. 0.47±0.10, p<0.001) were higher in Group I. Mean PDW value (16.21±1.84 vs.16.75±1.77, p=0.110) had no significantly difference. According to ROC analysis, the cut-off values for platelet, MPV and eosinophil were 242 (AUC: 0.783, p<0.001), 7.24 (AUC: 0.951, p<0.001) and 0.5 (AUC: 0.675, p=0.001), respectively. In multivariate analysis, MPV and eosinophil were found to be more important independent factors in predicting ED after RP.
DISCUSSION AND CONCLUSION: It is shown that platelet, MPV and eosinophil are independent predictive factors in predicting ED following prostatectomy.

GÝRÝÞ ve AMAÇ: Çalýþmamýzda FPBG obstrüksiyonlarýnda endovasküler tedavinin (EVT) etkinliðini araþtýrmayý amaçladýk.

YÖNTEM ve GEREÇLER: Çalýþmaya 39'u tromboze, 18'i stenoz olmak üzere toplam 57 femoropopliteal bypass greft obstrüksiyonu dahil edilmiþtir. Uygulanan EVT iþlemleri intra-arteriyel trombolitik tedavi, perkütan translüminal anjiyoplasti ve stentlemeden oluþmaktadýr. Ýþlem sonrasý greft açýk kalým oranlarý Kaplan Meier analizi ile tespit edilmiþ ve gruplar arasýndaki farklýlýklar Log-Rank metodu ile deðerlendirilmiþtir.

BULGULAR: Tromboze greftlerin % 74.3'ünde, stenozlu greftlerin % 100'ünde EVT sonrasý patensi saðlanmýþtýr. EVT sonrasý teknik baþarý PTFE greftlerde % 78, SV greftlerde % 90 olarak hesaplanmýþtýr. Tromboze PTFE greftlerde primer patensi (p = 0.01) ve asiste primer patensi (p = 0.03) oranlarý SV greftlerden daha anlamlý olarak daha yüksektir. Stenozlu PTFE ve SV greftlerin patensi oranlarý arasýnda anlamlý farklýlýk bulunmamýþtýr. Tromboze greftlerde trombolitik ajanlarýn greft patensi oranlarý arasýnda anlamlý farklýlýk bulunmamýþtýr. Total komplikasyon oraný tromboze greftlerde % 23, stenozlu greftlerde % 11.1’dir.
Sonuç: EVT, uygun maliyete sahip olmasý, kolay uygulanabilir olmasý ve iþlem sonrasý inatçý obstrüksiyonlara kolaylýkla tekrar müdahele edilebilmesi gibi avantajlarý nedeniyle tromboze veya stenozlu greftlerin tedavisinde önemli bir role sahiptir. EVT, tromboze PTFE greftlerde SV greftlere göre daha uzun patensi saðlamaktadýr. Bu nedenle özellikle cerrahi açýdan yüksek risk taþýyan hastalarda geliþen PTFE greft trombozlarýnda EVT’nin etkin bir tedavi yöntemi olduðunu düþünmekteyiz.


TARTIÞMA ve SONUÇ: EVT, uygun maliyete sahip olmasý, kolay uygulanabilir olmasý ve iþlem sonrasý inatçý obstrüksiyonlara kolaylýkla tekrar müdahele edilebilmesi gibi avantajlarý nedeniyle tromboze veya stenozlu greftlerin tedavisinde önemli bir role sahiptir. EVT, tromboze PTFE greftlerde SV greftlere göre daha uzun patensi saðlamaktadýr. Bu nedenle özellikle cerrahi açýdan yüksek risk taþýyan hastalarda geliþen PTFE greft trombozlarýnda EVT’nin etkin bir tedavi yöntemi olduðunu düþünmekteyiz.

INTRODUCTION: The purpose of this study was to evaluate the role of endovascular therapy in femoropopliteal bypass graft failure.
METHODS: Fifty seven (39 thrombosed grafts, 18 stenosed grafts) endovascular interventions were performed to 40 grafts. Endovascular treatment (EVT) options were catheter directed intra-arterial thrombolytic therapy, percutaneous transluminal angioplasty and stent placement. After EVT, the duration of patency was analyzed with Kaplan-Meier analysis and statistical significance of differences between groups was evaluated with Log-Rank method.
RESULTS: The initial successes of EVT in the thrombosed and stenosed grafts were 74.3 % and 100%, respectively. The initial success rates of EVT in the SV grafts and PTFE grafts were 90% and 78.5%, respectively. The primary patentcy (p = 0.01), assisted primary patency rates (p = 0.03) were significantly higher in thrombosed polytetrafluoroethylene (PTFE) grafts than saphenous vein (SV) grafts. There was no significant difference between patency rates of stenosed PTFE and SV grafts. We found no significant difference between patency rates among thrombolytic agents. The total complication rates were 23% in thrombosed grafts and 11.1% in stenosed grafts.
DISCUSSION AND CONCLUSION: EVT plays an important role in the treatment of thrombosed and stenosed grafts due to advantages of being cost-effective, having an easy application and being available for serial interventions for refractory lesions. Furthermore, EVT is more effective in thrombosed PTFE grafts than SV grafts, thus we consider that EVT is the best alternative for thrombosed PTFE grafts, especially in the high surgical risk patients.

GÝRÝÞ ve AMAÇ: Kas invazyonu yapmamýþ yüksek dereceli mesane kanserlerinin tedavisinde adjuvan intravesikal mitomisin-c tedavisinin sonuçlarýný bildirmek
YÖNTEM ve GEREÇLER: Kliniðimizde Ocak 2012 ile Aralýk 2018 tarihleri arasýnda mesane kanseri nedeniyle endoskopik tedavi uygulanmýþ hastalarýn patolojileri geriye dönük olarak deðerlendirildi. Kas invazyonu yapmamýþ ve yüksek dereceli ürotelyal tümörü olan hastalarýn hastane baþvuru kayýtlarý incelenerek adjuvan intravezikal mitomisin-c tedavisi almýþ olan hastalarýn bilgileri çalýþmaya dahil edildi. Hastalarýn demografik verileri, sistoskopi bulgularý, patolojik bulgular ve poliklinik baþvuru kayýtlarý incelenerek analize dahil edildi.
BULGULAR: Toplam 54 hasta istatistiksel analize dahil edildi. Bu hastalar içinde 50 hastada patolojik evre T1 saptanýrken 4 hastada patolojik evre Ta saptandý. Hiçbir hastada karsinoma in situ varlýðý tespit edilmedi. Ortalama tümör boyutu 1.4 cm olarak bulundu. Adjuvan tedavi baþlanmasý için endoskopik tedavi sonrasýndaki bekleme süresi ortalama 2 (1-4) haftaydý. Ortalama takip süresi 21 ay olarak saptandý. Takiplerde evre ilerlemesi hastalarýn 14'ünde (%26) görülürken yüksek dereceli nüks 22 hastada (%41), düþük dereceli nüks 4 hastada (%7) görüldü. Nüks görülen 22 hastanýn 6'sýnda ayný zamanda ilerleme de görüldü.
TARTIÞMA ve SONUÇ: Kas invazyonu yapmamýþ yüksek dereceli mesane kanseri daha ileri evreye ilerleme ve nüks ihtimali yüksek bir kanser türüdür. Kýlavuzlarda ilk önerilen adjuvan tedavi seçeneði intravezikal Bacillus-Calmette-Guérin suþu uygulamasýdýr. Bizim sonuçlarýmýza göre mitomycin-c tedavisi de adjuvan intravezikal tedavi için baþarýlý bir alternatif olarak deðerlendirilebilir.

INTRODUCTION: The aim of the present study is to evaluate and report the clinical efficiacy of adjuvant intravesical mitomycin-c in the treatment of non-muscle invaziv high-grade bladder cancer patients of a tertiary single health-care center.
METHODS: Electronic records of the patients who had undergone endoscopic treatment of bladder tumors between Jan 2012 and Dec 2018 are retrospectively reviewed. Data of the patients who were diagnosed with non-invasive high-grade urothelial carcinoma are further evaluated if adjuvant intravesical mitomycin-c therapy had been initiated and included in the study. Patient demographics, cystoscopy findings, pathological findings, and outpatients record are included in the analysis.
RESULTS: Total of 54 patients included in this study. Among them 50 patients had pT1 disease while 4 patients had pTa disease. None of the patients in this cohort had carcinoma-in-situ. Mean tumor diameter was 1.4 cm. Mean time from initial transurethral resection to the application of the adjuvant therapy was 2 weeks (1-4 weeks). Mean follow-up time was 21 months. During the follow-up, tumor progression was observed in 14 (26%) patients, high-grade tumor recurrence was observed in 22 (41%) patients, and low-grade tumor recurrence was observed in 4 (7%) patients. Among the 22 patients who had high-grade recurrence, 6 patients had also tumor progression during the follow-up
DISCUSSION AND CONCLUSION: Non-invasive high-grade bladder cancer holds significant risk of stage progression and recurrence. The contemporary clinical guidelines endorse adjuvant intravesical BCG treatment in the management of non-muscle invasive bladder cancer. Due to our results, adjuvant intravesical mitomycin-c therapy can be considered as a accomplished alternative.

GÝRÝÞ ve AMAÇ: Sumak (Rhus coriaria L., Anacardiaceae), Anadolu'da geleneksel olarak yenilebilir bitkidir. Sumak, pek çok biyoaktif fitokimyasal ihtiva etmesinden dolayý, alternatif tedavi yaklaþýmlarýnda tercih edilmesine raðmen; literatür araþtýrmalarý sumak özütlerinin antikanser ve antiproliferatif aktivitelerini analiz etmek amacýyla sýnýrlý sayýda çalýþmalar yapýldýðýný göstermiþtir.
YÖNTEM ve GEREÇLER: Bu nedenle, sumak bitkisinin týbbi ve geleneksel kullanýmlarýna katkýda bulunmak amacýyla, R. coriaria L. meyvelerinden elde edilen özütlerin kanseri önleyici potansiyellerinin araþtýrýlmasý amaçlanmýþtýr. Bu baðlamda, A549, H1299 ve H460 insan akciðer kanseri hücre hatlarýna karþý antikanser ve antiproliferatif potansiyeller, lizozomal ve laktat dehidrojenaz inhibitör etkileri belirlenmiþtir.
BULGULAR: Sonuçlar, sumak ekstraktlarýnýn zamana ve doza baðýmlý olarak güçlü antikanser ve sitotoksik aktivite gösterdiðini ortaya koymuþtur. Sumak özütleri arasýnda, sulu ve metanolik ekstrelerin, test edilen tüm insan akciðer kanseri hücrelerine karþý 5,08 - 6,49 µg / mL IC50 deðer aralýðýyla yüksek derecede sitotoksik olduðu bulunmuþtur. Kanser hücre hatlarýnda, hücre büyümesinin ve hücre canlýlýðýnýn sumak özütleri tarafýndan engellendiði gözlenmiþtir. Ayrýca, hücre hatlarýnýn uzun süre ve artan dozlarda özütlere maruz kalmasý, hücrelerde lizozomal fonksiyonlarý ve membran geçirgenliðini artýrmýþtýr.
TARTIÞMA ve SONUÇ: Sonuç olarak, çalýþma bulgularý sumak bitkisinin gýda ve baharat olarak kullanýmýnýn yaný sýra; alternatif bitkisel terapötik ajan olarak kanser tedavisinde kullanýlma potansiyelini ortaya koymuþtur.

INTRODUCTION: Sumac (Rhus coriaria L., Anacardiaceae) is traditionally used edible-plant in the Anatolia. Although, it has been preferred in alternative therapeutic approaches due to the presence of many bioactive phytochemicals, the literature survey demonstrated limited works have been undertaken for analyzing the anticancer and antiproliferative activities of the extracts.
METHODS: Therefore, the current research was aimed to evaluate totally anticancer potentials of extracts from R. coriaria L. fruits for contribution to medicinal and traditional uses of sumac. In this respect, anticancer and antiproliferative potentials, lysosomal and lactate dehydrogenase inhibitory effects were determined against A549, H1299 and H460 human lung cancer cell lines.
RESULTS: The results revealed almost all the extracts of sumac exhibited powerful anticancer and cytotoxic activities in a time and dose dependent manner. Among the extracts, aqueous and methanolic extracts were found to be highly cytotoxic with IC50 values in range of 5,08 – 6,49 µg/mL against all tested human lung cancer cells. It was observed that cell growth and cell viability in cancer cell lines were inhibited by the extracts. Additionally, increasing extracts exposure time and dose resulted in increasing the lysosomal functions and membrane permeability in the cell lines.
DISCUSSION AND CONCLUSION: Consequently, these findings suggest that sumac has potential uses in cancer therapy as an alternative herbal therapeutic agent as well as their uses as food and spice.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý baþ boyun kanserli hastalarda radyoterapi ya da eþzamanlý kemoradyoterapi sonrasý tedavi cevabýnýn Pozitron EmisyonTomografi/Bilgisayarlý Tomografi ile deðerlendirilmesidir.

YÖNTEM ve GEREÇLER: Nisan 2009 ile Nisan 2011 tarihleri arasýnda, kliniðimizde tedavi edilmiþ baþ boyun kanserli 36 hasta prospektif olarak çalýþmaya dahil edilmiþtir. Tüm hastalara tedavi öncesinde ve sonrasýnda Pozitron Emisyon Tomografi/Bilgisayarlý Tomografi görüntüleme yapýlmýþtýr ve bu görüntülemede elde edilen maksimum standart tutulum deðerleri incelenerek tedaviye yanýt deðerlendirilmiþtir. Hastalýk evrelemesi yapýlýrken primer tümörden alýnan biyopsilerin histopatolojik incelenmesi ve Pozitron Emisyon Tomografi/Bilgisayarlý Tomografi esas alýnmýþtýr. Tümörlerin evrelemesi American Joint Committee on Cancer 6. baskýya göre yapýlmýþtýr.

BULGULAR: Çalýþmaya alýnan 36 hastanýn 32’si erkek (% 88,9), 4’ü kadýn (% 11,1)’dýr. Yaþ ortalamasý ise 57,5 (35-77) olarak saptanmýþtýr. Olgularýmýzýn ortalama takip süresi 13,5 aydýr. Hastalarýn tedavi öncesi Pozitron Emisyon Tomografi/Bilgisayarlý Tomografi ile ölçülen maksimum standart tutulum deðerlerinin ortalamasý 11 (3,5-23)’dir. Maksimum standart tutulum deðeri 11’den büyük hastalarýn
tedavi yanýtlarý küçük olan hastalara göre daha kötü bulunmuþtur. Evrenin artýþýyla standart tutulum deðerinin arttýðý ve standart tutulum deðerinin tedavi sonunda erken evre hastalarda (p=0,002), ileri evre hastalara kýyasla çok daha fazla gerilediði saptanmýþtýr (p<0,001).

TARTIÞMA ve SONUÇ: Bu çalýþmada tedavi öncesi maksimum standart tutulum deðeri yüksek hastalarýn tedavi yanýtlarýnýn daha kötü olduðu ayrýca tedavi öncesi standart tutulum deðerleri ve standart tutulum fark deðerleri ile tedavi yanýtý arasýnda güçlü bir iliþkinin olduðu gösterilmiþtir.

INTRODUCTION: The aim of this study is to assessment of therapy response to radiotherapy or concurrent chemoradiotherapy in patients with head and neck carcinoma using with Positron Emission Tomography/Computer Tomography.

METHODS: 36 head and neck cancer patients who were treated in our clinic between April 2009 and April 2011 were prospectively included this study. All patients were scanned with Positron Emission Tomography/Computer Tomography imaging before and after treatment and therapy response was evaluated by using standard uptake value max. Positron Emission Tomography/Computer Tomography results and biopsy that was taken from primary tumor as histopatologic assessing used for patients staging. This staging is based on American Joint Committee on Cancer 6.th edition.

RESULTS: Patients who were accepted this study were 32 male (88,9 %) and 4 female (11,1 %). The mean age of the patients was 57,5 (35-77) years. Mean follow up time was 13,5 months. Pretreatment mean of standard uptake value max was 11. High standard uptake values max (>11) predicted significantly worse treatment response as compared with low standard uptake value max (<11). Standard uptake value max was increased as the stage increased. At the end of the treatment standard uptake value max in early stage patients (0,002) was much more regressed than advanced stage patients (<0,001).

DISCUSSION AND CONCLUSION: In this study demonstrated that the patients with pretreatment high standard uptake value max had poorer treatment response. This study showed that pretreatment and the difference standard uptake values max are strong related with therapy response.

GÝRÝÞ ve AMAÇ: Oldukça heterojen bir grup sayýlan orta riskli kas invaze olmayan mesane kanserlerinde (KÝOMK), tümör büyüklüðü, sayýsý ve önceki rekürrens durumu açýsýndan alt gruplar oluþturarak, hangi etkenin rekürrensi öngörmede daha önemli olduðunu deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Kliniðimizde Ocak 2009-Aralýk 2015 arasýnda, orta riskli KÝOMK tanýsýyla tedavi ve takip edilen 99 hasta retrospektif olarak deðerlendirildi. Primer, tek sayýda, Ta evre, düþük dereceli, >3 cm olan tümörler Grup I; Primer, Ta evre, düþük dereceli, <3 cm, multipl sayýda olan tümörler Grup II; daha önce düþük risk grubunda olan ve takiplerinde tek sayýda, <3 cm, düþük dereceli tümür rekürrensi olanlar Grup III olarak sýnýflandýrýldý. Üç grup klinik, patolojik bulgular ve takipte rekürrens geliþimi açýsýndan karþýlaþtýrýldý.
BULGULAR: Hastalarýn ortalama yaþý 65.73±12.21 olup, ortanca 48 (15-84) aylýk takipte toplamda 41 (%41.4) hastada rekürrens görülmüþtür. Grup III’te gözlenen rekürrens oraný (%58.8), Grup I (%29.6) ve Grup II’den (%34.2) anlamlý olarak daha yüksek bulundu (p=0.039). Grup III’teki hastalarýn öngörülen rekürrenssiz saðkalým süresi (36.1 ay), Grup I (54.8 ay) ve Grup II’deki hastalardan (61.2 ay) anlamlý olarak daha düþük izlendi (sýrasýyla p=0.01 ve p=0.003). Tek deðiþkenli analizde önceki rekürrens varlýðý, tümör boyutu, sayýsý ve CUETO skoru rekürrensi öngören baðýmsýz prediktif faktörler olarak belirtilirken; çok deðiþkenli analizde sadece önceki rekürrens varlýðýnýn daha önemli olarak bulundu.
TARTIÞMA ve SONUÇ: Orta riskli KÝOMK olgularýnýn alt gruplara ayrýlarak daha benzer özellikte olanlarýn sýnýflandýrýlmasý, tümör tedavisi ve takibini belirlemede yol gösterici olabilmektedir. Önceden rekürrens öyküsü olan orta riskli hastalarda, yeni tümör rekürrenslerinin daha fazla olabileceðini düþünmekteyiz.

INTRODUCTION: We aimed to create subgroups in terms of tumor size, number and previous recurrence status in intermediate-risk non-muscle invasive bladder cancer (NMIBC) and evaluate the predictive roles of these parameters in determining recurrence.
METHODS: 99 patients who were treated and followed up between January 2009 and December 2015 with the diagnosis of intermediate-risk NMIBC were retrospectively analyzed. Group I consisted of primary, single, Ta grade, low grade, > 3 cm tumors; Group II consisted of primary, Ta grade, low grade, <3 cm, multiple tumors and Group III consisted of recurrence of previous low-risk tumors. Three groups were compared in terms of clinical, pathological findings and recurrence in follow-up.
RESULTS: Mean age of patients was 65.73±12.21. Among them, 41 (41.4%) patients had recurrence in median 48 (15-84) monthly follow-up. Recurrence rate in Group III (58.8%) was significantly higher than Group I (29.6%) and Group II (34.2%) (p = 0.039). The predicted recurrence-free survival (36.1 months) in Group III was significantly lower than Group I (54.8 months) and Group II (61.2 months) (p=0.01 and p=0.003, respectively). In univariate analysis, the presence of previous recurrence, tumor size, number and CUETO score were reported as independent predictive factors for recurrence. In multivariate analysis, only the presence of previous recurrence was found to be significant.
DISCUSSION AND CONCLUSION: The subgroup analysis of intermediate-risk NMIBC may be helpful in determining tumor treatment and follow-up protocols.We state that new tumor recurrences may be higher in intermediate-risk NMIBC with previous recurrence history.

GÝRÝÞ ve AMAÇ: Meme koruyucu cerrahinin lokal anestezi altýnda yapýlabileceðini göstermek.
YÖNTEM ve GEREÇLER: Ardýþýk 60 meme kanseri hastasýna lokal anestezi altýnda meme koruyucu cerrahi uygulandý. Bütün hastalara lumpektomi ve sentinel lenf nodu biyopsisi uygulandý. Palpe edilemeyen lezyonlar tel ile iþartelendi. Yapýlan iþlem detaylý bir þekilde açýklandý.
BULGULAR: Eksizyonel biyopsi ve sentinel lenf nodu biyopsisi arasý ortalama süre 27,1±3 gündü. 24 (%40) hastada telle iþaretli biyopsi gerekli oldu. 51 (%85) hastada cerrahi lokal anestezi altýnda tamamlandý. 9 (%15) hastada sentinel lenf nodu biyopsisi tümör-pozitifti. Bu hastalara genel anestezi altýnda aksilla diseksiyonu yapýldý. Hiçbir hastanýn lokal anesteziye intoleransý olmadý.
TARTIÞMA ve SONUÇ: Lokal anestezi altýnda bariz bir þekilde hasta konforu saðladý. Bu sayede hastalar günübirlik cerrahide tedavi oldular ve genel anestezinin yan etkilerinden ve ekstra maliyetten kaçýnýlmýþ olundu. Bizim sonuçlarýmýz tekniðin yapýlabilirliðinin güzel bir göstergesidir.

INTRODUCTION: To show the viability of breast-conserving surgery under local anesthesia.
METHODS: 60 consecutive breast cancer patients treated with breast-conserving surgery under local anesthesia are reported in this study. Wide excisional biopsy and sentinel lymph node biopsy were performed in all patients. Wire-guided biopsy method was used in non-palpable lesions. Techniques used are described in detail.
RESULTS: Average time between excisional biopsy and sentinel lymph node biopsy was 27.1±3 days. Wire-guided excisional biopsy was the method of choice in 24 (40%) patients. In 51 of 60 (85%) patients, surgery was completed under local anesthesia. 9 (15%) patients’ sentinel lymph node biopsy result was tumour-positive. These patients required axillary dissection under general anesthesia. None of the patients showed intolerance to surgery under local anesthesia.
DISCUSSION AND CONCLUSION: Surgery under local anesthesia provides significantly better patient comfort as the patients can be handled in the outpatient clinic. Local anesthesia is free of side effects and extra costs of general anesthesia are avoided. Our report is a good addition to the literature supporting the viability of the technique.

Desmoid tümörler yavaþ büyüyen ve lokal olarak agresif fibroblastik tümörlerdir. Primer tedaviyi oluþturan cerrahi rezeksiyon sonrasý bile lokal rekürrens eðilimi gösterirler. Bu tümörlerin komþu hayati organlarý invazyonu ciddi morbiditeye neden olabilir ve özellikle ailevi adenomatöz polipozisi olan hastalarda intraabdominal desmoidlerin ortaya çýkmasý ölümcül sonuçlar doðurabilir. Rezeke edilemeyen, kabul edilemez morbidite olmadan rezeksiyonun mümkün olmadýðý ve yeterli lokal terapiye raðmen birçok kez lokal yineleme gösteren hastalarda sistemik tedavi endikedir. Sistemik tedavi seçenekleri sitotoksik kemoterapi, hormonal terapi, nonsteroidal anti-inflamatuar ilaçlar ve hedefleyici ilaçlardýr. Tedavinin seçimi, klinik durumun aciliyetine baðlýdýr. Bu makalemizde farklý klinik seyir gösteren mezenterik desmoid tümör tanýlý üç olgumuzu sunmayý amaçladýk.

Desmoid tumors are slowly progressing and locally aggressive fibroblastic tumors. Even after primary surgical resection the probability of local recurrence is high. The invasion of these tumors to near vital organs and tissues may produce serious morbidity and especially occurrence of intra-abdominal desmoids tumors in familial adenomatous polyposis may cause mortality. Systemic treatment is necessary if the tumor is inoperable or morbidity is inevitable after radical resection of tumor and there are many local recurrences even after adequate local treatments. Systemic treatment options are cytotoxic chemotherapy, hormonal therapy, nonsteroidal anti-inflammatory drugs and targeted treatments. The choice of treatment depends on the symptoms of disease. In this case report we aimed to present three mesenteric desmoid tumor patients with different clinical progress.

Nefrojenik adenom, üreteryal mukozanýn nadir benign bir lezyonudur. Bizim olgumuz mesanede insidental olarak saptanan, bilateral hidronefrozun eþlik ettiði nefrojenik adenom olgusudur. 59 yaþýnda kadýn hasta. Sistoskopide mesane karþý duvarda 1 cm boyutunda þüpheli papiller lezyon izlendi ve transüretral rezeksiyon uygulandý. Patoloji sonucu nefrojenik adenom (nefrojenik metaplazi) olarak raporlandý.
Nefrojenik adenom %68.6 ile en çok mesanede görülürken üretra(%13.3), üreter(%8.2), renal pelvis(%8.2) ve nadiren de prostatta(%2) görülebilmektedir. Nefrojenik adenomlar, kronik iritasyon veya idrar yolunun inflamasyonu ile güçlü bir þekilde iliþkilidir. Ýmmünohistokimyasal olarak diðer malign lezyonlardan ayrýmý yapýlmalýdýr. Eþlik edebileceði malign lezyonlardan ve rekürrens açýsýndan takip edilmelidir.

Nephrogenic adenoma is a rare benign lesion of urothelial mucosa. Our case is an incidentally detected nephrogenic adenoma accompanied by bilateral hydronephrosis. A 59-year-old female. At cystoscopy, suspicious papillary lesion measuring 1 cm was observed on anteior wall of the bladder and transurethral resection was performed.Pathologically, the result was reported as nephrogenic adenoma (nephrogenic metaplasia). The urinary bladder is the most common location of nephrogenic adenom (68.6 %)and it is followed by the urethra (13.5 %),ureter (8.2%), renal pelvis (8.2%) and prostate (2%). Nephrogenic adenomas are strongly associated with chronic irritation or inflammation of the urinary tract. Other malign lesions should be distinguished immunohistochemically and histopathologically. It should be followed for concomitant malignant lesions and frequent local recurrences.

Ekrin spiradenoma ter bezlerinden köken alan benign bir yumuþak doku tümörüdür. Ekstremitede oldukça nadir görülmektedir. Yayýnda sol proksimal ön kol bölgesinde dev kitle ile baþvuran bir vakanýn olgu sunumu yapýlmýþtýr. Ýnsizyonel biyopsi esnasýnda ciddi kanamasý olan ve biyopsi sonucu taný konulamayan hastaya, 2 cm saðlam cerrahi sýnýrla eksizyon ve frozen inceleme planlandý. Hastaya nihai inceleme sonucunda ekrin spiradenom tanýsý kondu. Ekrin spiradenom benign kabul edilmesine raðmen, üst ektremite kitlelerinde bu olasý ve oldukça nadir tanýnýn varlýðýndan haberdar olmak hastaya ve cerraha zaman kazandýrmaktadýr. Klinik deneyimimize göre, insizyonel biyopsinin yetersiz olmasý durumunda, eksizyonel biyopsi ve eþ zamanlý frozen inceleme tedavi þemasýný oluþturmaktadýr. Ýncelemede olasý malign transformasyonun akýlda tutulmasý gerekmektedir.

Eccrine spiradenoma is a benign soft tissue tumor arising from sweat glands. Their occurence in extremities is quite rare. Patient presented with a mass lesion is his left proximal forearm. Significant bleeding from the mass occured in incisional biopsy and results were inconclusive so excision of the mass with 2 cm borders and frozen sampling was planned. Patient was diagnosed with an eccrine spiradenoma. Even though eccrine spiradenoma is a benign condition, awareness of the entity is beneficial and time saving during differentials. According to our experience when incisional biopsy is inconclusive, preparation for total excision and frozen sectioning is the standard of care. Malignant transition must be kept in mind during pathological examination.